ReviewCurrent medical therapies for patients with peripheral arterial disease: a critical review
Section snippets
Selection criteria
We searched Medline and the reference lists of relevant articles for treatment trials that included patients with peripheral arterial disease. Disease-related terms included peripheral arterial disease, peripheral vascular disease, peripheral atherosclerosis, claudication, and intermittent claudication. Risk factor–related or drug-related terms included lipids, dyslipidemia, hyperlipidemia, hypertension, diabetes, smoking, estrogen, menopause, antiplatelet, angiotensin-converting enzyme (ACE),
Antiplatelet therapy
The Antiplatelet Trialists’ Collaboration evaluated the efficacy of prolonged (1 month or longer) antiplatelet therapy (in most cases, aspirin) in preventing vascular events, including nonfatal myocardial infarction, stroke, and vascular death (19). This meta-analysis combined data from 145 randomized studies involving more than 100,000 patients, including approximately 70,000 high-risk patients with evidence of cardiovascular disease, such as myocardial infarction, stroke, or transient
Treatment of cardiovascular risk factors
The most common cardiovascular risk factors for peripheral arterial disease include smoking, diabetes, hypertension, dyslipidemia, and abnormalities of homocysteine metabolism, as well as lower estrogen levels after menopause. There is insufficient level 1 or 2 evidence to support the relation between treatment of these risk factors and improved cardiovascular outcomes in persons with peripheral arterial disease. Nonetheless, expert consensus publications strongly recommend treating these risk
Medical treatment of claudication
Medical therapy for claudication includes exercise rehabilitation as well as two drugs approved by the FDA. There are other therapeutic agents in development for this indication, but they await further development.
Treating peripheral arterial disease: evidence versus consensus
Evidence available for cardiovascular risk reduction therapies in patients with peripheral arterial disease supports the use of antiplatelet drugs, in particular clopidogrel. Similarly, data also suggest that ACE inhibitor therapy is likely to be effective. However, these conclusions were derived from subgroup analyses of trials in patients with a broad range of atherosclerotic disease manifestations. Consensus opinion based on evidence from trials in patients with other manifestations of
Acknowledgements
Our thanks to Dr. Gillian Leng for her helpful responses to queries regarding this manuscript.
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