[Conservative treatment of peripheral arterial disease]

Area of Science:

• Cardiology
• Vascular Medicine
• Pharmacology

Background:

• Peripheral arterial disease (PAD) is linked to polyvascular atherosclerosis, increasing risks of major adverse cardiovascular events (MACE) and major adverse limb events (MALE).
• MACE include cardiovascular death, myocardial infarction, and stroke; MALE encompass amputation and acute limb ischemia.
• Conservative treatment for PAD aims to mitigate MACE and MALE, and for intermittent claudication, to enhance walking distance.

Purpose of the Study:

• To outline the conservative treatment strategies for peripheral arterial disease (PAD).
• To emphasize risk factor management and appropriate antithrombotic therapies for PAD patients.
• To highlight the undertreatment of high-risk PAD patients in clinical practice.

Main Methods:

• Management of modifiable risk factors: smoking cessation, statin therapy (LDL-C target <55 mg/dL, ≥50% reduction), glycemic control, and hypertension management (target <140/90 mmHg).
• Antithrombotic therapy recommendations: antiplatelet agents (aspirin 100 mg or clopidogrel 75 mg).
• Combination therapy for high thrombotic risk/low bleeding risk patients: aspirin 100 mg plus rivaroxaban 2x2.5 mg.
• Exercise therapy is strongly recommended for intermittent claudication.

Main Results:

• Risk factor modification is crucial for reducing MACE and MALE in PAD.
• Specific antithrombotic regimens are indicated based on thrombotic and bleeding risk.
• Exercise therapy significantly improves walking distance in patients with intermittent claudication.

Conclusions:

• Comprehensive risk factor management and tailored antithrombotic strategies are essential for PAD patients.
• Exercise therapy offers significant benefits for patients with intermittent claudication.
• There is a critical need to address the undertreatment of high-risk PAD patients to improve outcomes and reduce event rates.