What is the efficacy of pharmacologic therapy for treatment of peripheral arterial occlusive disease (PAOD)?

Updated: Sep 12, 2019
  • Author: Josefina A Dominguez, MD; Chief Editor: Vincent Lopez Rowe, MD  more...
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In a randomized, double-blind, placebo-controlled trial, O’Donnell et al assessed the vascular and biochemical effects of cilostazol therapy on 80 patients with peripheral arterial disease, finding that this agent to be an efficacious treatment that, besides improving patients’ symptoms and quality of life, appeared to have beneficial effects on arterial compliance. [17]

The investigators in this study measured arterial compliance, transcutaneous oxygenation, ankle-brachial index (ABI), and treadmill walking distance. [17] As compared with the placebo group, the cilostazol group had significant reduction in the augmentation index and also showed reduction in transcutaneous oxygenation levels. The mean percentage change in walking distance from baseline was greater in the cilostazol group than in the placebo group. Lipid profiles were also improved in the cilostazol group.

In 2009, Momsen et al evaluated the efficacy of drug therapy for improving walking distances in intermittent claudication. [18] Their study determined that statins seemed to be the best at improving maximal walking distance.

Evidence from the Heart Protection Study indicated that cholesterol-lowering statin agents (simvastatin), besides effectively lowering blood cholesterol profiles, reduced the rate of first major vascular events (myocardial infarction [MI], stroke, or limb revascularization), with the largest benefits seen in patients with peripheral vascular disease. [19] The benefits were demonstrated regardless of the baseline cholesterol profile.

These results suggest that cholesterol-lowering statin agents should be considered for medical treatment in patients with peripheral arterial disease. Such agents appear to provide substantial benefit for individuals with PAOD. [20]

Additional medical treatment may include control of diabetes as appropriate. For example, insulin-sensitizing medication may reduce PAOD in type 2 diabetics with coronary disease. [21]

In a secondary analysis of the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial, of 303 patients with type 2 diabetes and stable coronary disease without peripheral arterial disease (PAD) at baseline, those treated with insulin-sensitizing therapy (16.9%) (ie, metformin or a glitazone) were less likely to develop any type of new PAD during 4.6 years of follow-up than were patients treated with insulin-providing therapy (24.1%). [21]

In the study, patients who received insulin-sensitizing therapy had lower frequencies of lower-extremity revascularization (1.1% vs 2.6%), low ankle-brachial index (16.5% vs 22.7%), and amputation (0.1% vs 1.6%) than patients who received insulin-providing therapy. [21] These findings suggest that progression of system-wide atherosclerosis, and thus development of PAD, in diabetic individuals with relatively advanced coronary disease may be slowed or reduced with insulin-sensitizing medication.

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