Pathogenetic justification and clinical significance of using arginine for prevention of critical ischemia of lower extremities and fatal manifestations of multifocal atherosclerosis

The aim — to investigate the results of treatment with L‑arginine of patients with intermittent claudication for prevention of critical stages of limb ischemia.Materials and methods. 86 patients with intermittent claudication were randomly divided into two groups of 43 patients each. Patients of the first group received 8 g of L‑arginine (Tivortin) twice a day, patients of the second group — 40 mg of prostaglandin E1 (PGE1) twice a day.Results and discussion. Administration of L‑arginine contributed to an increase in the distance of painless walk by 230 ± 63 %, the absolute walk distance — by 155 ± 48 % (p < 0.05), the administration of PGE1 — by 209 ± 63 % and 144 ± 28 %, respectively (p < 0.05). Treatment with L‑arginine increased the value of the coefficient of L‑arginine/asymmetric dimethylarginine in plasma and the excretion of nitrates and cGMP in the urine, which indicated the normalization of the biosynthesis of endogenous NO. PGE1 therapy did not significantly affect endothelium‑dependent vasodilation parameters. The coefficient of quality of life, estimated in an analog scale, increased from 3.51 ± 0.18 to 8.3 ± 0.4 in the arginine group and to 7.0 ± 0.5 in the PGE1 group (all p < 0.05).Conclusions. Arginine is a drug of choice to prevention of severe forms of lower limbs ischemia and other manifestations of multifocal atherosclerosis.