Lipid-lowering and anti-thrombotic therapy in patients with peripheral arterial disease: European Atherosclerosis Society/European Society of Vascular Medicine Joint Statement

Jill J. F. Belch (Lead / Corresponding author), Marianne Brodmann, Iris Baumgartner, Christoph J. Binder, Manuela Casula, Christian Heiss, Thomas Kahan, Paolo Parini, Pavel Poredos, Alberico L. Catapano, Lale Tokgözoğlu (Lead / Corresponding author)

Research output: Contribution to journalReview articlepeer-review

7 Citations (Scopus)
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Abstract

Patients with peripheral arterial disease (PAD) are at very high risk of cardiovascular events, but risk factor management is usually suboptimal. This Joint Task Force from the European Atherosclerosis Society and the European Society of Vascular Medicine has updated evidence on the management on dyslipidaemia and thrombotic factors in patients with PAD. Guidelines recommend a low-density lipoprotein cholesterol (LDLC) goal of more than 50% reduction from baseline and <1.4 mmol/L (<55 mg/dL) in PAD patients. As demonstrated by randomized controlled trials, lowering LDL-C not only reduces cardiovascular events but also major adverse limb events (MALE), including amputations, of the order of 25%. Addition of ezetimibe or a PCSK9 inhibitor further decreases the risk of cardiovascular events, and PCSK9 inhibition has also been associated with reduction in the risk of MALE by up to 40%. Furthermore, statin- based treatment improved walking performance, including maximum walking distance, and pain-free walking distance and duration. This Task Force recommends strategies for managing statin-associated muscle symptoms to ensure that PAD patients benefit from lipid-lowering therapy. Antiplatelet therapy, either daily clopidogrel 75 mg or the combination of aspirin 100 mg and rivaroxaban (2×2.5 mg) is also indicated to prevent cardiovascular events. Dual pathway inhibition (aspirin and rivaroxaban) may be considered following revascularization, taking into account bleeding risk. This Joint Task Force believes that adherence with these recommendations for lipid-lowering and antithrombotic therapy will improve the morbidity and mortality in patients with PAD.

Original languageEnglish
Pages (from-to)401-411
Number of pages11
JournalVASA
Volume50
Issue number6
Early online date8 Nov 2021
DOIs
Publication statusPublished - Nov 2021

Keywords

  • Cholesterol, LDL
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors/adverse effects
  • Peripheral Arterial Disease/diagnosis
  • Proprotein Convertase 9
  • Treatment Outcome
  • treatment targets
  • Peripheral arterial disease
  • lipid lowering

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