Systemic atherosclerosis risk and the mandate for intervention in atherosclerotic peripheral arterial disease

Peripheral arterial disease (PAD), characterized by obstruction of the arteries in the lower limbs, is an important manifestation of atherosclerosis. There are >10 million individuals with PAD in the United States alone, and as the overall population in developed countries ages, PAD will become increasingly prevalent. Many individuals with PAD are asymptomatic and therefore remain undiagnosed and untreated. Most patients with PAD are at high risk for having a serious coronary or cerebrovascular event. Even for patients in whom symptoms, such as leg pain, are clearly evident, current treatment strategies tend to ignore the systemic nature of the disease and do not reduce overall atherosclerotic risk. Proven medical treatment options for patients with intermittent claudication include smoking cessation, exercise, and cilostazol. Pentoxifylline appears marginally effective. Several novel therapies for PAD are currently under investigation. Of particular interest are the observations from some studies that show that lipid-lowering therapy might be of benefit to PAD patients. The results of 2 ongoing prospective trials of dyslipidemic therapy in claudicants should further clarify the benefits of reducing serum lipid levels in patients with established PAD.