Recommendation for Statin Agents
COR	LOE	Recommendation
I	A	Treatment with a statin medication is indicated for all patients with PAD.96,153–157
See Online Data Supplements 15 and 16.		Statin therapy improves both cardiovascular and limb outcomes in patients with PAD.157 In a subgroup of 6748 patients with PAD in the HPS (Heart Protection Study), simvastatin 40 mg daily reduced the rate of first major vascular event by 22% relative to placebo.155
		In a multinational registry, statin use among patients with PAD reduced 4-year adverse limb-related events (ie, worsening claudication, new CLI, new lower extremity revascularization, new ischemic amputation) compared with no statin.153 Use of simvastatin in the HPS reduced relative risk of peripheral vascular events (including noncoronary revascularization, aneurysm repair, major amputation, or PAD death) compared with placebo.155 In Medicare patients undergoing lower extremity revascularization, 1-year limb salvage rates were improved among those receiving statin medication.154 In a multicenter RCT, use of atorvastatin 80 mg daily improved pain-free walking time and community-based walking at 12 months compared with placebo.156 In 1 cohort study of 5480 patients with asymptomatic PAD, statin treatment improved cardiovascular outcomes.96 Guidelines for dosing of statin medications have been previously published.24