Role of Lipids and Lipid Management Therapy Among Patients With Peripheral Artery Disease: A Reappraisal of the Current Evidence and Future Directions

Peripheral artery disease (PAD), defined by stenosis or occlusion of the extremities (particularly the lower extremities), affects 200 million individuals worldwide, including an estimated 7% of adults in the United States alone. It is the third leading cause of atherosclerotic morbidity after coronary artery disease and stroke. Regardless of symptoms, individuals with PAD are known to be at a significantly increased risk for development of a major adverse cardiovascular event and have a higher all-cause mortality than those without disease. Despite PAD underdiagnosis, higher atherosclerotic cardiovascular disease burden, and evidence of decreased atherosclerotic cardiovascular disease risk with lipid modification, lipid undertreatment and nontreatment remain common among patients with PAD. This review addresses (1) the role of lipids in the pathophysiology of incident PAD and in adverse outcomes in those with PAD, (2) the role of lipid-modifying therapies in primary and secondary prevention of PAD, and (3) insights regarding future directions of the study of lipids as it relates to PAD.