Table 1.

Lifestyle and Pharmaceutical Management of Peripheral Artery Disease¹⁷

Medical therapy	Proposed intervention
Antiplatelets	Aspirin (81 mg) daily or clopidogrel 75 mg daily Dual antiplatelet therapy (clopidogrel 75 mg+aspirin 81 mg) for 1 to 6 mo after endovascular revascularization
Anticoagulation	Rivaroxaban 2.5 mg twice daily+low-dose aspirin (81 mg) reduced cardiovascular event rates compared with aspirin in people with stable atherosclerosis, including those with PAD.
Lipid-lowering therapy	All patients with PAD should be treated with high-intensity statin therapy. Further lipid-lowering therapy may be necessary in patients taking a maximum dose of statin or who are statin-intolerant, namely ezetimibe and PCSK9 inhibitors, to achieve low-density lipoprotein goals as documented in the American College of Cardiology/American Heart Association 2018 lipid management guidelines.  Statins: Atorvastatin 40–80 mg or rosuvastatin 20–40 mg once daily  PCSK9 inhibitor: Evolucomab 140 mg SC or alirocumab 150 mg SC every 2 wk  Ezetimibe 10 mg once daily
Antihypertensive agents	Patients with PAD who have hypertension should have blood pressure treated as recommended by current hypertension guidelines. Angiotensin-converting enzyme inhibitors and angiotensin receptor blockers may have advantages for patients with PAD.
Peripheral vasodilators	Cilostazol is effective in improving symptoms and increasing walking distance in patients with claudication.
Smoking cessation	Patients with PAD who smoke cigarettes should be advised to quit smoking and offered pharmacotherapy to assist with smoking cessation (including varenicline, bupropion or nicotine replacement therapy, or both) at every clinical visit.
Exercise therapy	Patients with PAD who have claudication should undergo supervised exercise therapy to improve functional status, improve quality of life, and reduce leg symptoms. Home-based exercise programs with behavioral change therapy can improve functional status and improve walking ability.
Diet therapy	Patients with PAD should eat a diet high in fruits and vegetables, which contain flavonoids and polyphenols to reduce risk of atherosclerosis and inflammation and to improve endothelial function and vitamin K that may decrease arterial calcification. A high-fiber diet lowers total and low-density lipoprotein cholesterol and is associated with lower PAD risk. Diets should limit processed and higher fat cuts of meats and saturated and trans fats. Mediterranean and DASH style diets incorporate PAD diet therapy recommendations and can be beneficial. Vitamin D can upregulate nitric oxide, and lower circulating 25-hydroxyvitamin D is associated with endothelial dysfunction and lower prevalence of PAD.
Antidiabetic Therapy	Consider initiation of therapy to lower cardiovascular risk and treat hyperglycemia in patients with PAD who have concomitant diabetes.  Sodium-glucose cotransporter 2 inhibitors: empagliflozin, canagliflozin, dapagliflozin  Glucagon-like peptide 1 agonists: dulaglutide, exenatide, liraglutide, semaglutide

DASH indicates Dietary Approaches to Stop Hypertension; PAD, peripheral artery disease; and PCSK9, proprotein convertase subtilisin/kexin type 9.