p.18 抽出テキスト

CLINICAL STATEMENTS AND GUIDELINES

June 11, 2024 Circulation. 2024;149:e1313–e1410. DOI: 10.1161/CIR.0000000000001251 e1330

Synopsis Although all patients with PAD are at increased risk of MACE and MALE, additional factors (Table 9, Figure 3) have been identified that further escalate this risk. Diabetes is a wellestablished risk factor for development of PAD and is also associated with MACE and MALE, including CLTI and risk of amputation.1–6 Ongoing smoking among patients with PAD has been associated with MACE and MALE.7,8 CKD and PAD share a common underlying pathophysiology of inflammation and oxidative stress, and CKD is an established risk factor for PAD.9–16 Patients with PAD and CKD and particularly those with end-stage kidney disease (ESKD) are at high cardiovascular risk as well as risk of amputation.9–16 Concomitant microvascular disease (eg, retinopathy, neuropathy, nephropathy) has been associated with increased risk of MALE among patients with PAD.1–3,17–19 Management of hypertension is a critical component of GDMT, not only because it is the most prevalent risk factor for PAD, but also because uncontrolled hypertension is associated with risk of MACE as well as CKD and polyvascular disease20 (see Section 5.3, “Antihypertensive Therapy for PAD”). Polyvascular disease, defined as the presence of atherosclerotic disease involving ≥2 vascular beds (coronary, peripheral, or cerebrovascular), is common among patients with PAD and has recently emerged as an important PAD-related risk amplifier.20,21 Patients with polyvascular disease and PAD have compounded cardiovascular risk,

Figure 3. Health Disparities and PAD-Related Risk Amplifiers Increase Risk of MACE and MALE. MACE indicates major adverse cardiovascular events; MALE, major adverse limb events; and PAD, peripheral artery disease.

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