Peripheral artery disease (PAD) is a manifestation of systemic
atherosclerosis. Modifiable risk factors including cigarette smoking,
dyslipidemia, diabetes, poor diet quality,
obesity, and physical inactivity, along with underlying genetic factors contribute to lower extremity
atherosclerosis. Patients with PAD often have coexistent coronary or
cerebrovascular disease, and increased likelihood of major adverse cardiovascular events, including
myocardial infarction,
stroke and cardiovascular death. Patients with PAD often have reduced walking capacity and are at risk of acute and chronic
critical limb ischemia leading to major adverse limb events, such as peripheral revascularization or
amputation. The presence of polyvascular disease identifies the highest risk patient group for major adverse cardiovascular events, and patients with prior
critical limb ischemia, prior lower extremity revascularization, or
amputation have a heightened risk of major adverse limb events. Medical
therapies have demonstrated efficacy in reducing the risk of major adverse cardiovascular events and major adverse limb events, and improving function in patients with PAD by modulating key disease determining pathways including
inflammation, vascular dysfunction, and metabolic disturbances. Treatment with guideline-recommended
therapies, including smoking cessation,
lipid lowering drugs, optimal
glucose control, and antithrombotic medications lowers the incidence of major adverse cardiovascular events and major adverse limb events. Exercise training and
cilostazol improve walking capacity. The heterogeneity of risk profile in patients with PAD supports a personalized approach, with consideration of treatment intensification in those at high risk of adverse events. This review highlights the medical
therapies currently available to improve outcomes in patients with PAD.