Cardiovascular Disease Continuum

Abstract

Peripheral artery disease (PAD) is an occlusive disease of extremities, which used to be diagnosed and treated as an isolated disease of the limbs or other parts of the body. Nowadays, the role of PAD transcends the affected limb; instead, the cardiovascular system must be observed as a whole, with PAD having a prognostic role. About 200 million people are affected by PAD worldwide. The prevalence of PAD is likely to increase steadily in the future due to the global aging of the population and the predominantly sedentary lifestyle, along with the expected universal increase in the major PAD risk factors such as smoking habit, diabetes mellitus, dyslipidemia and hypertension. Patients with PAD are at a higher risk of coronary disease and cardiovascular events in comparison to healthy control subjects. The severity of PAD correlates with the development and complications of cardiovascular disease. In PAD patients, percutaneous coronary intervention is more demanding, associated with more comorbidities, more complex lesions, and poorer procedural success as compared with PAD-free patients. For a year now, the use of antiplatelet therapy with acetylsalicylic acid in combination with low (vascular) dose of a direct oral anticoagulant has been recommended for cardiovascular and lower limb protection in PAD patients. In the future, we expect a better understanding of atherosclerotic disease, stronger modulation of systemic inflammation, and the discovery of new therapies. In the meantime, it is necessary to identify the risk population and aggressively treat the classic factors – control of blood pressure, glycemia and lipids with antiplatelet and new anticoagulant therapy. The goal is to protect the limb and preserve the cardiovascular continuum. The negative consequences of COVID- 19 on treatment CVD will be estimated in the following years.