Table 18. Guide to Cardiovascular Risk Reduction in Patients with Peripheral Arterial Disease (PAD)

Risk Intervention Goal(s)   Recommendations    Lipid Management:   Primary goal LDL-C <100 mg/dL (optimal goal: <70 mg/dL)     If LDL-C is >100 mg/dL, treatment with a statin is recommended. If multiple risk factors are present (especially diabetes); severe and poorly controlled risk factors such as continued cigarette smoking; multiple risk factors of the metabolic syndrome (especially ↑ triglycerides > 200 mg/dL, non–HDL-C >130 mg/dL with low HDL <40 mg/dL); and in presence of acute coronary syndrome, use therapeutic option of LDL-C <70 mg/dL Blood pressure control:   <140/90 mm Hg    (nondiabetics) <130/80 mm Hg    (diabetics and those with chronic renal failure)     Beta blockers are effective antihypertensive agents and are not contraindicated in patients with PAD.   ACE inhibitors are reasonable for symptomatic patients with lower extremity PAD to reduce the risk of adverse cardiovascular events.   ARBs may be considered for patients with asymptomatic lower extremity PAD to reduce the risk of adverse cardiovascular events. Glucose control:   HbA1c <7%     Diabetics with lower extremity PAD should be treated aggressively to reduce their HbA1c to <7%.   Frequent foot inspection will enable early identification of foot lesions and ulcerations and facilitate prompt referral for treatment. Smoking:   Complete cessation     Offer comprehensive smoking cessation interventions, including behavior modification therapy, nicotine replacement therapy, or bupropion. Antiplatelet agents Antiplatelet therapy is indicated to reduce the risk of MI, stroke, or vascular death Aspirin therapy (75–325 mg) is recommended daily Clopidogrel (75 mg) is recommended as an effective alternative antiplatelet therapy to aspirin Warfarin is not recommended Physical activity •  Supervised exercise training is recommended as an initial treatment modality. Training should be performed for a minimum of 30–45 minutes, in sessions performed at least 3 times per week for a minimum of 12 weeks. •  Unsupervised exercise programs are not recommended.

Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic)—Executive Summary. J Am Coll Cardiol. 2006:47;ahead of print.