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The Current Evidence for Lipid Management in Patients with Lower Extremity Peripheral Artery Disease: What Is the Therapeutic Target?

  • Peripheral Vascular Disease (WS Jones, Section Editor)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

There is a lack of consistency among the ACC/AHA and ESC Guidelines on the treatment of patients with lower extremity PAD to a targeted LDL-c level. A review of the current guidelines, as well as the evidence that exists for use of various lipid-lower therapies in patients with PAD, is needed to guide clinical practice and to examine the current gaps in evidence that exist.

Recent Findings

There is evidence that statins and PCSK9 inhibitors reduce the risks of major adverse cardiovascular and limb events in patients with PAD. Most statin and non-statin trials have examined the association of LLT use with clinical outcomes, and not the association between the degree of LDL-c lowering and the reduction in risk of clinical outcomes. As such, there is a lack of agreement between the American and European PAD Guidelines over whether to treat patients with PAD to a targeted LDL-c goal.

Summary

Both statins and PCSK9 inhibitors have been shown to reduce the risk of major cardiovascular and limb events in patients with PAD. Further research is needed to determine if target driven LDL-c lowering is associated with improved outcomes in patients with PAD.

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Abbreviations

ABI:

Ankle brachial index

CLTI:

Chronic limb-threatening ischemia

IC:

Intermittent claudication

MACE:

Major adverse cardiovascular event

MALE:

Major adverse limb event

MWT:

Maximal walking time

PAD:

Peripheral artery disease

PCSK9i:

Proprotein convertase subtilisin/kexin type 9 inhibitors

PFWT:

Pain-free walking time

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Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Authors and Affiliations

  1. Division of Cardiology, Duke University Medical Center, 2301 Erwin Road, Durham, NC, 27705, USA

    Jennifer A. Rymer, Rajesh V. Swaminathan, Manesh R. Patel & J. Antonio Gutierrez

  2. Vanderbilt Translational and Clinical Cardiovascular Research Center, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA

    Aaron W. Aday

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  2. Rajesh V. Swaminathan
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Corresponding author

Correspondence to Jennifer A. Rymer.

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Conflict of Interest

Jennifer Rymer reports grants from Boston Scientific and Abbott.

Rajesh V. Swaminathan reports grants and non-financial support from ACIST Medical, personal fees and non-financial support from Medtronic, and grants from Cardiovascular Systems, Inc.

Aaron W. Aday reports personal fees from OptumCare.

Manesh R. Patel reports grants and personal fees from Janssen Pharmaceuticals, Amgen, and Bayer; and grants from Novartis and NHBLI.

Antonio Gutierrez reports personal fees from Janssen Pharmaceuticals and Amgen.

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This article is part of the Topical Collection on Peripheral Vascular Disease

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Rymer, J.A., Swaminathan, R.V., Aday, A.W. et al. The Current Evidence for Lipid Management in Patients with Lower Extremity Peripheral Artery Disease: What Is the Therapeutic Target?. Curr Cardiol Rep 23, 13 (2021). https://doi.org/10.1007/s11886-021-01451-0

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