Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia.
The Department of Vascular and Endovascular Surgery, Townsville University Hospital, Townsville, QLD, Australia.
Drugs. 2022 Jul;82(11):1165-1177. doi: 10.1007/s40265-022-01755-7. Epub 2022 Aug 12.
Peripheral artery disease (PAD) is the occlusion or narrowing of the arteries supplying the lower extremities. Peripheral artery disease has been estimated to affect approximately 240 million people worldwide, approximately 70% of whom are within low- or middle-income countries. Due to the ageing population and diabetes epidemic, the prevalence of PAD is rapidly rising. The symptoms of PAD are heterogeneous and thus a high index of suspicion is needed to prevent delays in diagnosis and treatment. Measurement of ankle brachial pressure index or arterial duplex ultrasound are traditionally used to diagnose PAD. Patients with PAD have a high risk of major adverse cardiovascular events. Early diagnosis and implementation of secondary cardiovascular prevention is therefore critical. This includes therapies to reduce low-density lipoprotein cholesterol, such as statins, ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, blood-pressure reducing medications and anti-thrombotic drugs. Treatments to facilitate smoking cessation and control blood sugar if relevant and an exercise programme are also critical in reducing cardiovascular risk. Currently, these treatments are not well implemented. This review summarises the clinical presentation, risk factors and medical management of PAD. Global efforts are needed to reduce the burden from the growing PAD epidemic by implementing best practices and improving outcomes through further research.
外周动脉疾病（PAD）是指供应下肢的动脉阻塞或变窄。据估计，全球约有 2.4 亿人患有外周动脉疾病，其中约 70%的人生活在中低收入国家。由于人口老龄化和糖尿病流行，PAD 的患病率正在迅速上升。PAD 的症状多种多样，因此需要高度怀疑才能防止诊断和治疗的延误。传统上使用踝肱血压指数或动脉双功能超声来诊断 PAD。PAD 患者发生主要不良心血管事件的风险很高。因此，早期诊断和实施二级心血管预防至关重要。这包括降低低密度脂蛋白胆固醇的治疗方法，如他汀类药物、依折麦布和前蛋白转化酶枯草溶菌素 9（PCSK9）抑制剂、降低血压的药物和抗血栓药物。如果相关，还需要促进戒烟和控制血糖的治疗以及运动方案，以降低心血管风险。目前，这些治疗方法并没有得到很好的实施。这篇综述总结了 PAD 的临床表现、危险因素和医学管理。需要全球共同努力，通过实施最佳实践和通过进一步研究改善结果来减轻日益严重的 PAD 流行带来的负担。
