Update About the Management of Low-Density Lipoprotein Cholesterol and Hypertriglyceridemia in Lower Extremity Peripheral Artery Disease Patients: Consensus of the French Society of Vascular Medicine and the French Society for Vascular and Endovascular Surgery.
[en] [en] BACKGROUND: A French intersociety consensus on behalf the Société Française de Médecine Vasculaire and the Société de Chirurgie Vasculaire et Endovasculaire was proposed in 2021 for the management of patients with lower extremity peripheral artery disease (LEAD). Recent studies have been published and an update of this consensus about the management of low-density lipoprotein cholesterol (LDLc) and hypertriglyceridemia was required.
METHODS: A steering committee of 12 vascular physicians and surgeons defined questions of interest about LDLc and hypertriglyceridemia management. A French expert panel voted the proposals. Consensus was considered to have been achieved if more than 80% of the responses corresponded to either "Agreement" or "Disagreement".
RESULTS: Among the 56 experts who were asked to participate, 46 (82%) accepted. After the first round of the Delphi procedure, the 4 proposals reached consensus. The following suggestions and recommendations were approved: 1. For LEAD patients treated by the highest tolerated statin dose ± ezetimibe and who have an LDLc ≥0.70 g/L, we recommend adding a proprotein convertase subtilisin/kexin type 9 inhibitor. 2. For LEAD patients treated by statin and who have elevated triglyceride level between ≥150 mg/dL and ≤500 mg/dL, we suggest adding Icosapent Ethyl. 3. Before adding Icosapent Ethyl in LEAD patients treated with statin, we suggest looking for symptoms that may suggest atrial fibrillation. 4. For LEAD patients treated by Icosapent Ethyl and who have symptoms that suggest atrial fibrillation, we recommend performing an electrocardiogram.
CONCLUSIONS: This update will help clinicians to improve LEAD patient management.
Disciplines :
Cardiovascular & respiratory systems
Author, co-author :
Mahé, Guillaume; Vascular Medicine Department, Radiology and Medical Imaging Department, Rennes University Hospital Centre, Rennes, France. Electronic address: maheguillaume@yahoo.fr
Boge, Gudrun; Vascular Medicine Department, Montpellier University Hospital Centre, Montpellier, France
Bura-Rivière, Alessandra; Vascular Medicine Department, Toulouse University Hospital Centre, Rangueil Hospital, Toulouse, France
Chakfé, Nabil; Vascular Surgery and Kidney Transplantation Department, Strasbourg University Hospital Centre, Strasbourg, France
Constans, Joël; Vascular Medicine Department, Bordeaux University Hospital Centre, Saint André Hospital, Bordeaux, France
Goueffic, Yann; Vascular Surgery Department, Saint-Joseph Paris Hospital Group, Paris, France
Lacroix, Philippe; Vascular Medicine Department, Limoges University Hospital Centre, Limoges, France
Le Hello, Claire; Vascular Medicine Department, Saint-Etienne University Hospital, Saint-Etienne, France
Pernod, Gilles; Vascular Medicine Department, Grenoble University Hospital Centre, Grenoble, France
Perez-Martin, Antonia; Vascular Investigation and Vascular Medicine Department, Nimes University Hospital Centre, Nimes, France
Picquet, Jean; Vascular and Thoracic Surgery Department, Angers University Hospital Centre, Angers, France
Sprynger, Muriel ; Université de Liège - ULiège > Département des sciences cliniques
Update About the Management of Low-Density Lipoprotein Cholesterol and Hypertriglyceridemia in Lower Extremity Peripheral Artery Disease Patients: Consensus of the French Society of Vascular Medicine and the French Society for Vascular and Endovascular Surgery.
Mahé, G., Boge, G., Bura-Rivière, A., et al. Disparities between international guidelines (AHA/ESC/ESVS/ESVM/SVS) concerning lower extremity arterial disease: consensus of the French Society of Vascular Medicine (SFMV) and the French Society for Vascular and Endovascular Surgery (SCVE). Ann Vasc Surg 72 (2021), 1–56.
Gerhard-Herman, M.D., Gornik, H.L., Barrett, C., et al. 2016 AHA/ACC guideline on the management of patients with lower extremity peripheral artery disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 135 (2017), e726–e779.
