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Updated: Sep 22, 2025

Preclinical Model of Hind Limb Ischemia in Diabetic Rabbits
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Renin-Angiotensin-Aldosterone System Inhibitors, Statins, and Beta-Blockers in Diabetic Patients With Critical Limb

Paolo Cimaglia1, Davide Bernucci2, Laura Sofia Cardelli2

  • 146807Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy.

Journal of Cardiovascular Pharmacology and Therapeutics
|May 20, 2022
PubMed

Insights

Patients with critical limb ischemia (CLI) often do not receive optimal medical therapy (OMT) for secondary prevention. Under-treatment impacts major adverse cardiovascular events and mortality, highlighting a need for improved cardiovascular care in CLI patients.

Area of Science:

  • Vascular Medicine
  • Cardiovascular Disease Prevention
  • Critical Limb Ischemia

Background:

  • Secondary prevention therapies are underutilized in peripheral artery disease (PAD), particularly in critical limb ischemia (CLI).
  • Limited data exist on cardiovascular preventive therapy prescription in CLI patients, especially concerning coronary artery disease (CAD) comorbidity.

Purpose of the Study:

  • To assess the prescription rates of cardiovascular preventive therapies in patients admitted for CLI and foot lesions.
  • To evaluate the association between optimal medical therapy (OMT) and major adverse cardiovascular events (MACE) and all-cause mortality in CLI patients.

Main Methods:

  • Prospective cohort study of 618 patients admitted for CLI and foot lesions.
  • Recording of discharge prescriptions for renin-angiotensin-aldosterone system (RAAS) inhibitors, statins, beta-blockers, and antithrombotic drugs.
  • Follow-up for at least 1 year to determine MACE and all-cause mortality.

Main Results:

  • Optimal medical therapy (OMT), defined as RAAS inhibitor + statin + antithrombotic, was prescribed in only 43% of patients.
  • OMT prescription was not influenced by coronary artery disease (CAD) diagnosis but was affected by renal function.
  • OMT was independently associated with reduced MACE (HR 0.688) and all-cause mortality (HR 0.626).

Conclusions:

  • Patients with critical limb ischemia (CLI) are frequently undertreated with guideline-recommended cardiovascular preventive therapies.
  • This under-treatment, irrespective of CAD diagnosis, is linked to poorer prognosis, emphasizing the need for improved secondary prevention strategies in CLI.

Keywords:
RAAS inhibitordiabetic footperipheral artery diseasesecondary preventionstatin

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