Dyslipidemia and peripheral arterial disease
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Date
2024-03
Journal Title
Journal ISSN
Volume Title
Publisher
Elsevier
Abstract
Peripheral arterial disease (PAD) affects 12 % of adult population and is increasing globally and in India. Pe- ripheral arterial disease when associated with atherosclerosis in two or more other arterial beds such as coronary artery disease (CAD), mesenteric/renal artery and cerebrovascular disease (CVD), is known as polyvascular disease. The Reduction of Atherothrombosis for Continued Health (REACH) registry reported that 1 out of 6 patients had multi-vascular bed involvement. Progression of PAD to critical limb ischaemia (CLI) is seen in 1 % of affected patients per year, but patients who progress to CLI may have a 10- to 15-fold increased risk of car- diovascular death. The 2019 ECS/EAS guidelines for the management of dyslipidaemias have suggested that for primary or secondary prevention in very high risk, patients should follow a therapeutic regimen that achieves >50 % LDL-C reduction from baseline and an LDL-C goal of <55 mg/dl. High Intensity Statin is mainstay of treatment but optimal management is inadequate. Statin treatment reduces all-cause mortality by 39 %, CV death by 41 %, CV outcomes by 34 %, ischaemic stroke by 28 %, acute limb ischaemia by 30 % and amputations by 35 %. Ezetimibe when added to statins in IMPROVE-IT trial, showed significant reduction of MACE. PCSK9 inhibitor (FOURIER TRIAL) showed reduction in primary end point in PAD vs Non PAD patients (3.5 % vs 1.6 %). There is a critical need for an Indian multi-disciplinary task force for research on the direct impact of lipid- lowering agents on limb salvage rates and major limb-related events in PAD patients.
Description
Keywords
Dyslipidaemia, Peripheral arterial disease, Ezetimibe, Polyvascular disease, LDL-C goal of <55 mg/dl
Citation
Yadav Ajay, Sawant Vivek, Bedi Varinder Singh, Yadav Kanupriya . Dyslipidemia and peripheral arterial disease. Indian Heart Journal. 2024 Mar; 76(1): 86-89