Professional Practice Guide -FCSV-EN

27 for the Management of Peripheral Artery Disease 5.2 DYSLIPIDEMIA According to the Canadian Cardiovascular Society’s Clinical Practice Guidelines⁴, high-intensity statin therapy is recommended as first-line treatment for secondary prevention of cardiovascular disease. Treatment intensification is recommended if the following targets are not achieved: • LDL ≥ 1.8 mmol/L • Non-HDL ≥ 2.4 mmol/L • ApoB ≥ 0.7 g/ Second-line therapeutic options include ezetimibe and PCSK9 inhibitors. In cases of persistent hypertriglyceridemia despite the use of a statin at the maximum tolerated dose, icosapent ethyl may be considered. 5.3 DIABETES  According to the Canadian Cardiovascular Society’s Clinical Practice Guidelines⁵, glycemic control may be beneficial. There is no specific glycated hemoglobin target for patients with diabetes and PAD; the usual threshold of < 7.0% is generally recommended. Antithrombotic therapy is the treatment specific to PAD. 5.4 STABLE PAD According to the Canadian Cardiovascular Society’s Clinical Practice Guidelines⁶, single antiplatelet therapy, preferably clopidogrel, is recommended for all patients with stable PAD to reduce cardiovascular risk. Until recently, no pharmacological therapy had been shown to reduce the risk of lower limb events (need for revascularization, acute ischemia, amputation). However, low-dose rivaroxaban (2.5 mg twice daily) combined with aspirin has been shown to be reduce cardiovascular risk in high- risk patients, particularly those with coronary artery disease.⁷ This combination also reduces the risk of limb events. In this context, this combination is recommended in stable high-risk patients, including: • Patients with polyvascular disease, diabetes, heart failure, or chronic kidney disease • Patients with a high-risk cardiovascular condition, such as acute or critical ischemia or myocardial infarction 5.5 PAD FOLLOWING REVASCULARIZATION In 2020, the VOYAGER PAD study demonstrated a reduction in the risk of cardiovascular events, including limb-related events, in patients following revascularization.⁸ The use of low-dose rivaroxaban combined with aspirin is therefore recommended for these patients. When rivaroxaban is contraindicatedandthepatient has undergone endovascular revascularization, dual antiplatelet therapy (aspirin plus clopidogrel) is recommended for one month following the procedure.