Unmet needs for lipid management in patients with peripheral arterial disease: A narrative review

BACKGROUND: Lower extremity peripheral arterial disease (PAD) is a prevalent manifestation of systemic atherosclerosis associated with significant morbidity, mortality, and economic burden. Lipid-lowering therapy (LLT) with high-intensity statins and nonstatin therapies is a cornerstone of guideline-directed management to reduce the risk of major adverse limb and cardiovascular events. Despite robust evidence and clear guideline re--ations, the utilization of LLT in patients with PAD remains suboptimal. SOURCES OF MATERIAL: We review evidence that highlights gaps in lipid management for patients with PAD, and how these may be addressed by leveraging implementation science. ABSTRACT OF FINDINGS: A large proportion of patients with PAD do not receive re--ed LLT and subsequently do not achieve low-density lipoprotein cholesterol (LDL-C) goals. These patients are at risk of major adverse cardiovascular and limb events, including preventable amputations. Health inequities can further exacerbate the underutilization of LLT. While there is a paucity of studies specifically evaluating the effectiveness of implementation strategies for lipid management in patients with PAD, we propose approaches that are grounded in evidence from broader populations with other forms of atherosclerotic cardiovascular disease. CONCLUSION: There is a clear and urgent need for better implementation strategies to ensure optimal care is provided to patients with PAD, regardless of race, ethnicity, or socioeconomic status. Addressing the underutilization of guideline-re--ed LLT in PAD requires multifaceted approaches considering healthcare systems, clinicians, and patients' needs. By ensuring that all patients with PAD receive appropriate LLT to achieve guideline-directed LDL-C goals, we can hope to substantially improve their cardiovascular outcomes and quality of life.