Peripheral Artery Disease in the Legs

N Engl J Med. 2026 Jan 29;394(5):486-496. doi: 10.1056/NEJMcp2501200.

Abstract

Peripheral artery disease affects approximately 236 million persons worldwide and is diagnosed with an ankle-brachial index of less than 0.90. Among older persons, 3.3% of those without peripheral artery disease, 18.1% with mild disease, and 52.0% with severe disease could not complete a 6-minute walk test without resting. To prevent cardiovascular events in persons with peripheral artery disease, intensive cholesterol-lowering medications (statins), antiplatelet medications or low-dose aspirin with rivaroxaban, blood-pressure lowering to less than 130/80 mm Hg, and semaglutide are recommended, along with sodium-glucose cotransporter 2 inhibitors in patients with diabetes. Supervised walking exercise and structured home-based walking exercise each improve walking ability in persons with peripheral artery disease. Revascularization in the legs should be reserved for those with persistent disease symptoms that do not respond to exercise.

Publication types

  • Review

MeSH terms

  • Ankle Brachial Index
  • Cardiovascular Diseases / etiology
  • Cardiovascular Diseases / prevention & control
  • Exercise Therapy / methods
  • Glucagon-Like Peptide-1 Receptor Agonists / therapeutic use
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
  • Leg* / blood supply
  • Peripheral Arterial Disease* / complications
  • Peripheral Arterial Disease* / diagnosis
  • Peripheral Arterial Disease* / epidemiology
  • Peripheral Arterial Disease* / therapy
  • Platelet Aggregation Inhibitors / therapeutic use
  • Sodium-Glucose Transporter 2 Inhibitors / therapeutic use
  • Vascular Surgical Procedures
  • Walking

Substances

  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Platelet Aggregation Inhibitors
  • Glucagon-Like Peptide-1 Receptor Agonists
  • Sodium-Glucose Transporter 2 Inhibitors