The Burden of Peripheral Artery Disease and the Role of Antiplatelet Therapy

Along with coronary artery disease and cerebrovascular disease, peripheral artery disease (PAD) is primarily caused by atherosclerosis. In fact, PAD is a marker of advanced atherosclerotic disease, as evidenced from several studies that suggest approximately 60% of patients with PAD have polyvascular disease or manifestations of atherosclerosis in the coronary or cerebrovascular territories as well. However, despite a PAD prevalence that is > 15% in patients with cardiovascular risk factors aged 60 to 69 years and > 35% in patients aged 70 to 82 years, there is a lack of disease awareness on the part of both physicians and patients. This lack of awareness most likely contributes to the high cardiovascular risk associated with a diagnosis of PAD. For example, in the Reduction of Atherothrombosis for Continued Health (REACH) Registry, patients with PAD experienced the highest rates of all-cause mortality, cardiovascular death, myocardial infarction, stroke, or hospitalization for atherothrombotic events. High-risk patients should be screened for the presence of PAD. If diagnosed, physicians should institute a comprehensive treatment strategy that includes lifestyle modification and appropriate risk-reducing therapies. Because PAD is a manifestation of atherosclerosis, antiplatelet therapy should be a critical component of any PAD treatment plan. This article reviews the epidemiology and cardiovascular risks associated with PAD, as well as available diagnostic and treatment options.