Aboyans, V., Ricco, J.-B., Bartelink, M.-L.E.L., et al. 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European Society for Vascular Surgery (ESVS): document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J 39 (2018), 763–816.
Frank, U., Nikol, S., Belch, J., et al. ESVM guideline on peripheral arterial disease. Vasa 48 (2019), 1–79.
Society for Vascular Surgery Lower Extremity Guidelines Writing Group Conte, M.S., Pomposelli, F.B., et al. Society for Vascular Surgery practice guidelines for atherosclerotic occlusive disease of the lower extremities: management of asymptomatic disease and claudication. J Vasc Surg 61 (2015), 2S–41S, 10.1016/j.jvs.2014.12.009.
Lambert, G., Krempf, M., Costet, P., PCSK9: a promising therapeutic target for dyslipidemias?. Trends Endocrinol Metab 17 (2006), 79–81.
Sherratt, S.C.R., Libby, P., Bhatt, D.L., et al. A biological rationale for the disparate effects of omega-3 fatty acids on cardiovascular disease outcomes. Prostaglandins Leukot Essent Fatty Acids, 182, 2022, 102450.
Ministère des solidarités et de la santé. JORF n° 0186 du 30 juillet 2020. Available at:, 2020 https://www.legifrance.gouv.fr/download/pdf?id=IhV8YBj8ff6F2ICX931-zaBVOO4Ees1U922iCwIn4_8=. (Accessed 30 July 2020)
Sabatine, M.S., Giugliano, R.P., Keech, A.C., et al. Evolocumab and clinical outcomes in patients with cardiovascular disease. N Engl J Med 376 (2017), 1713–1722.
Bonaca, M.P., Nault, P., Giugliano, R.P., et al. Low-density lipoprotein cholesterol lowering with evolocumab and outcomes in patients with peripheral artery disease: insights from the FOURIER trial (Further Cardiovascular Outcomes Research With PCSK9 Inhibition in Subjects With Elevated Risk). Circulation 137 (2018), 338–350.
Agence Nationale de Sécurité du Médicament. Médicaments hypocholestérolémiants anti-PCSK9 : la prescription élargie aux médecins vasculaires et aux neurologues/. Available at:, 2022 https://ansm.sante.fr/actualites/medicaments-hypocholesterolemiants-anti-pcsk9-la-prescription-elargie-aux-medecins-vasculaires-et-aux-neurologues. (Accessed 3 November 2023)
Schwartz, G.G., Steg, P.G., Szarek, M., et al. Alirocumab and cardiovascular outcomes after acute coronary syndrome. N Engl J Med 379 (2018), 2097–2107.
Haute Autorité de Santé. Vazkepa (isocapent éthyl) - Avis sur les médicaments. Available at:, 2022 https://www.has-sante.fr/jcms/p_3314513/fr/vazkepa-isocapent-ethyl. (Accessed 8 February 2022)
Bhatt, D.L., Steg, P.G., Miller, M., et al. Cardiovascular risk reduction with icosapent ethyl for hypertriglyceridemia. N Engl J Med 380 (2019), 11–22.
Bhatt, D.L., Steg, P.G., Miller, M., et al. Abstract 10627: benefits of icosapent ethyl in patients with prior peripheral artery disease: REDUCE-IT PAD. Circulation, 144, 2021, A10627.
Jünger, S., Payne, S.A., Brine, J., et al. Guidance on Conducting and REporting DElphi Studies (CREDES) in palliative care: recommendations based on a methodological systematic review. Palliat Med 31 (2017), 684–706.
Grundy, S.M., Stone, N.J., Bailey, A.L., et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 73 (2019), e285–e350.
Mach, F., Baigent, C., Catapano, A.L., et al. 2019 ESC/EAS guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J 41 (2020), 111–188.
Keech, A., Simes, R.J., Barter, P., et al. Effects of long-term fenofibrate therapy on cardiovascular events in 9795 people with type 2 diabetes mellitus (the FIELD study): randomised controlled trial. Lancet 366 (2005), 1849–1861.
Effects of combination lipid therapy in type 2 diabetes mellitus. N Engl J Med 362 (2010), 1563–1574.
