Lipid-Lowering and Anti-Thrombotic Therapy in Patients With Peripheral Arterial Disease: European Atherosclerosis Society/European Society of Vascular Medicine Joint Statement

Abstract

An updated evidence-based consensus of the Joint Task Force from the European Atherosclerosis Society and European Society of Vascular Medicine. The guidelines for patients with peripheral arterial disease (PAD) include a low-density lipoprotein cholesterol (LDL-C) goal of a >50% reduction from baseline and <1.4 mmol/L (<55 mg/dL). Lowering LDL-C reduces the incidence of cardiovascular events and major adverse limb events, including amputations, by 25%. The addition of ezetimibe or a PCSK9 (proprotein convertase subtilisin/kexin type 9 serine protease) inhibitor will further decrease the risk of cardiovascular events (the latter has been associated with a reduction in the risk of major adverse limb events by 40%). Statin-based treatment improved patients’ walking distance. Daily clopidogrel 75 mg or the combination of aspirin 100 mg and rivaroxaban (2 × 2.5 mg) is indicated to prevent cardiovascular events and should be used after lower extremity revascularization (with consideration of the bleeding risk). Adherence with these recommendations for lipid-lowering and antithrombotic therapy will improve the morbidity and mortality of patients with PAD.