Medical optimization of the peripheral artery disease patient.

Peripheral artery disease (PAD) impacts an estimated 230 million adults worldwide, including more than 9.5 million adults older than 40 years in the United States. PAD remains more underdiagnosed and undertreated than manifestations of atherosclerosis elsewhere in the body, such as coronary artery disease and cerebrovascular disease. Medical therapies benefit all patients with PAD, including those who are asymptomatic, as well as those with symptoms and advanced disease requiring intervention. Comprehensive medical management of PAD is based on tempering atherosclerotic disease processes and should include smoking cessation, exercise therapy, cholesterol reduction, antiplatelet, and/or anticoagulation therapy, as well as the application of peripheral vasodilators and blood pressure control, when indicated. For patients with intermittent claudication, supervised exercise therapy has been shown to provide similar or superior benefit compared with intervention and is recommended by major society guidelines as first-line therapy. In patients with advanced PAD requiring endovascular or surgical intervention, continued adherence to optimal medical therapy has been found to improve functional outcomes and decrease post-interventional mortality. Optimal medical management provides crucial benefits to patients with early, moderate, and advanced PAD and, once started, should be continued for life.