Medical Management
Applied
Type
ModificationConfidence
85%
Created
Mar 27, 2026
Evidence
3 sources
Rationale
The section was updated to reflect the latest 2025 ACC scientific statement on PAD and diabetes, specifically the inclusion of SGLT2 inhibitors and GLP-1 RAs which have become standard of care for reducing limb and cardiovascular events. The SMART2-HF model was integrated to address the importance of heart failure risk prediction in the vascular patient population. Additionally, the Saudi Heart Association guidelines were added to provide a broader international perspective on cardiovascular prevention. All new abbreviations (SGLT2, GLP-1 RA, MACE, MALE, ASCVD) and existing ones (ACE) were expanded on first use as required.
Evidence
Content Changes
removedadded
* **Lifestyle modification:** Smoking cessation reduces abdominal aortic aneurysm (AAA) expansion and peripheral arterial disease (PAD) progression [@golledge2017]. Exercise therapy improves walking distance in PAD. Global prevention guidelines emphasize structured risk assessment and lifestyle interventions as the foundation of care [@national2026-national]. * **Antiplatelet therapy:** Aspirin or clopidogrel for secondary prevention in symptomatic atherosclerotic disease [@lancet1996]. * **Anticoagulation:** Low-dose rivaroxaban plus aspirin benefits select PAD patients; see [[Peripheral Artery Disease|Ch. 10]] for COMPASS/VOYAGER-PAD evidence and patient selection criteria. * **Lipid lowering:** High-intensity statins reduce events and slow aneurysm growth. PCSK9 inhibitors provide additional risk reduction in statin-intolerant or high-risk patients [@sabatine2017]. * **Blood pressure and glycemic control:** ACEAngiotensin-converting enzyme (ACE) inhibitors and tight glycemic control improve vascular outcomes [@aha2016]. In patients with PAD and diabetes, sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are recommended to reduce major adverse cardiovascular events (MACE) and major adverse limb events (MALE) [@acc2025-g]. Management should also include monitoring for incident heart failure risk in patients with established atherosclerotic cardiovascular disease (ASCVD), utilizing predictive tools such as the SMART2-HF model [@reitsma2026-c].