Optimization of the pharmacological therapy in patients with poly-vascular disease: A multidisciplinary approach

Abstract

The recent shift of the concept of cardiovascular disease as a chronic progressive condition, potentially involving multiple districts, has driven attention to the optimal management of patients with concomitant coronary and peripheral artery disease, representing a subset of patients with an increased risk of events and impaired survival. Recent pharmacological achievements in terms of antithrombotic therapy and lipid-lowering drugs allow multiple therapeutical combinations, thus requiring optimizing the treatment in a tailored fashion according to patients’ risk profiles. Nevertheless, data dedicated to this specific subset of patients are still modest. We summarize currently available strategies and indications for the management of antithrombotic and lipid-lowering drugs in patients with the poly-vascular disease.

Undercover Peripheral Arterial Disease

“…In this case, we present a clinical case of a stroke that has revealed itself as being seldom a presentation of an undercover severe diffuse atherosclerotic disease. In fact, this patient has a polyvascular disease, defined as affecting two or more arterial beds [5].…”

“…Polyvascular disease can include any combination of PAD, cerebrovascular disease (CVD) and coronary artery disease (CAD). It has a worsened prognosis than either of them alone in terms of major adverse cardiovascular events (HR 1.99; 95% CI, 1.78-2.24; P < 0.001) and mortality (4.6% vs 2.4%) as shown in "Reduction of Atherothrombosis for Continued Health Registry" (REACH) at four-year follow-up, an international prospective registry including patients ≥ 45 years of age with established CAD, CVD, PAD, or ≥ 3 risk factors for atherosclerotic disease [5,6]. Interestingly, the worsened prognosis was verified despite polyvascular disease patients being more intensively treated.…”

“…However, they were older, more often former or current smokers, and suffered more often from hypertension, diabetes, and diabetic nephropathy, which can contribute to the overall prognosis [6]. The indications for polyvascular disease screening, even in the presence of evidence of atherosclerotic disease in one territory are not defined [5,7].…”

Ischemic cardio-cerebrovascular disease and all-cause mortality in Chinese elderly patients: a propensity-score matching study

“…The concept of the "cardio-cerebrovascular continuum" delineates a state characterized by an increased likelihood of fatal progression in the absence of interventions that disrupt this pathological cycle [ 5 ]. Contemporary advancements, particularly in the domains of potent antithrombotic and lipid-lowering treatments, have markedly altered the prognosis of these patients.…”