New PAD Guideline Emphasizes Medical Therapy, Exercise

Joint guidelines for the treatment of peripheral artery disease (PAD), which include recommendations on the use of antiplatelet therapy to reduce the risk of blood clots and statin drugs to lower cholesterol and advise PAD patients to participate in a structured exercise program, were published Nov. 13 by the ACC and the American Heart Association (AHA) and simultaneously published in the Journal of the American College of Cardiology.

The new recommendations replace guidelines last updated in 2011 and provides comprehensive recommendations across the spectrum of PAD. It emphasizes that the signs and symptoms of PAD include not only claudication, but other atypical leg symptoms or walking impairments, ischemic rest pain, or physical examination findings such as abnormal lower extremity pulses, vascular bruit, non-healing wounds or gangrene.

Recommended medical management recommendations continue to include statins and antiplatelet therapy such as aspirin or clopidogrel. The guideline also discusses situations when dual-antiplatelet therapy may be considered, such as after vascular surgery or stenting procedures. Measuring ankle brachial index (ABI) by health care providers continues to be recommended for patients with symptoms and signs of PAD. Patients are now recommended to participate in a structured exercise program, which should be individualized to the patient and should include specific instructions for the type, frequency, intensity and duration of exercise. The most effective form of structured exercise, according to the writing committee, is a supervised exercise program in a hospital or outpatient exercise facility, but other options include home- or community-based walking exercise or alternative forms of exercise such as upper-body exercises.

Previous guidelines emphasized the importance of smoking cessation for the patient with PAD, but the new guidelines also strongly advise patients with PAD to avoid second-hand smoke. Another new recommendation for PAD patients is to get an annual flu shot to avoid cardiovascular complications of flu.

"Periodically reassessing how we manage and treat complex diseases by incorporating the latest evidence is critical to ensure that clinicians are equipped to provide optimal care for their patients," said Marie Gerhard-Herman, MD, FACC, chair of the writing group and a cardiologist at Brigham and Women’s Hospital.

Keywords: Extremities, Ischemia, Embolectomy, Exercise, Aortic Diseases, Endovascular Procedures, Blood Glucose, Functional Residual Capacity, Peripheral Vascular Diseases, Peripheral Arterial Disease, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Thromboembolism, Tobacco, Smoking, Vascular Diseases, Wounds and Injuries, Thrombectomy, Reperfusion, Aneurysm, Anticoagulants, Fibrinolytic Agents, Platelet Aggregation Inhibitors, Angiography, Multidetector Computed Tomography

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