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Published on: September 22, 2020
Cardiovascular Prognosis in Patients with Peripheral Artery Disease and Approach to Therapy
Antonio Curcio1, Alessandra Panarello1, Carmen Spaccarotella2
1Division of Cardiology, Department of Medical and Surgical Sciences, Magna Graecia University, 88100 Catanzaro, Italy.
Insights
Peripheral artery disease (PAD), affecting over 200 million globally, signifies high cardiovascular risk. Early identification and aggressive management of PAD are crucial for improving patient outcomes and preventing heart attack and stroke.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Atherosclerosis Research
Background:
- Peripheral artery disease (PAD) affects over 200 million people worldwide, characterized by atherosclerosis in lower limb arteries.
- PAD is a significant indicator of systemic atherosclerosis, increasing risks of myocardial infarction and stroke.
- Identifying PAD, especially in patients with coronary artery disease (CAD), is vital for accurate cardiovascular risk assessment and targeted therapies.
Purpose of the Study:
- To provide a comprehensive review of PAD, covering its pathophysiology, diagnosis, and prognosis.
- To detail current management strategies for PAD, including risk factor modification, antithrombotic therapy, and revascularization.
- To explore emerging therapeutic options for advanced PAD, such as gene therapy for "desert foot" conditions.
Main Methods:
- Literature review focusing on pathophysiology, diagnosis, prognosis, and management of PAD.
- Analysis of cardiovascular events, coronary artery disease, and heart failure in relation to PAD.
- Discussion of contemporary and novel treatment modalities for PAD.
Main Results:
- PAD is a critical predictor of cardiovascular events, often surpassing traditional risk factors.
- Integrated management of PAD and CAD is essential for optimizing patient outcomes.
- Newer therapeutic avenues, including gene therapy, show promise for refractory PAD cases.
Conclusions:
- An aggressive approach to identify and treat PAD is warranted across medical specialties.
- Preventive strategies are crucial for improving prognosis in patients with co-existing CAD and PAD.
- Continued research into advanced therapies is necessary for managing complex PAD cases.
Abstract:
Peripheral artery disease (PAD), the pathophysiologic narrowing of the arterial blood vessels of the lower limbs due to atherosclerosis, is estimated to affect more than 200 million people worldwide and its prevalence ranges from 0.9 to 31.3% in people aged ≥50 years. It is an established marker of systemic obstructive atherosclerosis, which depicts patients at higher risk of myocardial infarction and stroke, due to the involvement of coronary and cerebral arteries in the atherosclerotic process. Therefore, identifying PAD, particularly in patients with coronary artery disease, is important to assess the cardiovascular risk score and implement specific therapies and prevention strategies. Since PAD emerged as an important clinical cardiovascular predictor, even more than other typical cardiovascular risk factors, an aggressive strategy to identify and treat PAD patients should be pursued by general practitioners, cardiologists, and vascular surgeons; similarly, preventive strategies should be implemented to improve prognosis and outcomes, particularly in patients suffering from both coronary artery disease and PAD. In this review, we describe the pathophysiology, including limb vasoconstriction after coronary angioplasty, the diagnosis of PAD, prognosis according to cardiovascular events, coronary artery disease, and heart failure. Furthermore, a large section of this review is on management, which spans from risk factors' modification to antithrombotic therapy, and revascularization is provided. Finally, considerations about newer therapeutic options for the "desert foot" are discussed, including gene therapy.
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