Pharmacotherapy for Intermittent Claudication: From Consensus-Based to Evidence-Based Treatment
Intermittent claudication is the earliest and the most common presenting symptom of atherosclerotic lower extremity peripheral arterial disease, with a prevalence of 3% to 6% in men aged 60 years. Although claudication may impair community-based walking ability and quality of life in many patients, the fate of claudicant patients is rather benign with respect to their legs, with only 2% of patients needing a major amputation over 5 years. However, patients presenting with claudication are at high risk for cardiovascular events, such as myocardial infarction, stroke and cardiovascular death as a result of coexistent coronary artery and cerebrovascular atherosclerosis. Therefore, appropriate therapeutic goals for claudication include prevention of cardiovascular events and leg disease progression as well as improvement in walking capacity, functional status and quality of life. Until recently, therapeutic recommendations for the prevention of ischemic events in claudicant patients, including long-term antiplatelet therapy and aggressive risk factor modification, have mostly been based on extrapolation from results of studies of patients with coronary heart disease. In the last few years, however, direct, reliable evidence has emerged that supports the use of statins (simvastatin), antiplatelet drugs (aspirin or clopidogrel) as well as angiotensin-converting enzyme inhibitors (ramipril) as secondary preventive treatments in claudication patients. Supervised exercise training is the most effective medical treatment for symptomatic relief in persons with claudication. Several drugs, including pentoxifylline, naftidrofuryl, buflomedil, prostaglandin E1 and the novel agents cilostazol and propionyl-L-carnitine, have also been shown to be effective in improving claudication-related walking impairment, although the benefits appear to be of small magnitude. Drug therapy may have a role in alleviating claudication symptoms when exercise is impossible or ineffective. Alternatively, drugs for claudication may be used to potentiate the benefits of exercise. Promising new pharmacological agents for claudication, including oral prostaglandins, L-arginine, and angiogenic growth factors, are currently being evaluated.
No Supplementary Data
No Article Media
Document Type: Review Article
Affiliations: Unita Operativa di Medicina Interna e Terapia Medica, Universita di Catania, c / o Ospedale V. Emanuele, Via Plebiscito 628, 95124 Catania, Italy.
Publication date: 2004-03-01
More about this publication?
- Vascular Disease Prevention publishes reviews as well as original papers to update all those concerned with this topic at the clinical or scientific level. In addition to clinically relevant topics, we consider reviews and original papers dealing with the more scientific aspects of vascular disease prevention. This includes the evaluation of emerging vascular risk factors, research dealing with the pathogenesis of atherosclerosis and the investigation of new treatment options both at the clinical and scientific level (e.g. epidemiology, patient-based studies, experimental models, in vitro experiments or molecular research). Therefore, another function of Vascular Disease Prevention is to bridge the gap between clinical practice and ongoing laboratory-based research.
In particular, we welcome critical reviews and comments on recent trials. This is a topic that requires regular updates because of the large number of trials published every year.
Debates are encouraged in the correspondence section of this journal.
The editorial structure of Vascular Disease Prevention is set up with the aim of dealing with the submitted material as rapidly as possible. Specialist editors will provide a more expert and rapid assessment unlike a more centralized editorial structure.