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7.1.2 Physical activity Few patients with chronic symptomatic PAD meet the physical activity guidelines252 for reducing the risk of major adverse cardiac events (MACE).253,254 Better ambulation, HRQoL, and vascular outcomes have been observed in patients meeting the physical activity time-intensity guidelines.19,255 Regular physical activity is also relevant in patients with aortic diseases70,71,256–259 and lowers resting heart rate and BP, thus decreasing the risk of aortic complications.256,259 Few data exist on the practice of exercise and sports in patients with aortic diseases.70,71,256–259 Recommendations should be individualized and based on risk stratification.71 Medications Lifestyle Targets Targets Systolic blood pressure ≤120–129 mmHg Beta-blockers ACEi or ARB Calcium channel blockers Antiplatelet therapy Statins Ezetimibe PCSK9i Bempedoic acid Reducing risk of atherothrombosis Optimal glucose control (HbA1c <7%) Educational programmes Psychological support Genetic counselling Supervised exercise training LDL <55 mg/dL (<1.4 mmol/L) Healthy diet BMI 20–25 kg/m2 Waist: <94 cm men; <80 cm women Low-to-moderate exercise training Limit isometric exercise in aortic diseases Avoid excessive alcohol intake Avoid smoking/smoking cessation Avoid cocaine and stimulating drugs Glucose-lowering agents Diastolic blood pressure ≤70–79 mmHg Anticoagulants Figure 7 Cardiovascular risk modification and healthy lifestyle interventions and targets in patients with peripheral arterial and aortic diseases. ACEi, angiotensin-converting enzyme inhibitors; ARB, angiotensin receptor blocker; BMI, body mass index; LDL, low-density lipoprotein; PCSK9i, proprotein convertase subtilisin/kexin type 9 inhibitor; HbA1c, glycated haemoglobin. ESC Guidelines 3569 Downloaded from academic.oup.com/eurheartj/article/45/36/3538/7738955 by guest on 07 October 2026