Impact of guideline-directed medical therapy on outcomes in patients with peripheral arterial disease: a multicenter prospective study

Background Guideline-directed medical therapy (GDMT) is recommended for patients with peripheral arterial disease (PAD) to reduce cardiovascular complications. However, its impact on patient outcomes remains unclear. This study investigates the association between GDMT adherence and clinical outcomes in a multicenter cohort of PAD patients. Methods This prospective, multicenter, observational registry study included PAD patients from ten medical centers and teaching hospitals. GDMT was defined using two models: Model 1 included antiplatelet agents, statins, and ACEI/ARB, while Model 2 further incorporated diabetes control with an HbA1c target of <8%. Patients were analyzed using inverse probability of treatment weighting (IPTW) to balance baseline characteristics. The primary outcomes were cardiovascular (CV) death, nonfatal stroke, ischemic stroke, hemorrhagic stroke, transient ischemic attack (TIA), nonfatal myocardial infarction (MI), and cardiac arrest requiring resuscitation. The secondary outcomes included hospitalization for coronary revascularization, unstable angina, congestive heart failure, other CV causes, non-CV causes, and amputation. Results A total of 963 patients were included in the analysis, with a mean age of 70.4 years and 59.6% male. The prevalence of comorbidities included diabetes (66.6%), hypertension (77.3%), hypercholesterolemia (59.0%), current smoking (16.3%), prior coronary intervention (32.1%), prior lower extremity arterial intervention (57.4%), atrial fibrillation (10.7%), and end-stage renal disease (24.8%). While GDMT adherence did not significantly impact the primary outcomes, it was associated with a significant reduction in hospitalization for heart failure. Compared to non-GDMT patients, those receiving Model 1 had an odds ratio (OR) of 0.364 (95% CI: 0.194–0.683, P = 0.002), while those on Model 2 had an even greater reduction in risk, with an OR of 0.184 (95% CI: 0.081–0.415, P < 0.001). Although there was no statistically significant difference in CV death, a trend favoring GDMT was observed. The OR for Model 1 versus non-GDMT was 0.809 (95% CI: 0.388–1.688, P = 0.572), and for Model 2, it was 0.503 (95% CI: 0.218–1.156, P = 0.106). Conclusion Despite no significant impact on primary cardiovascular outcomes, adherence to GDMT, particularly when incorporating diabetes control, was associated with a substantial reduction in hospitalization for heart failure. The trend toward lower CV mortality further supports the potential benefits of optimizing GDMT adherence in PAD patients. These findings underscore the importance of comprehensive medical therapy in mitigating heart failure-related complications in this high-risk population, warranting further investigation into the underlying mechanisms and broader clinical implications.Outcomes of GDMT vs Non-GDMT