The influence of oral supplementation of L-arginine on intermittent claudication in patients with peripheral arterial disease of the lower extremities

Abstract

Background. More and more data indicate that the increase of production of free radicals by the endothelium with simultaneously decreasing synthesis and/or increasing nitric oxide (NO) degradation is the basis of changes in atheromatous vessel structure and reactivity. It is suggested that the administration of L-arginine to patients with NO deficiency is the rational method both of increasing NO production by the endothelium and decreasing the free radical release. In the last year it has been proven that this therapeutic procedure could be successful in patients with atherosclerotic ischaemia of lower extremities. The aim of this study was the estimation of the influence of 28-day L-arginine oral supplementation on intermittent claudication in patients with peripheral arterial occlusive disease.
Material and methods. The authors studied 48 patients (25 men/23 women) with peripheral arterial disease - Fontaine II. They were randomly divided into two groups: group I - 24 patients receiving L-arginine 3 × 4 g/day and group II - 24 patients receiving placebo 3 × 4 g/day. During the study patients were under strict clinical observation, the aim of which was to evaluate drug tolerance and to observe possible adverse effects of L-arginine used in therapy. During the study at 0 h, after 3 h, and on the 7^th, 14^th, and 28^th days subjective and objective examinations were conducted with evaluation of pain-free distance and total walking distance.
Results. After L-arginine treatment clinical improvement was observed in all patients, such as elongation of pain-free walking distance (from 80 m at the beginning to 438 m at the end) and total walking distance (from 158 m to 687 m), while there was no clinical improvement in patients with placebo.
Conclusions. In patients with peripheral arterial occlusive disease Fontaine stage II oral supplementation of L-arginine results in elongation of pain-free and total walking distance.