Pharmacists Are Vital in Complex, Team-Based Treatment of PAD

As novel lipid-lowering, antithrombotic, and diabetes therapies emerge, medical management of peripheral arterial disease (PAD) has become increasingly complex, outstripping the capacity of primary care physicians or surgical specialists alone.¹

According to a recently published article in The Lancet, multidisciplinary models incorporating nonsurgeon specialists are required to optimize long-term prescribing and adherence among patients with PAD. Pharmacists are essential team members in managing this complex pharmacotherapy landscape, ensuring patients receive comprehensive cardiometabolic risk reduction rather than relying solely on procedural or surgical revascularization.¹

“Atherosclerosis of arteries in the legs leads to peripheral arterial disease (PAD), increasing the risk of future cardiovascular events,” according to authors of a study in the Journal of Clinical Pharmacy and Therapeutics.² “Worldwide prevalence estimates indicate >200 million people have PAD, but this is likely underestimated given the variability in symptoms and lack of awareness by patients and clinicians.”

Despite the staggering global prevalence of over 300 million individuals, PAD remains dangerously underdiagnosed and undertreated. Advanced stages of the condition carry a 5-year mortality rate ranging between 30% and 50%, a grim outcome that surpasses many severe cancers and acute heart attacks.^1,3

Furthermore, between 46% and 68% of patients with PAD suffer from polyvascular disease in multiple arterial beds, dramatically escalating their risk of major adverse cardiovascular events (MACE). Because symptoms often remain silent for decades before manifesting as claudication or nonhealing wounds, early identification and comprehensive risk reduction are essential.³

READ MORE: Cardiovascular Disease Now Leads as Cause of Death of Hispanic Adults

The Impact and Health Disparities of Vascular Disease

The individual toll of PAD extends far beyond circulatory limitations, bringing chronic pain, functional decline, and severe loss of independence. Patients frequently experience intractable leg pain, mobility restriction, depression, and a heightened reliance on long-term opioid prescriptions that can lead to dependency and frequent hospital readmissions.¹

The burden falls disproportionately on underserved groups, including women, ethnic minorities, low-income households, and residents of rural areas.

In the US, patients face an average annual out-of-pocket expense of $1027 for medications alone, creating financial barriers that severely impair adherence to necessary therapies. When diagnostic delays occur, the condition can progress to major lower-limb amputations, which carry a 50% job loss rate among affected individuals.¹

Expanding the Clinical Capacity of Health Care Teams

To combat these alarming outcomes, health care delivery must shift from relying primarily on surgical revascularization and move toward integrated, team-based medical management.

Pharmacists are uniquely positioned to serve as vital care extenders within cardiometabolic teams, bridging critical gaps in patient care. Clinical visits with pharmacists often last up to an hour for initial evaluations and 30 minutes for follow-up appointments, providing significantly more time for patient education than traditional 15-minute physician visits.⁴

Through collaborative practice agreements, pharmacists help eliminate therapeutic inertia by optimizing drug regimens, adjusting dosages for renal function, and navigating medication coverage barriers. This extended clinical touchpoint helps ensure that patients maintain adherence to lifestyle modifications and complex drug regimens.^2,4,5

Advanced Antithrombotic Strategies and Pharmacy Interventions

Recent landmark clinical trials have revolutionized the pharmacological management of PAD.²

Major clinical trials like COMPASS (NCT01776424) and VOYAGER-PAD (NCT02504216) demonstrate that combining low-dose rivaroxaban at 2.5 milligrams twice a day with low-dose aspirin reduces MACE by 28% and major amputations by up to 70% compared with aspirin alone.

Community pharmacists play an essential role in guiding patients on OTC aspirin selection and preventing harmful drug interactions from duplicate therapies. Furthermore, pharmacists actively engage in disease prevention by implementing smoking cessation programs using the 5 A's framework, promoting structured physical activity, setting realistic weight-loss goals, and establishing medication synchronization programs.^2,5

Frontline Screening and the Path Toward Equitable Care

Beyond medication management, pharmacists are expanding their clinical scope into early disease identification and noninvasive screening. Pharmacy schools now train students to measure the ankle-brachial index using handheld Doppler devices, allowing pharmacists in community and outpatient clinics to screen high-risk individuals.²

In patients with diabetes or chronic kidney disease, where arterial calcification causes noncompressible ankle vessels, pharmacists recognize the need for alternative diagnostic tools like the toe-brachial index.^2,3,5

By identifying at-risk patients during routine encounters, conducting thorough medication reviews, and more, pharmacists serve as an indispensable defense against disease progression and health inequities in the cardiometabolic space.^1,2,5

“In order to address the huge and escalating global burden of PAD, a paradigm shift in the current systems for managing this disease are needed,” they concluded.¹ “Health care systems need revising to better reimburse treatment of early-stage disease, better train specialists in PAD medical care, and incorporate standalone multidisciplinary models to deliver medical and rehabilitation care.”

READ MORE: Cardiology Resource Center

REFERENCES

1. Golledge J, Søgaard M, Svensson M, et al. Peripheral arterial disease: adverse impacts, disparities in outcomes, and the path ahead. The Lancet. September 1, 2026. doi:10.1016/s0140-6736(26)00847-0

2. Stacy Z. Peripheral arterial disease and the pharmacist’s role in management. J Clin Pharm Ther. 2023;2023(1). doi:10.1155/2023/2352051

3. Behrendt CA, Norgren L, Nicolajsen CW, et al. Understanding peripheral arterial disease in the current era. The Lancet. September 1, 2026. doi:10.1016/s0140-6736(26)00846-9

4. Peroutky R, Schmidt E. The role of pharmacists in cardiometabolic care. Advisory Board. April 29, 2026. Accessed September 28, 2026. https://www.advisory.com/sponsored/pharmacists-role-cardiometabolic-care

5. Hayes Jr. H, Colvin NN, Dalton EE, et al. Peripheral arterial disease from a community pharmacy perspective. U.S. Pharmacist. 2019;44(2):25-31. https://www.uspharmacist.com/article/peripheral-arterial-disease-from-a-community-pharmacy-perspective