In the same guidelines clopidogrel (75 mg/day) is considered an alternative in patients with aspirin intolerance. Regarding patients affected by carotid artery disease evidence supporting the use of antiplatelet therapy for secondary prevention of recurrent stroke is stronger than that available for asymptomatic patients, therefore single antiplatelet treatment was in this district indicated in both asymptomatic and symptomatic patients but with different class of indications: class IA for symptomatic patients and class IIa C for asymptomatic patients. Due to the complexity in medical and interventional treatment of this arteries district, we will review in two separate sections data on LEAD and carotid stenosis.ĮSC, European Society of Cardiology LEAD, lower extremity. We will proceed starting from a summary of latest European guidelines indications, followed by a revision of available evidence on antiplatelet treatment. The purpose of this review is to examine the available data derived from registries, randomized trials and meta-analysis on antiplatelet treatment in patients with LEAD and carotid artery disease, with the aim to provide the evidence to support clinical decision making. Data on antiplatelet treatment in the setting of LEAD and carotid stenosis are limited and often deduced from small clinical studies. Nevertheless, the greatest evidence showing the benefit of antiplatelet agents in reducing recurrence of CV events derived from large trials on treatment of coronary artery disease (CAD).
Risk factors modification and the use of cardioprotective medications, as antihypertensive drugs, statin and antiplatelet medications represent the cornerstone of medical management. Both carotid artery disease and LEAD are associated with an increased risk of CV mortality and morbidity. At the same time, the rates of mortality for LEAD have grown between 19 in Europe, with 3.5 per 100,000 individuals in 2010 in Western Europe ( 1, 3). In recent years, also a great increase in the incidence of LEAD, nearly to 23%, has been registered as result of global aging, increased incidence of diabetes, and more widespread of tobacco use ( 3). The prevalence of carotid stenosis is higher in patients older than 70 years (6.9% in females and 12.5% in males) ( 2). Data derived from a recent meta-analysis estimated a prevalence of 4.2% for moderate to severe carotid artery disease. As well underlined in the latest Guidelines by the European Society of Cardiology (ESC) the term PADs should be distinguished from the term “peripheral artery disease” often used to describe lower extremity artery disease (LEAD), as this also includes the carotid and vertebral, upper extremities, mesenteric and renal arteries ( 1).
In this context an important, and frequently underestimated role, is played by peripheral arterial diseases (PADs), which include all arterial diseases, other than coronary arteries and the aorta. The purpose of this review is to examine the available data from registries, randomized trials and meta-analysis on antiplatelet treatment in patients with LEAD and carotid stenosis with the aim to provide evidence to support clinical decision making.Ītherosclerotic cardiovascular (CV) disease represents the most common cause of mortality and morbidity in Western countries with an estimated incidence of more than 200 million of adults affected worldwide. Despite their clinical relevance, data on optimal antiplatelet treatment in this clinical setting are lacking and often derived from clinical trials on coronary artery disease and by subgroups analysis. Medical treatment, including antiplatelet therapy, is a cornerstone in management of these patients, even when they are treated with endovascular or surgical procedures. In particular, lower extremity artery disease (LEAD) and/or carotid artery disease present growing incidence in general population and a consequent increase in mortality and morbidity. An increased risk of CV events was identified in patients with peripheral arterial diseases (PADs), which include all arterial diseases, other than coronary arteries and the aorta. Atherosclerotic cardiovascular (CV) disease represents one of leading cause of mortality and morbidity in Western countries.
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