Dyslipidemia and peripheral arterial disease

Area of Science:

• Cardiology
• Vascular Medicine
• Public Health

Background:

• Peripheral arterial disease (PAD) affects 12% of the global adult population, with increasing prevalence.
• Polyvascular disease, involving PAD with atherosclerosis in multiple arterial beds (CAD, mesenteric/renal, CVD), is common, affecting 1 in 6 patients per the REACH registry.
• Progression to critical limb ischaemia (CLI) in PAD patients carries a 10-15 fold increased risk of cardiovascular death.

Purpose of the Study:

• To review current management strategies for dyslipidaemia in very high-risk patients, including those with PAD.
• To highlight the efficacy of lipid-lowering agents like statins, ezetimibe, and PCSK9 inhibitors in reducing cardiovascular events.
• To emphasize the need for an Indian multi-disciplinary task force to investigate the impact of lipid-lowering agents on limb salvage and major limb events in PAD.

Main Methods:

• Review of existing literature and clinical trial data on PAD, polyvascular disease, and lipid-lowering therapies.
• Analysis of guideline recommendations for dyslipidaemia management in high-risk populations.
• Examination of data from registries like REACH and trials such as IMPROVE-IT and FOURIER.

Main Results:

• High-intensity statin therapy significantly reduces all-cause mortality, CV death, CV outcomes, stroke, acute limb ischaemia, and amputations in PAD patients.
• Combination therapy with ezetimibe and statins (IMPROVE-IT) further reduces major adverse cardiovascular events (MACE).
• PCSK9 inhibitors demonstrate a reduction in primary endpoints, with a notable benefit in PAD patients compared to non-PAD patients (3.5% vs 1.6% in FOURIER trial).

Conclusions:

• Optimal management of dyslipidaemia in PAD patients remains a challenge, despite proven benefits of lipid-lowering agents.
• There is a critical need for focused research in India to understand the direct impact of lipid-lowering therapies on limb salvage and limb-related events in PAD.
• Establishing an Indian multi-disciplinary task force is essential for advancing research and improving outcomes for PAD patients.