Treatment of Mild Peripheral Artery Disease

First-Line Interventions

The European Society of Cardiology recommends supervised exercise training as the primary treatment for patients with mild PAD, with a frequency of at least three times per week for at least 30 minutes per session over a minimum of 12 weeks 1, 2
When supervised exercise training is not available, a structured home-based exercise training program with monitoring should be considered, as recommended by the European Heart Journal 1, 3
Walking should be the first-line training modality, with high-intensity exercise recommended for optimal results, according to the European Heart Journal 1, 2
Exercise improves walking performance through multiple mechanisms, including improved mitochondrial function, arteriogenesis, endothelial function, and reduced inflammation, as stated in the European Heart Journal 2

The American College of Cardiology recommends smoking cessation for all patients with PAD who smoke, as it is essential for reducing cardiovascular risk 4, 5

The American College of Cardiology recommends antiplatelet therapy with aspirin or clopidogrel to reduce myocardial infarction, stroke, and vascular death in symptomatic PAD, with clopidogrel preferred based on the CAPRIE trial 4, 7
Antiplatelet therapy is reasonable to reduce cardiovascular events in asymptomatic patients with PAD, according to the American College of Cardiology 4, 7

The American College of Cardiology indicates statin therapy for all patients with PAD, with a target LDL-C of <70 mg/dL for those at very high cardiovascular risk 4, 5

The American College of Cardiology recommends antihypertensive therapy to reduce cardiovascular events in patients with PAD and hypertension, with a target blood pressure of <140/90 mmHg for patients without diabetes and <130/80 mmHg for patients with diabetes or chronic kidney disease 4, 5

Cilostazol, a phosphodiesterase III inhibitor, has shown benefit in improving maximal walking distance and ankle-brachial index in patients with claudication, as reported in Circulation 8

Revascularization is not recommended for asymptomatic PAD or solely to prevent progression to chronic limb-threatening ischemia, as stated in the European Heart Journal 1, 3
Patients with PAD should be screened for abdominal aortic aneurysm, according to the American College of Cardiology 4, 5
Women may respond less well than men to exercise therapy, though evidence is inconsistent, as noted in the European Heart Journal 2
The effectiveness of dual antiplatelet therapy to reduce cardiovascular events in PAD is not well established, according to the American College of Cardiology 4
Patients with PAD are often undertreated compared to those with other forms of cardiovascular disease, as reported in the Journal of the American College of Cardiology 7