Lipid Optimization in Lower Extremity Peripheral Arterial Disease

Area of Science:

• Cardiovascular Medicine
• Vascular Surgery
• Pharmacology

Background:

• Peripheral arterial disease (PAD) significantly increases cardiovascular and limb event risks.
• Lipid management is crucial for secondary prevention in PAD patients.
• Current international guidance for lipid optimisation in PAD presents challenges.

Purpose of the Study:

• To review current global guidance on lipid management in PAD.
• To identify issues and propose improvements for lipid optimisation strategies.
• To explore the role of novel therapies like PCSK9 inhibitors.

Main Methods:

• A narrative review of global PAD guidelines.
• Focus on low-density lipoprotein cholesterol (LDL-C) reduction strategies: 'treating to target', 'fire and forget', and percentage reduction.
• Literature searches in PubMed and Google Scholar for recent PAD lipid guidance.

Main Results:

• International PAD lipid guidance needs enhancement for effective implementation.
• The arbitrary 1.4 mmol/L LDL-C target should be re-evaluated, especially with new PCSK9 inhibitor data.
• Maximal lipid reduction therapies can significantly reduce major adverse cardiovascular and limb events.
• Community-based PAD clinics and further research on practical lipid-reduction strategies are recommended.

Conclusions:

• Current PAD lipid-reduction treatments and global guidance lack clarity.
• Further research is essential to reduce mortality and morbidity in PAD patients compared to cardiovascular disease peers.
• Improved lipid management is key to better outcomes in PAD.