Medical Management
Applied
Type
ModificationConfidence
92%
Created
Apr 26, 2026
Evidence
1 source
Rationale
The stale guideline citation acc 2025 d in the blood pressure and glycemic control bullet was replaced with the superseding ACC/AHA guideline ACC/AHA (PMID 41252847), which directly addresses management of lower extremity PAD including glucose-lowering therapy recommendations. Per the stale guideline replacement instructions, the newer guideline covers the same claim and therefore replaces rather than supplements the older citation. No other content changes were warranted as the remaining claims are supported by their existing citations.
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. Comprehensive risk factor modification, including diet and physical activity, remains the cornerstone of cardiovascular prevention [@national2026]. * **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 [@national2026]. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors provide additional risk reduction in statin-intolerant or high-risk patients [@sabatine2017]. * **Blood pressure and glycemic control:** Angiotensin-converting enzyme (ACE) inhibitors and tight glycemic control improve vascular outcomes [@svs2024-gornik]. In patients with diabetes and PAD, management requires intensive risk factor control and the use of evidence-based glucose-lowering therapies to reduce the risk of major adverse limb and cardiovascular events [@acc2025-d].[@acc2026-b]. * **Risk stratification:** In patients with established atherosclerotic cardiovascular disease (ASCVD), the SMART2-HF model can be utilized to predict the risk of incident heart failure, facilitating early intervention and personalized management [@reitsma2026-b].