Muristek
Lower extremity peripheral artery disease (PAD) is a morbid manifestation of atherosclerosis that affects an estimated 230 million people worldwide. In the context of an aging population and the increasing rates of diabetes, the prevalence of PAD is expected to increase. Patients with PAD, by virtue of having atherosclerosis, have a heightened risk of myocardial infarction and stroke; thus reducing these risks has been the primary focus of most medical interventions. Although these efforts are warranted, recent evidence has broadened awareness that the dominant morbidity involves the limbs, including functional impairment and adverse limb events such as acute limb ischemia and amputation. Recent advances in medical therapeutics have brought hope by demonstrating benefits in reducing amputation and acute limb ischemia. However, effective therapies to address functional impairment remain an area of unmet need. It has been more than 2 decades since the last medical therapy for intermittent claudication was approved by the US Food and Drug Administration. The TELEX (Telmisartan Plus Exercise to Improve Functioning in Peripheral Artery Disease) randomized clinical trial reported by McDermott et al in this issue of JAMA is an important reminder of both the challenges and the great need for development of effective therapies to improve functional impairment in patients with PAD.
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