Physician Update: AHA Special Edition
Read more articles from our most relevant research presented at the 2024 AHA Scientific Sessions.
Clinical Heart and Vascular Center
The Evolution of Therapies in Vascular Disease
By Joshua A. Beckman, M.D., M.P.H.
Professor of Internal Medicine
Chief of Vascular Medicine
The evolution of vascular disease therapies highlights a multidisciplinary interplay of basic science, clinical research, and serendipity. For peripheral artery disease (PAD), coronary artery disease (CAD) and related conditions, overlapping mechanisms such as atherosclerosis have facilitated therapeutic crossover. Statins, ACE inhibitors, and antiplatelet agents, initially developed for CAD, have been adapted for PAD. Antiplatelet therapy has advanced from aspirin to P2Y12 inhibitors and PAR-1 antagonists, offering more nuanced thrombotic risk management for PAD patients despite their primary initial target of patients with CAD.
Basic science serves as the second major source of therapies and continues to uncover novel targets. These include clonal hematopoiesis, medial artery calcification, microbiome influences, and angiogenesis, promising disease-specific interventions. However, serendipity has also driven significant breakthroughs; for example, arterial-dose rivaroxaban and sildenafil emerged from unexpected findings during unrelated investigations.
“This reliance underscores an urgent need for PAD-specific research and innovation, as current approaches inadequately serve this vulnerable population.”
In contrast to PAD, venous thromboembolism (VTE) – comprising deep vein thrombosis (DVT) and pulmonary embolism (PE) – has followed a more directed course. Targeted therapies such as low molecular weight heparin, direct thrombin inhibitors, and Factor Xa inhibitors have revolutionized VTE management by addressing its unique pathophysiology. Unlike PAD, VTE therapies are largely independent of innovations in other vascular diseases, reflecting a focused development trajectory that directly addresses patient needs.
Despite this progress, PAD therapy remains heavily reliant on CAD-derived strategies, which often fail to address the disease's unique challenges, such as systemic inflammation, arterial calcification, and impaired angiogenesis. Consequently, PAD patients remain at high risk for major adverse cardiac and limb events. This reliance underscores an urgent need for PAD-specific research and innovation, as current approaches inadequately serve this vulnerable population. The continued evolution of vascular medicine demands greater investment in targeted solutions to bridge these gaps and improve outcomes for all affected patients.
