Every PACE Counts

Bretón‐Romero, Rosa; Hamburg, Naomi M.

doi:10.1161/circulationaha.117.025894

Cited by 2 publications

(1 citation statement)

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“…12 Arterial obstruction in the limb is a core feature of PAD leading to diminished blood flow and ischemia. 13 However, the symptoms of PAD including claudication, functional limitation, and critical limb ischemia are not fully determined by reduced ankle brachial index (ABI). 14 Vascular dysfunction with abnormal endothelium-mediated vasodilation impairs augmentation of blood supply during exercise and reduces functional capacity in patients with PAD.…”

Section: Pathophysiologic Drivers Of Clinical Padmentioning

confidence: 99%

Contemporary Medical Management of Peripheral Artery Disease

Bonaca

Hamburg

Creager

2021

Circulation Research

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Peripheral artery disease (PAD) is a manifestation of systemic atherosclerosis. Modifiable risk factors including cigarette smoking, dyslipidemia, diabetes, poor diet quality, obesity, and physical inactivity, along with underlying genetic factors contribute to lower extremity atherosclerosis. Patients with PAD often have coexistent coronary or cerebrovascular disease, and increased likelihood of major adverse cardiovascular events, including myocardial infarction, stroke and cardiovascular death. Patients with PAD often have reduced walking capacity and are at risk of acute and chronic critical limb ischemia leading to major adverse limb events, such as peripheral revascularization or amputation. The presence of polyvascular disease identifies the highest risk patient group for major adverse cardiovascular events, and patients with prior critical limb ischemia, prior lower extremity revascularization, or amputation have a heightened risk of major adverse limb events. Medical therapies have demonstrated efficacy in reducing the risk of major adverse cardiovascular events and major adverse limb events, and improving function in patients with PAD by modulating key disease determining pathways including inflammation, vascular dysfunction, and metabolic disturbances. Treatment with guideline-recommended therapies, including smoking cessation, lipid lowering drugs, optimal glucose control, and antithrombotic medications lowers the incidence of major adverse cardiovascular events and major adverse limb events. Exercise training and cilostazol improve walking capacity. The heterogeneity of risk profile in patients with PAD supports a personalized approach, with consideration of treatment intensification in those at high risk of adverse events. This review highlights the medical therapies currently available to improve outcomes in patients with PAD.

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Section: Pathophysiologic Drivers Of Clinical Padmentioning

confidence: 99%