Antiplatelet therapy for peripheral artery disease

Atherosclerotic cardiovascular (CV) disease represents the most common cause of mortality and morbidity in Western countries with an estimated incidence of more than 200 million of adults affected worldwide. In this context an important, and frequently underestimated role, is played by peripheral arterial diseases (PADs), which include all arterial diseases, other than coronary arteries and the aorta. As well underlined in the latest Guidelines by the European Society of Cardiology (ESC) the term PADs should be distinguished from the term “peripheral artery disease” often used to describe lower extremity artery disease (LEAD), as this also includes the carotid and vertebral, upper extremities, mesenteric and renal arteries (1). Data derived from a recent meta-analysis estimated a prevalence of 4.2% for moderate to severe carotid artery disease. The prevalence of carotid stenosis is higher in patients older than 70 years (6.9% in females and 12.5% in males) (2). In recent years, also a great increase in the incidence of LEAD, nearly to 23%, has been registered as result of global aging, increased incidence of diabetes, and more widespread of tobacco use (3). At the same time, the rates of mortality for LEAD have grown between 1990 and 2010 in Europe, with 3.5 per 100,000 individuals in 2010 in Western Europe (1,3). Both carotid artery disease and LEAD are associated with an increased risk of CV mortality and morbidity. Risk factors modification and the use of cardioprotective medications, as antihypertensive drugs, statin and antiplatelet medications represent the cornerstone of medical management. Nevertheless, the greatest evidence showing the benefit of antiplatelet agents in reducing recurrence of CV events derived from large trials on treatment of coronary artery disease (CAD). Data on antiplatelet treatment in the setting of LEAD and carotid stenosis are limited and often deduced from small clinical studies. The purpose of this review is to examine the available data derived from registries, randomized trials and meta-analysis on antiplatelet treatment in patients with LEAD and carotid artery disease, with the aim to provide the evidence to support clinical decision making