Intensive lipid lowering and non-statin therapy in PAD (targets and limb outcomes)
Applied
Type
ReinforcementConfidence
90%
Created
Mar 19, 2026
Evidence
1 source
Rationale
The section was updated to include the most recent 2025 ACC scientific statement focusing on PAD in patients with diabetes. This population represents a 'very high-risk' cohort where aggressive lipid-lowering targets and the use of non-statin therapies (ezetimibe and PCSK9 inhibitors) are strongly emphasized. Abbreviations were expanded on first use as required by the instructions.
Evidence
Content Changes
removedadded
All patients with peripheral arterial disease (PAD) should receive high-intensity statin therapy unless contraindicated. The HPSHeart Protection Study (HPS) and 4SScandinavian Simvastatin Survival Study (4S) trials demonstrated significant cardiovascular risk reduction with statin therapy [@hps2002, @4s1994]. For very high-risk patientspatients, particularly those with concomitant diabetes mellitus, who do not achieve target LDL-Clow-density lipoprotein cholesterol (LDL-C) levels with statins alone, addthe addition of ezetimibe or a PCSK9proprotein inhibitor.convertase subtilisin/kexin type 9 (PCSK9) inhibitor is recommended [@acc2025-f]. The FOURIER and ODYSSEY OUTCOMES trials support this escalation strategy, with PAD subgroup analyses demonstrating both cardiovascular and limb benefits from PCSK9 inhibition [@fourier2017, @odyssey2018].