Blinc A, Poredos P
Department of Vascular Diseases, University of Ljubljana Medical Centre, Ljubljana, Slovenia.
Eur J Clin Invest. 2007 Mar;37(3):157-64. doi: 10.1111/j.1365-2362.2007.01767.x.
Peripheral arterial disease (PAD) is strongly associated with atherosclerosis in the coronary and carotid arteries, leading to a highly increased incidence of myocardial infarction, ischaemic stroke and cardiovascular death. Fortunately, pharmacological interventions in large clinical trials have been as effective in subgroups of patients with PAD as in subjects with other atherosclerotic disease. Antiplatelet treatment is indicated in virtually all patients with PAD. Aspirin 75-325 mg day(-1) is considered as first-line treatment, and clopidogrel 75 mg day(-1) is an effective alternative. Statin therapy is indicated to achieve a target low-density lipoprotein cholesterol level of < or = 2.5 mmol L(-1) in patients with PAD and there is emerging evidence that even lower levels are beneficial. Lowering of plasma homocysteine by supplementing folic acid, vitamin B(12) and vitamin B(6) is not recommended in patients with mild to moderate hyperhomocysteinaemia in the 12-25 micromol L(-1) range, since it does not reduce the incidence of cardiovascular events. Antihypertensive treatment is indicated to achieve a goal blood pressure of < or = 140/90 mmHg or < or = 130/80 mmHg in the presence of diabetes or chronic kidney disease. All classes of antihypertensive drugs are acceptable for treatment of hypertension in patients with PAD, but angiotensin-converting enzyme inhibitors ramipril or perindopril are especially appropriate because they reduce the incidence of cardiovascular events beyond their blood pressure-lowering effects. Beta-blockers should not be used as first-line antihypertensive treatment. Diabetic patients with PAD should reduce their glycosylated haemoglobin to < or = 7%. In conclusion, pharmacological secondary prevention of cardiovascular morbidity and mortality in patients with PAD should be as comprehensive as that in patients with established coronary or cerebrovascular disease.
外周动脉疾病（PAD）与冠状动脉和颈动脉粥样硬化密切相关，导致心肌梗死、缺血性中风和心血管死亡的发生率大幅上升。幸运的是，大型临床试验中的药物干预措施对PAD患者亚组的疗效与对其他动脉粥样硬化疾病患者的疗效相同。几乎所有PAD患者都需要进行抗血小板治疗。阿司匹林75 - 325毫克/天被视为一线治疗药物，氯吡格雷75毫克/天是一种有效的替代药物。对于PAD患者，应使用他汀类药物治疗，使低密度脂蛋白胆固醇目标水平≤2.5毫摩尔/升，并且越来越多的证据表明更低的水平有益。对于血浆同型半胱氨酸水平在12 - 25微摩尔/升范围内的轻度至中度高同型半胱氨酸血症患者，不建议补充叶酸、维生素B12和维生素B6来降低同型半胱氨酸水平，因为这并不能降低心血管事件的发生率。对于存在糖尿病或慢性肾病的患者，应进行降压治疗，使血压目标值≤140/90毫米汞柱或≤130/80毫米汞柱。所有类别的降压药物都可用于治疗PAD患者的高血压，但血管紧张素转换酶抑制剂雷米普利或培哚普利尤其合适，因为它们除了具有降压作用外，还能降低心血管事件的发生率。β受体阻滞剂不应作为一线降压治疗药物。患有PAD的糖尿病患者应将糖化血红蛋白水平降至≤7%。总之，PAD患者心血管疾病发病率和死亡率的药物二级预防应与已确诊的冠心病或脑血管疾病患者的预防一样全面。
