Medications for Peripheral Artery Disease

Peripheral artery disease (PAD) is a common circulatory condition in which narrowed arteries reduce blood flow to the limbs — most often the legs — due to the buildup of plaque (atherosclerosis), the same process that causes coronary artery disease. When leg arteries are narrowed, muscles do not receive enough blood during activity, causing symptoms. PAD affects approximately 6.5 million Americans aged 40 and older and is significantly more common in people who smoke or have diabetes. The most characteristic symptom is claudication — cramping, aching, or fatigue in the calf, thigh, or buttock muscles that occurs with walking and is relieved by rest. In more severe cases, pain occurs even at rest (critical limb ischemia), and there may be numbness, coolness, skin discoloration, non-healing sores, or in the most advanced cases, gangrene.

PAD is a strong predictor of cardiovascular events — people with PAD have a significantly elevated risk of heart attack, stroke, and cardiovascular death because the same atherosclerotic process affects the coronary and carotid arteries. Without treatment, severe PAD can progress to critical limb ischemia and may ultimately require amputation. Treatment has two goals: reducing cardiovascular risk and improving walking ability and quality of life. Medications include antiplatelet agents (aspirin and clopidogrel) to reduce clot formation, statins to lower LDL cholesterol and stabilize plaques, antihypertensives to control blood pressure, and cilostazol — a phosphodiesterase inhibitor that widens blood vessels and improves walking distance in people with claudication. The medications listed below are among the most commonly prescribed for managing peripheral artery disease.