Marc Bonaca, MD: Personalizing Therapy in Peripheral Artery Disease Patients


Marc Bonaca, MD discusses the personalization of treatment in PAD patients, lack of proper research into the condition, and optimizing delivery of care.

As part of the 2021 American Society for Preventive Cardiology Virtual Summit on CVD Prevention, Marc Bonaca, MD, MPH, CPC Clinical Research, presented a talk entitled "Peripheral Artery Disease: Evaluation, Treatment, and Management."

In an interview with HCPLive, Bonaca highlighted two important research trends in peripheral artery disease (PAD) accompanying the presentation.

In the first, he noted that while the focus of medical therapy has traditionally been preventing major adverse cardiovascular events, there is minimal research on how to prevent major adverse limb events, including amputation and acute limb ischemia.

"I think one of the trends right now that we're seeing is that there's a recognition that the dominant morbidity in peripheral artery disease is limb morbidity, functional issues, amputation, acute limb ischemia, critical limb ischemia," Bonaca said. "And we need better therapies there, and that we shouldn't do trials of therapies without understanding what the effects are in the limb."

Further, the second trend he observed was the recognition of what he noted was the "heterogeneity of risk" within patients with PAD and that all patients are not the same.

"There's some patient populations like those with polyvascular disease that are at a very high risk of heart attack and stroke and those who've had prior revascularization, who are in a very high risk of limb events and better understanding who the highest risk populations are as important as we think about personalizing therapy," Bonaca said.

Bonaca also mentioned emerging therapies including lipid modifying agents, such as Lp(a), PCSK9i combined with statins, and anti-thrombotic drugs, including rivaroxaban in combination with aspirin.

In addition, Bonaca spoke on the barriers in treating patients with PAD, in terms of research and under-recognition of the risk profiles of the patient population.

"We have many many randomized trials looking at the best medical therapies for patients with coronary disease, whether it be the acute coronary syndrome or stable secondary prevention, but there are a tiny number of PAD trials, because there hasn't been the same level of interest in investment and I think that is hopefully changing," Bonaca said.

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