PAD is not just undertreated — it is systematically undertreated despite repeated signals that proper medication changes survival, cardiovascular risk, and limb outcomes. This review shows where the real gaps are, which therapies carry the strongest signal, and why better discharge and follow-up prescribing may be one of the most actionable opportunities in vascular care.
Abstract: To synthesize the current evidence regarding the utilization patterns, clinical efficacy, and adherence challenges of pharmacological therapies in patients with peripheral artery disease. The review utilises 180 original studies with 2662177 total participants (topic deduplicated ΣN). This evidence map highlights a consistent and clinically important signal: PAD remains undertreated with guideline-directed medication despite repeated associations between GDMT and better outcomes, including a 67% lower all-cause mortality in newly diagnosed PAD and lower MACE with cardioprotective therapy. Treatment gaps were substantial across care settings, with statin use reported as low as 19.7% in some cohorts and only 25% of patients in BEST-CLI meeting all four OMT criteria. At the same time, the mapped literature suggests that several medication strategies may offer meaningful benefit in selected patients, including high-intensity or adherent statin therapy, antiplatelet treatment, rivaroxaban plus aspirin after revascularization, cilostazol for claudication, and semaglutide in PAD with type 2 diabetes. A practical implication is that PAD care should place greater emphasis on reliable initiation and continuation of secondary prevention at discharge and during follow-up, supported by systems interventions such as pharmacist involvement and prescribing prompts. Because much of the evidence base remains heterogeneous and observational, future research should prioritize pragmatic randomized and implementation studies that define optimal medication combinations, duration, and personalization across distinct PAD phenotypes, especially advanced disease, women, and racially diverse populations.
Keywords: Peripheral artery disease; Antiplatelet therapy; Statin therapy; Antithrombotic therapy; Intermittent claudication; Optimal medical therapy; Major adverse limb events; Medication adherence; Type 2 diabetes; Cardiovascular risk reduction
Review Stats
Final search date and database lock: 2026-04-03 23:39:14 CEST
Plan: Pro (expanded craft tokens; source: PubMed)
Source: PubMed
Total Abstracts/Papers: 486
Downloaded Abstracts/Papers: 486
Included original and non-original Abstracts/Papers (all): 195
Included original Abstracts/Papers (Vote counting by direction of effect): 180
Reference Index (links used in paper): 81
Total participants (topic deduplicated ΣN): 2662177
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Reference Index (81)
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