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An early symptom of peripheral vascular disease, intermittent claudication is associated with atherosclerosis of the aorta and arteries of the lower extremities. The symptoms of claudication include muscular pain during exercise that can progress to pain at rest, ulcers, and gangrene. Common interventions include exercise, low-fat diets, and control of comorbid conditions such as diabetes, hypertension, and hyperlipidemia. Adjunct pharmacologic therapy may include aspirin, pentoxifylline and cilostazol. Ginkgo biloba has recently been shown to useful in the management of intermittent claudication. Evidence has shown that ginkgo can modulate the endothelial microenvironment by acting as a free-radical scavenger, inhibitor of platelet-activating factor, and mediator of nitric oxide metabolism, erythrocyte aggregation, and nuclear transcription factors. Wei et al found that ginkgo inhibited nuclear factor kappa-B, an important regulator of vascular pathophysiology. Additional research has also explored ginkgo's antiplatelet effects. Using a rabbit model, Akiba et al showed that EGb 761 inhibited platelet aggregation in response to oxidative stress. The most recent meta-analysis of randomized, double blind, placebo controlled trials of intermittent claudication was conducted by Pittler and Ernst. They evaluated the effects of ginkgo, using pain free walking distance as a primary outcome measure. In this trial, a total of 415 patients with intermittent claudication received 120-160 mg/d of gingko biloba extract or placebo for 6-24 weeks. When subject to statistical pooling, an increase in pain free walking distance was noted in subjects treated with ginkgo a compared to placebo. The difference was approximately 34 m (95% confidence interval: 24-43 m). In 2007, an article in Clinical Rehabilitation showed that Ginkgo taken by mouth causes small improvements in claudication symptoms. However, exercise therapy and/or prescription drugs may be more helpful. A MayoClinic.com search for the uses of Gingko gives its use for intermittent claudication a grade of A, which equates to strong scientific evidence for this use. While this evidence is tentative, ginkgo biloba may be a useful adjunct to exercise and lifestyle modification in the treatment of mild to moderate intermittent claudication. Data are lacking about its efficacy compared to other commonly used therapies. |