Abstract
Individuals with lower extremity peripheral artery disease (LE PAD) represent a subset of patients with atherosclerotic cardiovascular disease that are among the highest risk for major adverse cardiovascular and limb events. Despite this, LE PAD is frequently under diagnosed, and an individual patient's risk for cardiovascular morbidity and limb loss is often underestimated and undertreated. To change the course of PAD disease progression, aggressive secondary prevention therapies are required. This is of particular importance among individuals undergoing surgical or endovascular lower extremity revascularization (LER), who represent the PAD subgroup with the highest risk of cardiovascular and limb adverse events. The cornerstone of secondary prevention is centered on symptom control, lifestyle and behavioural interventions that include exercise therapy, smoking cessation, healthy nutrition and weight management. Individuals with high-risk concomitant comorbidities, such as ongoing smoking, diabetes, and chronic kidney disease, represent an even higher risk population that warrant stringent monitoring and may benefit the most from pharmacological therapies. Guideline-recommended pharmacological therapies include antiplatelet and anticoagulant medications, lipid lowering therapies, diabetes medications, and cilostazol. Despite guideline recommendations, these medical therapies remain under-utilized in patients with PAD. Based on the elevated risk profile of individuals with LE PAD undergoing LER, increased efforts are required to initiate and escalate secondary prevention therapies. To achieve this, the development of effective, patient-centred and scalable implementation strategies remains a priority.