CPC Clinical Research, Aurora, CO, USA.
Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
Curr Cardiol Rep. 2024 Jun;26(6):651-659. doi: 10.1007/s11886-024-02065-y. Epub 2024 May 2.
Patients with lower extremity peripheral artery disease (PAD) are at high risk for major adverse cardiovascular events (MACE) and major adverse limb events (MALE). This manuscript will review the current evidence for medical therapy in patients with PAD according to different clinical features and the overall cardiovascular (CV) risk.
The management of PAD encompasses non-pharmacologic strategies, including lifestyle modification such as smoking cessation, supervised exercise, Mediterranean diet and weight loss as well as pharmacologic interventions, particularly for high risk patients. Benefits for reduction of CV and limb outcomes have been demonstrated for new therapies, including antithrombotic therapy (i.e., low-dose rivaroxaban plus aspirin), lipid lowering therapy (i.e., proprotein convertase subtilisin/kexin type 9 inhibitors), and glucose lowering therapy (i.e., sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists). However, the adoption of these therapies in PAD remains suboptimal in practice. Implementation science studies have recently shown promising results in PAD patients. Comprehensive medical and non-medical management of PAD patients is crucial to improving patient outcomes, mitigating symptoms, and reducing the risk of MACE and MALE. A personalized approach, considering the patient's overall risk profile and preference, is essential for optimizing medical management of PAD.
下肢外周动脉疾病（PAD）患者发生主要不良心血管事件（MACE）和主要不良肢体事件（MALE）的风险较高。本文将根据不同的临床特征和整体心血管（CV）风险，综述目前 PAD 患者的医学治疗证据。
PAD 的治疗包括非药物治疗策略，包括生活方式改变，如戒烟、监督锻炼、地中海饮食和减肥，以及药物干预，特别是针对高危患者。新型治疗方法，包括抗血栓治疗（即低剂量利伐沙班加阿司匹林）、降脂治疗（即前蛋白转化酶枯草溶菌素 9 抑制剂）和降糖治疗（即钠-葡萄糖协同转运蛋白 2 抑制剂和胰高血糖素样肽-1 受体激动剂），已被证明可降低 CV 和肢体结局的风险。然而，这些治疗方法在 PAD 中的实际应用仍不理想。实施科学研究最近在 PAD 患者中显示出了有希望的结果。对 PAD 患者进行全面的医疗和非医疗管理对于改善患者预后、减轻症状以及降低 MACE 和 MALE 的风险至关重要。考虑到患者的整体风险状况和偏好，采用个性化方法对于优化 PAD 的医学管理至关重要。
