glucuronyl-glucosamine-glycan-sulfate and Intermittent-Claudication

The peripheral obstructive artery disease (POAD) epidemiology raises some concerns about its continuously increased incidence in Western countries. The most part of the patients affected by POAD have systemic cardiovascular complications and die because of cardiac and cerebrovascular disorders. Thus the social cost of this disease is very high. A large part of risk factors for the POAD is well-known and they are reversible trough an efficacious life-style improvement (mainly physical activity increase and cigarette smoking habit cessation) and cardiovascular disease risk factors control (diabetes mellitus, hypercholesterolemia, blood hypertension). On the contrary, no much data are available as it regards efficacious therapies for clinically active disease. The only ones that have been adequately investigated and already available in the market are cilostazol (maybe useful only in more serious patients), and sulodexide (that could improve the pain free walking distance till the 75%). Further research is needed in order to develop new efficacious drugs for POAD treatment, but in the meantime it is necessary to recognise all POAD patients as soon as possible and to treat them adequately with the available therapies.

Topics: Arterial Occlusive Diseases; Cilostazol; Drug Therapy, Combination; Europe; Glycosaminoglycans; Humans; Hypolipidemic Agents; Incidence; Intermittent Claudication; Italy; Lower Extremity; Motor Activity; Smoking Cessation; Tetrazoles; Vasodilator Agents

Patients with peripheral arterial obstructive disease require treatment to prevent major cardiovascular events and to relieve intermittent claudication. The walking performance of peripheral arterial obstructive disease patients was used to evaluate the usefulness of sulodexide, a glycosaminoglycan containing fast moving heparin and dermatan sulphate.. A randomized, multicentre, double-blind, placebo-controlled study was performed in 286 patients with Leriche-Fontaine stage II peripheral arterial obstructive disease. Patients received placebo (n=143) or sulodexide (n=143) for 27 weeks. The primary end-point was the doubling of the pain-free walking distance at the end of treatment, and this was achieved by 23.8% of patients treated with sulodexide and 9.1% of those on placebo (P=0.001). The pain-free walking distance increased on average (+/-SE) by 83.2+/-8.6 m (+64.7% from baseline) with sulodexide and 36.7+/-6.2 m (+29.9% from baseline) with placebo (P=0.001). The maximum walking distance increased by 142.3+/-15.8 m (+76.0% from baseline) and 54.5+/-8.4 m (+27.9% from baseline) (P<0.001), respectively. Results for patients with type II diabetes were similar to those for non-diabetic patients. Plasma fibrinogen decreased with sulodexide, but increased with placebo.. Sulodexide improved the walking ability of peripheral arterial obstructive disease patients to a significantly greater extent than placebo, with a concurrent significant decrease in fibrinogen. The treatment was well tolerated.

Topics: Aged; Analysis of Variance; Double-Blind Method; Female; Fibrinogen; Fibrinolytic Agents; Glycosaminoglycans; Humans; Intermittent Claudication; Italy; Male; Middle Aged; Treatment Outcome

Thirty patients suffering from peripheral vascular disease (stage-II according to Fontaine) were included in a double-blind study aimed at assessing the efficacy of a high-dose glycosaminoglycan (GAG) (Sulodexide) both in terms of laboratory parameters, such as lipid metabolism and blood coagulation components, and instrumental procedures (strain-gauge plethysmography). Compared with the fifteen control patients (treated with placebo), the fifteen patients treated with Sulodexide showed a significant decrease in blood triglycerides and fibrinogen as well as a significantly increased HDL-cholesterol, and positive instrumental changes: at the end of treatment Peak and Rest Flow values--and consequently also Winsor's index--were significantly increased only in patients treated with Sulodexide.

Topics: Aged; Arteriosclerosis; Cholesterol, HDL; Clinical Trials as Topic; Double-Blind Method; Female; Femoral Artery; Fibrinogen; Glycosaminoglycans; Humans; Intermittent Claudication; Male; Random Allocation; Triglycerides; Vascular Diseases

Topics: Fibrinogen; Fibrinolytic Agents; Glycosaminoglycans; Humans; Intermittent Claudication; Italy; Treatment Outcome