Patients with PAD are dramatically undertreated compared to their CAD counterparts, and there is significantly less research on efficacy of our treatment options. The ACC/AHA recommend that all patients with symptomatic PAD are placed on a high intensity statin. Patients with PAD plus another major atherosclerotic cardiovascular disease event should be treated to an LDL-C level of less than 70. These high-risk patients may benefit from the addition of Zetia to a statin if this target is unable to be met on statin monotherapy. PAD is also associated with platelet hyperaggregability, and in patients with symptomatic PAD there is a role for aspirin in preventing major cardiovascular events. The Clopidogrel Versus Aspirin in Patients at Risk for Ischemic Events (CAPRIE) trial subanalysis actually suggested Clopidogrel may be superior, but the ACC/AHA guidelines have not distinguished the type of antiplatelet therapy recommended. Though commonly tested on the medicine boards, Cilostazol is rarely used in medical practice due to its contraindication in patients with heart failure, as well as its common side effects. Blood pressure management, exercise therapy, and smoking cessation all play a key role in addition to considering pharmacotherapy. Smoking cessation is the greatest modifiable risk factor for development and progression of PAD.
References: Evidence-Based Medical Management of Peripheral Artery Disease