The Present and Future
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Antithrombotic Therapy in Peripheral Artery Disease: Generating and Translating Evidence Into Practice

https://doi.org/10.1016/j.jacc.2017.11.021Get rights and content
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Abstract

Atherosclerotic cardiovascular (CV) disease remains a major health concern affecting more than 200 million adults worldwide, and lower extremity peripheral artery disease (PAD) is associated with significant morbidity and mortality. Treatment strategies to reduce the burden of major adverse CV events and limb events have mainly involved the use of antiplatelet and statin medications. Unlike other types of atherosclerotic CV disease, the evidence base is not well developed for therapies in patients with PAD. Recently, studies from subgroups of patients with PAD and a large clinical trial of PAD patients have been published, signaling a burgeoning interest in studying this higher risk population. This review outlines the inherent CV risks of patients with PAD, risk reduction strategies, emerging clinical trial data, and opportunities for the CV community to generate evidence in real-world settings and translate evidence into practice as new therapies become available.

Key Words

antithrombotic therapy
clinical trials
peripheral artery disease
real-world evidence

Abbreviations and Acronyms

ABI
ankle-brachial index
CAD
coronary artery disease
CI
confidence interval
CLI
critical limb ischemia
CV
cardiovascular
FDA
U.S. Food and Drug Administration
HR
hazard risk
MI
myocardial infarction
PAD
peripheral artery disease
PPI
proton pump inhibitors
PVI
peripheral vascular intervention

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Dr. Jones has received research grants from the Agency for Healthcare Research and Quality, AstraZeneca, American Heart Association, Bristol-Myers Squibb, the Doris Duke Charitable Foundation, Merck, and the Patient-Centered Outcomes Research Institute; and has received honorarium/other from the American College of Physicians, Bayer, Bristol-Myers Squibb, Daiichi-Sankyo, and Janssen Pharmaceuticals. Dr. Patel has received research grants from AstraZeneca, Bayer, National Heart, Lung, and Blood Institute, and Heartflow; and has received honorarium/other from Medscape, Bayer, Janssen Pharmaceuticals, and AstraZeneca.

Listen to this manuscript's audio summary by JACC Editor-in-Chief Dr. Valentin Fuster.