Patients with atherosclerotic PAD are at heightened risk of major adverse cardiovascular events including cardiovascular death, myocardial infarction, and stroke. They also have specific risk related to atherosclerosis in the limbs including functional limitations from claudication, risk of chronic critical limb ischemia and ulceration (particularly in those with diabetes), acute limb ischemia, and amputation. Medical therapy for patients with PAD is aimed at reducing this broad spectrum of morbidity.
There is increasing understanding of the heterogeneity of risk that exists in patients with peripheral artery disease. For example, patients with PAD and symptomatic coronary disease are at heightened risk of major adverse cardiovascular events (MACE) beyond those with symptoms in either territory alone. Similarly, patients with a history of peripheral artery revascularization or amputation are at heightened risk of major adverse limb events (MALE). Recognizing this heterogeneity may be helpful in understanding how to tailor therapy for patients with PAD, particularly for therapies that have associated risks such as bleeding.
There is a range of therapeutic interventions for patients with PAD including lifestyle interventions, supervised exercise, smoking cessation, blood pressure management, lipid lowering, target-specific diabetes therapies, antithrombotic therapies, and therapies to reduce claudication. This module provides a guide to therapeutic decisions in a stepwise manner.