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外周动脉疾病治疗领域的新进展
A Bon VOYAGER for Peripheral Artery Disease


Mark A. Creager ... 心脑血管疾病 • 2020.05.21
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外周动脉疾病普遍,全世界患病人数超过2亿1。作为全身动脉粥样硬化的一个表现,外周动脉疾病与心肌梗死、卒中和心血管原因死亡的风险增加相关,而且由于其发生于肢体动脉,因此行走功能受到损害,且可能导致威胁肢体的严重缺血和截肢2。然而,令人遗憾的是,外周动脉疾病未被充分认识,并常常未得到适当的循证疗法治疗,因而未能保护生命和肢体。与已知的冠状动脉粥样硬化性心脏病(冠心病)合并外周动脉疾病患者相比,仅患外周动脉疾病的患者接受抗血小板药物、他汀类药物或戒烟等干预措施的可能性低30%~50% 3

对这一差异的一种解释是,与冠心病相比,对外周动脉疾病药物疗法开展的临床试验相对较少。关于降脂和抗血栓疗法疗效的证据主要是来自纳入稳定型动脉粥样硬化(包括冠心病和脑血管疾病,也包括一部分外周动脉疾病)广泛患者人群的研究。虽然这些临床试验很重要,并且指南中已经有治疗建议4,但我们仍有很大机会改善外周动脉疾病患者的治疗,减少其不良结局。





作者信息

Mark A. Creager, M.D.
From the Heart and Vascular Center, Dartmouth–Hitchcock Medical Center, and Geisel School of Medicine at Dartmouth, Lebanon, NH.

 

参考文献

1. Fowkes FGR, Rudan D, Rudan I, et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet 2013;382:1329-1340.

2. Bonaca MP, Creager MA. Pharmacological treatment and current management of peripheral artery disease. Circ Res 2015;116:1579-1598.

3. Berger JS, Ladapo JA. Underuse of prevention and lifestyle counseling in patients with peripheral artery disease. J Am Coll Cardiol 2017;69:2293-2300.

4. Gerhard-Herman MD, Gornik HL, Barrett C, et al. 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2017;135(12):e686-e725.

5. Hamburg NM, Creager MA. Pathophysiology of intermittent claudication in peripheral artery disease. Circ J 2017;81:281-289.

6. Klarin D, Lynch J, Aragam K, et al. Genome-wide association study of peripheral artery disease in the Million Veteran Program. Nat Med 2019;25:1274-1279.

7. Narula N, Dannenberg AJ, Olin JW, et al. Pathology of peripheral artery disease in patients with critical limb ischemia. J Am Coll Cardiol 2018;72:2152-2163.

8. Anand SS, Bosch J, Eikelboom JW, et al. Rivaroxaban with or without aspirin in patients with stable peripheral or carotid artery disease: an international, randomised, double-blind, placebo-controlled trial. Lancet 2018;391:219-229.

9. Hess CN, Wang TY, Weleski Fu J, et al. Long-term outcomes and associations with major adverse limb events after peripheral artery revascularization. J Am Coll Cardiol 2020;75:498-508.

10. Bonaca MP, Bauersachs RM, Anand SS, et al. Rivaroxaban in peripheral artery disease after revascularization. N Engl J Med 2020;382:1994-2004.

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