Established approaches to managing patients with peripheral arterial disease include regular exercise, stopping smoking, antiplatelet treatment, and surgery in a minority of patients. A case for lowering cholesterol can now also be made. There is evidence for regression of femoral atherosclerosis by lowering cholesterol, although this is not conclusive. Absolute changes in femoral artery lumen diameter after cholesterol reduction are small, and the clinical significance of this is uncertain. Recent randomized controlled trials have shown that patients with coronary-vent rates above 1.5% per year, and total cholesterol concentration ≤ 5.5 mmol/l, benefit from cholesterol lowering treatment with statins. Patients with peripheral vascular disease are at very high coronary risk, with coronary-event rates around 5% per year, and statin treatment should therefore result in significant reductions in coronary events. The incidence of stroke is also likely to be decreased by treatment. A strong case may therefore be made for treating all patients with peripheral arterial disease and total cholesterol ≤ 5.5 mmol/l with an appropriate lipid-lowering agent.