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Masterclass series in peripheral arterial disease

Intermittent claudication affects between 1.7% 1 and 7.1% 2 of the population over 55 years of age. In terms of the limb, the condition is relatively benign, with fewer than 10% of claudicants requiring intervention to prevent limb loss and fewer than 1% per year requiring amputation. 3 However, patients with intermittent claudication have a two to four times increased mortality from cardiovascular causes and are at as great a risk of dying from a heart attack as many patients who have survived their first myocardial infarction. 4 Epidemiological, post mortem and angiographic studies have consistently shown a strong positive correlation between plasma total cholesterol and the incidence of coronary heart disease (CHD). 5 In Western populations, the increased risk of future cardiovascular events is observed with serum cholesterol levels that were considered to be in the normal range and increases progressively in a linear manner with rising cholesterol concentrations. 5 This socalled normal range merely represents a national average as other nations have much lower serum cholesterol concentrations and correspondingly a reduced incidence of cardiac disease. However, even in populations with low serum cholesterol levels, such as Japan, an independent graded association between cholesterol levels and cardiac events has been shown to exist. 6 Although there may be debate regarding the threshold for cholesterol, reducing the high serum cholesterol concentrations seen in Western populations has been shown to reduce adverse cardiovascular outcomes. 7� 9