Tackling Elevated Risk in PAD: Focus on Antithrombotic and Lipid Therapy for PAD

AbstractThe PAD population is at increased risk of major adverse cardiovascular events (MACE) and major adverse limb events (MALE). Risk factor modification, symptom control, antithrombotic, and lipid therapies are the mainstays of PAD medical therapy. Recent data has challenged prior recommendations regarding the optimal secondary prevention strategies in PAD.Purpose of ReviewTo review clinical evidence from large randomized controlled trials showing the benefit of antithrombotic and lipid therapy in the PAD population.Recent FindingsThe COMPASS trial challenged prior recommendations regarding anticoagulation in PAD. Among the PAD subgroup, rivaroxaban 2.5  mg plus aspirin reduced MACE (HR 0.72, 95% CI 0.57–0.90,p = 0.0047), MALE (HR 0.54, 95% CI 0.35–0.82,p = 0.0037), and major amputation (HR 0.30, 95% CI 0.11–0.80,p = 0.011) compared with aspirin monotherapy. The THEMIS trial showed a 55% risk reduction for MALE with ticagrelor DAPT compared with aspirin monotherapy (HR 0.45, 95% CI 0.23–0.86). The FOURIER trial revealed that lowering LDL cholesterol below current targets with a PCSK9 inhibitor reduced M ACE (HR 0.73, 95% CI 0.59–0.91,p = 0.0040) and MALE (HR 0.43, 95% CI 0.19–0.99,p = 0.042) in subjects with symptomatic PAD.SummaryRecent high-quality evidence shows the benefit of antiplatelet therapy, anticoagulation therapy, and lipid therapy in reducing MACE and MALE in PAD. Despite these findings, implementation remains a challenge and ...
Source: Current Cardiology Reports - Category: Cardiology Source Type: research