Trista Betz, PharmD; CentraCare-Paynesville
Background: Peripheral artery disease (PAD) is an atherosclerotic disease that results in decreased blood flow to the limbs. The lower limbs are more commonly affected by PAD. This disease increases the risk of major adverse cardiovascular outcomes (MACE), such as myocardial infarction and stroke, and major adverse limb outcomes (MALE), such as amputations and critical limb ischemia. Guideline-recommended pharmacotherapies for PAD aim to reduce the risk of these major cardiovascular and limb complications as well as leg symptoms related to claudication.
Evidence/Discussion: The 2024 ACC/AHA Multisociety Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease was published in May 2024. Before this publication, the guidelines had not been updated since 2016. Evidence utilized to form these recommendations comes from human subject research from large research databases, such as Medline and Cochrane Library. Most pharmacotherapy updates focused on the utilization of antiplatelet and antithrombotic therapy. There was at least one new addition in each medication therapy section, except for the smoking cessation section which had no changes.
The following table outlines specific medication-related changes:
5.1 Antiplatelet and Antithrombotic Therapy for PAD |
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5.2 Lipid Lowering Therapy |
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5.3 Antihypertensive Therapy |
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5.4 Smoking Cessation |
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5.5 Diabetes Management for PAD |
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5.6 Other Medical Therapies for Cardiovascular Risk Reduction in PAD |
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5.7 Medications for Leg Symptoms in Chronic Symptomatic PAD |
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Abbreviations: COVID, Coronavirus Disease; DAPT, dual antiplatelet therapy; GLP1, Glucagon-like Peptide-1, MACE, Major Adverse Cardiovascular Events; MALE, Major Adverse Limb Events; PAD, Peripheral Artery Disease; PCSK9, Proprotein Convertase Subtilisin/Kexin Type 9; SGLT2i, Sodium-Glucose Cotransporter-2 Inhibitors
Clinical Impact: With these updates, practitioners now have additional guidance on appropriate use of antiplatelet and antithrombotic therapy in PAD, particularly in symptomatic or revascularized PAD. It is also more specific on which therapies should be utilized for lipid and diabetes management. These guidelines offer up to date, evidence based recommendations that highlight key pharmacotherapies to reduce risk of MACE and MALE in lower extremity peripheral artery disease.
Citations:
- DiPiro JT, Yee GC, Haines ST, Nolin TD, Ellingrod VL, Posey LM. DiPiro’s Pharmacotherapy : A Pathophysiologic Approach. 12th edition. McGraw Hill Medical; 2023.
- Gerhard-Herman MD, Gornik HL, Barrett C, et al. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines [published correction appears in J Am Coll Cardiol. 2017 Mar 21;69(11):1521.
- Gornik HL, Aronow HD, Goodney PP, et al. 2024 ACC/AHA/AACVPR/APMA/ABC/SCAI/SVM/SVN/SVS/SIR/VESS Guideline for the Management of Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2024;149(24):e1313-e1410.