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Review
. 2024 Jun;26(6):651-659.
doi: 10.1007/s11886-024-02065-y. Epub 2024 May 2.

Medical Therapy for Peripheral Artery Disease

Mario Enrico Canonico  1   2 , Connie N Hess  3   4 , R Kevin Rogers  3   4 , Marc P Bonaca  3   4
Affiliations
Review

Medical Therapy for Peripheral Artery Disease

Mario Enrico Canonico et al. Curr Cardiol Rep. 2024 Jun.

Abstract

Purpose of review: Patients with lower extremity peripheral artery disease (PAD) are at high risk for major adverse cardiovascular events (MACE) and major adverse limb events (MALE). This manuscript will review the current evidence for medical therapy in patients with PAD according to different clinical features and the overall cardiovascular (CV) risk.

Recent findings: The management of PAD encompasses non-pharmacologic strategies, including lifestyle modification such as smoking cessation, supervised exercise, Mediterranean diet and weight loss as well as pharmacologic interventions, particularly for high risk patients. Benefits for reduction of CV and limb outcomes have been demonstrated for new therapies, including antithrombotic therapy (i.e., low-dose rivaroxaban plus aspirin), lipid lowering therapy (i.e., proprotein convertase subtilisin/kexin type 9 inhibitors), and glucose lowering therapy (i.e., sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists). However, the adoption of these therapies in PAD remains suboptimal in practice. Implementation science studies have recently shown promising results in PAD patients. Comprehensive medical and non-medical management of PAD patients is crucial to improving patient outcomes, mitigating symptoms, and reducing the risk of MACE and MALE. A personalized approach, considering the patient's overall risk profile and preference, is essential for optimizing medical management of PAD.

Keywords: MACE; MALE; Medical Therapy; PAD.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
    1. • Criqui MH, Matsushita K, Aboyans V, Hess CN, Hicks CW, Kwan TW, et al. Lower Extremity Peripheral Artery Disease: Contemporary Epidemiology, Management Gaps, and Future Directions: A Scientific Statement From the American Heart Association. Circulation. 2021;144(9). The paper provides updates on the epidemiology and current knowledge in PAD.
    1. •• Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, et al. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation. 2017;135(12). The paper is the latest AHA/ACC LEPAD guidelines.
    1. •• Aboyans V, Ricco JB, Bartelink MLEL, Björck M, Brodmann M, Cohnert T, et al. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). Eur Heart J. 2018;39(9):763–816. The paper is the latest ESC PAD guidelines. - PubMed - DOI
    1. Hess CN, Huang Z, Patel MR, Baumgartner I, Berger JS, Blomster JI, et al. Acute Limb Ischemia in Peripheral Artery Disease. Circulation. 2019;140(7):556–65. - PubMed - DOI
    1. Kaplovitch E, Eikelboom JW, Dyal L, Aboyans V, Abola MT, Verhamme P, et al. Rivaroxaban and Aspirin in Patients With Symptomatic Lower Extremity Peripheral Artery Disease. JAMA Cardiol. 2020.

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