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

Belch, Jill J F; Brodmann, Marianne; Baumgartner, Iris; Binder, Christoph J; Casula, Manuela; Heiss, Christian; Kahan, Thomas; Parini, Paolo; Poredos, Pavel; Catapano, Alberico L; Tokgözoğlu, Lale (2021). Lipid-lowering and anti-thrombotic therapy in patients with peripheral arterial disease: European Atherosclerosis Society/European Society of Vascular Medicine Joint Statement. Atherosclerosis, 338, pp. 55-63. Elsevier 10.1016/j.atherosclerosis.2021.09.022

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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 antiplatelet therapy (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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Angiology

UniBE Contributor:

Baumgartner, Iris

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0021-9150

Publisher:

Elsevier

Language:

English

Submitter:

Rebecca Scheidegger

Date Deposited:

13 Jan 2022 12:03

Last Modified:

05 Dec 2022 15:58

Publisher DOI:

10.1016/j.atherosclerosis.2021.09.022

PubMed ID:

34763902

Uncontrolled Keywords:

Lipid lowering Peripheral arterial disease Treatment targets

BORIS DOI:

10.48350/162955

URI:

https://boris.unibe.ch/id/eprint/162955

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