0800_Kadian-Dodov.pdf

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1、Medical Management of Peripheral Artery DiseaseDaniella Kadian-Dodov,MD,FACC,FSVMAssociate Professor of Medicine Program Director,Vascular Medicine Fellowship Disclosures1.Speaking honoraria:Abbott Laboratories Boston Scientific2.Consultant Boston Scientific Zevra TherapeuticsPrevent MACEPrevent MAL

2、EImprove Symptoms of ClaudicationPADTreatment Goals for PADFramingham“High Risk”=20%at 10 yearsEvery patient with PAD is at“very high risk”CV Risk Increases With Decreasing ABI*Fatal or nonfatal MIUpdated Guideline Directed Medical TherapyInterventionRecommendationCOR/LOEAntiplatelet therapy Clopido

3、grel 75 mg daily alone vs ASA 81 mg daily alone is recommended to reduce MACEI/AAntithrombotic TherapyLow dose rivaroxaban 2.5 mg BID with low dose ASA daily is recommended to reduce MACE and MALEI/AIIa/BLipid lowering therapyTreatment with a statin is indicated for all PAD patients to reduce MACE H

4、IGH INTENSITY!LDL goal 70 MG/dL (LDL Goal 70 mg/dL on max tolerated statin,PCSK9i/ezetimibe addition is reasonable 2a/BRI/AHypertensionAnti-hypertensive therapy should be administered to reduce MACEI/ASBP GOAL 130/80 mm HgPrioritize use of ACEi/ARBI/BRDiabetesPatients with PAD and Diabetes,GLP1 and

5、SGLT2i are effective to reduce MACEI/ASmoking cessationPatients should be advised at every visit to quit tobacco and assisted in a plan for quitting(pharmacotherapy or referral to program)I/ACirculation 2024,May 14:PMID 38743805Eur heart J.2024,Sep 29;45:3538-3700Medical Therapy in Recent CLTI Trial

6、s:BEST-CLI and BASIL-2Medical InterventionBEST-CLIBASIL-2Antiplatelet therapyAspirinClopidogrelDOACAny anticoagulant1025/1424(72%)953/1424(66.9%)312/1424(21.9%)55/1424(3.9%)269/345(78%)96/345(28%)Lipid lowering therapy1001/1424(70.3%)269/345(78%)Hypertension Hypertension Treatment1238/1424(86.9%)NRN