Poredoš P, Jezovnik M, Kalodiki E, Andreozzi G, Antignani P-L, Clement D, Comerota A, Fareed J, Fletcher J, Fras Z, Griffin M, Markel A, Martini R, Mignano A, Nicolaides A, Novo G, Novo S, Roztočil K, Visona A
Department of Vascular Disease, University Clinical Centre Ljubljana, Ljubljana, Slovenia -
Int Angiol. 2015 Feb;34(1):75-93. Epub 2014 Jun 11.
Peripheral arterial disease (PAD) is one of the most frequent manifestations of atherosclerosis and is associated with atherosclerosis in the coronary and carotid arteries, leading to a highly increased incidence of cardiovascular events. Major risk factors of PAD are similar to those that lead to atherosclerosis in other vascular beds. However, there are differences in the power of individual risk factors in the different vascular territories. Cigarette smoking and diabetes mellitus represent the greatest risks of PAD. For prevention of the progression of PAD and accompanying cardiovascular events similar preventative measures are used as in coronary artery disease (CAD). However, recent data indicate that there are some differences in the efficacy of drugs used in the prevention of atherothrombotic events in PAD. Antiplatelet treatment is indicated in virtually all patients with PAD. In spite of the absence of hard evidence- based data on the long term efficacy of aspirin, it is still considered as a first line treatment and clopidogrel as an effective alternative. The new antiplatelet drugs ticagrelol and prasugrel also represent promising options for treatment of PAD. Statin therapy is indicated to achieve the target low density lipoprotein cholesterol level of ≤2.5 mmol/L (100 mg/dL) and there is emerging evidence that lower levels are more effective. Statins may also improve walking capacity. Antihypertensive treatment is indicated to achieve the goal blood pressure (<140/90 mmHg). All classes of antihypertensive drugs including beta-blockers are acceptable for treatment of hypertension in patients with PAD. Diabetic patients with PAD should reduce their glycosylated haemoglobin to ≤7%. As PAD patients represent the group with the highest risk of atherothrombotic events, these patients need the most intensive treatment and elimination of risk factors of atherosclerosis. These measures should be as comprehensive as those in patients with established coronary and cerebrovascular disease.
外周动脉疾病（PAD）是动脉粥样硬化最常见的表现之一，与冠状动脉和颈动脉粥样硬化相关，导致心血管事件的发生率大幅增加。PAD的主要危险因素与导致其他血管床动脉粥样硬化的因素相似。然而，不同血管区域中个体危险因素的影响程度存在差异。吸烟和糖尿病是PAD的最大风险因素。预防PAD进展及伴随的心血管事件，采用与冠状动脉疾病（CAD）相似的预防措施。然而，近期数据表明，用于预防PAD动脉粥样硬化血栓形成事件的药物疗效存在一些差异。几乎所有PAD患者都需要进行抗血小板治疗。尽管缺乏关于阿司匹林长期疗效的确凿循证数据，但它仍被视为一线治疗药物，氯吡格雷则作为有效的替代药物。新型抗血小板药物替格瑞洛和普拉格雷也是治疗PAD的有前景的选择。他汀类药物治疗的目标是使低密度脂蛋白胆固醇水平≤2.5 mmol/L（100 mg/dL），并且越来越多的证据表明更低的水平更有效。他汀类药物还可能改善步行能力。抗高血压治疗的目标是血压<140/90 mmHg。包括β受体阻滞剂在内的所有抗高血压药物类别都可用于治疗PAD患者的高血压。患有PAD的糖尿病患者应将糖化血红蛋白水平降至≤7%。由于PAD患者是动脉粥样硬化血栓形成事件风险最高的群体，这些患者需要最强化的治疗并消除动脉粥样硬化的危险因素。这些措施应与已确诊的冠状动脉和脑血管疾病患者的措施一样全面。
