Medical Therapy for Peripheral Artery Disease

Area of Science:

• Cardiovascular Medicine
• Vascular Surgery
• Pharmacology

Background:

• Patients with lower extremity peripheral artery disease (PAD) face high risks of major adverse cardiovascular events (MACE) and major adverse limb events (MALE).
• Effective management strategies are crucial for improving outcomes in this high-risk population.

Purpose of the Study:

• To review current evidence for medical therapy in peripheral artery disease (PAD) patients.
• To stratify treatment recommendations based on clinical features and cardiovascular (CV) risk.

Main Methods:

• Review of current evidence on medical therapies for PAD.
• Analysis of non-pharmacologic strategies including lifestyle modifications.
• Evaluation of pharmacologic interventions, including new antithrombotic, lipid-lowering, and glucose-lowering therapies.

Main Results:

• New therapies like low-dose rivaroxaban plus aspirin, PCSK9 inhibitors, SGLT2 inhibitors, and GLP-1 receptor agonists show benefits in reducing CV and limb outcomes.
• Non-pharmacologic strategies (smoking cessation, exercise, diet, weight loss) are fundamental.
• Adoption of new pharmacologic therapies in PAD practice remains suboptimal.
• Implementation science shows promise for improving treatment uptake.

Conclusions:

• Comprehensive management, combining medical and non-medical approaches, is vital for PAD patients.
• Personalized treatment strategies considering individual risk profiles and preferences are essential for optimizing care.
• Reducing MACE and MALE requires a multifaceted and tailored approach to PAD management.