Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University.
The Australian Institute of Tropical Health and Medicine, James Cook University.
J Atheroscler Thromb. 2021 Jun 1;28(6):573-583. doi: 10.5551/jat.62778. Epub 2021 Mar 21.
Patients with lower limb artery stenosis or occlusion (peripheral artery disease; PAD) have been determined to be at very high risk of both major adverse cardiovascular events, such as myocardial infarction and stroke, and major adverse limb events, such as amputation and requirement for artery surgery.Effective medical management has been identified as key in reducing this risk; however, this is often poorly implemented in clinical practice. Thus, the aim of this narrative review was to summarize the current evidence on the medical management of PAD in order to inform clinicians and highlight recommendations for clinical practice. International guidelines, randomized controlled trials, and relevant systematic reviews and meta-analyses have been included in this study. The focus was the management of the key modifiable risk factors to mitigate possible adverse events through prescription of anti-platelet and anticoagulation drugs and medications to control low-density lipoprotein cholesterol, blood pressure, and diabetes and aid smoking cessation. The available evidence from randomized clinical trials provide a strong rationale for the need for holistic medical management programs that are effective in achieving uptake of these medical therapies in patients with PAD. In conclusion, people with PAD have some of the highest adverse event rates among those with cardiovascular diseases. Secondary preventive measures have been proven effective in reducing these adverse events; however, they remain to be adequately implemented. Thus, the need for an effective implementation program has emerged to reduce adverse events in this patient group.
下肢动脉狭窄或闭塞（外周动脉疾病；PAD）的患者被认为具有发生重大心血管不良事件（如心肌梗死和中风）和重大肢体不良事件（如截肢和需要动脉手术）的极高风险。有效的医学管理已被确定为降低这种风险的关键；然而，在临床实践中，这往往实施得很差。因此，本叙述性综述的目的是总结 PAD 的医学管理的现有证据，以便为临床医生提供信息，并强调临床实践建议。本研究纳入了国际指南、随机对照试验以及相关的系统评价和荟萃分析。重点是管理可改变的关键风险因素，通过开具抗血小板和抗凝药物以及控制低密度脂蛋白胆固醇、血压和糖尿病的药物来减轻可能的不良事件，并帮助戒烟。来自随机临床试验的现有证据为需要进行整体医学管理计划提供了强有力的依据，这些计划在提高 PAD 患者对这些医学治疗的接受度方面非常有效。总之，PAD 患者的不良事件发生率在心血管疾病患者中是最高的。二级预防措施已被证明可有效降低这些不良事件；然而，它们仍未得到充分实施。因此，需要制定有效的实施计划，以降低该患者群体的不良事件发生率。
