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Current and future drug therapies for claudication
1Department of Medicine, University of Colorado Health Sciences Center, Denver 80262, USA.
Insights
Peripheral artery disease (PAD) treatment aims to reduce cardiovascular death and improve walking ability. Key strategies include aggressive risk factor modification, antiplatelet therapy, and lifestyle changes like smoking cessation and exercise.
Area of Science:
- Vascular Medicine
- Cardiovascular Disease
- Pharmacology
Background:
- Claudication, a symptom of peripheral artery disease (PAD), is associated with a significant 10-year mortality rate (60%), primarily from myocardial infarction and stroke.
- Effective management of PAD requires addressing multiple cardiovascular risk factors.
Purpose of the Study:
- To outline the primary objectives of claudication treatment: reducing cardiovascular mortality and enhancing walking ability.
- To detail essential therapeutic strategies for patients with claudication.
Main Methods:
- Comprehensive risk-factor modification: smoking cessation, lipid management, and treatment of hypertension, diabetes, and hyperhomocysteinemia.
- Consideration of antiplatelet therapy (aspirin, ticlopidine, clopidogrel) to mitigate vascular events.
- Evaluation of therapies for disabling claudication, focusing on pain relief and exercise performance improvement.
Main Results:
- Aggressive risk-factor modification is crucial for all claudicant patients.
- Antiplatelet agents are effective in reducing the risk of major vascular events.
- Exercise training and smoking cessation are the most effective interventions for disabling claudication; pentoxifylline shows modest benefits, with other agents under investigation.
Conclusions:
- Integrated management of claudication involves aggressive risk factor control, antiplatelet therapy, and targeted interventions for symptom relief.
- Ongoing research explores novel treatments, including antiplatelet agents and angiogenic growth factors, to further improve outcomes for PAD patients.
Abstract:
The primary objectives of claudication treatment are to reduce cardiovascular mortality and improve walking ability. Patients with claudication have 60% mortality over 10 years, with most deaths due to myocardial infarction and stroke. Aggressive risk-factor modification is required in all these patients, particularly smoking cessation, lipid modification, and treatment of hypertension, diabetes and elevated homocysteine levels. Aspirin, ticlopidine and clopidogrel are all effective in reducing the risk of myocardial infarction, stroke and vascular death, and thus antiplatelet therapy should be considered in all claudicants. Patients with disabling claudication should be considered for therapies that relieve claudication pain and improve exercise performance, the most effective being exercise training and smoking cessation. Pentoxifylline, the only approved claudication drug in the United States, has modest efficacy in improving treadmill exercise performance. Other drugs shown to be of some benefit in patients with claudication include propionyl-L-carnitine, cilostazol and possibly prostaglandin derivatives. Several antiplatelet agents and angiogenic growth factors are also being evaluated for the treatment of claudication.