ABC | Volume 113, Nº4, October 2019

Updated Updated Cardiovascular Prevention Guideline of the Brazilian Society Of Cardiology – 2019 Arq Bras Cardiol. 2019; 113(4):787-891 Chart 10.3 – Risk Factors / Therapeutic Conduct and their Recommendation Classes / Levels of Evidence at DAPEI according to the latest international Peripheral Artery Disease guidelines Risk Factor / Therapeutic Management Society for Vascular Medicine Guidelines (2015) 484 AHA / ACC Guidelines (2016) 483 European Society of Cardiology (ESC) Guidelines (2018) 482 Smoking Comprehensive preventive interventions aimed at smoking cessation in asymptomatic Lower extremity PAD, intermittent claudication and after open endovascular or surgical procedure I-A Lower extremity PAD smoking cessation programs, including pharmacotherapy I-A Smoking cessation is recommended in all patients with Lower extremity PAD I-B Statins In Lower extremity PAD with intermittent claudication I-A Optimized statin therapy is recommended for all patients with claudication and after endovascular or open surgical procedure I-A Suitable for all patients with Lower extremity PAD I-A Recommended statins for all patients with Lower extremity PAD I-A In patients with Lower extremity PAD it is recommended to lower LDL-c below 70 mg/ dL or to decrease it by > 50% if baseline values are between 70-135 mg/dL I-C Physical exercise Supervised Exercises I-A Residential exercises I-B Post limb revascularization exercises for claudication I-B At least annual follow-up of claudication to check the results from exercise I-C Treadmill test may help in functional evaluation in Lower extremity PAD IIa-B Supervised exercises in patients with claudication I-A Residential or community exercises with behavioral change techniques may be beneficial in functional improvement IIa-A In lameness patients, alternative exercises such as low intensity, painless walking may be beneficial in functional improvement IIa-A Supervised exercises are recommended in patients with lameness. I-A Unsupervised exercise in patients with claudication I-C Healthy diet and physical activity are recommended in patients with Lower extremity PAD I-C Antiplatelets Use of aspirin 75-325 mg/day in claudication I-A In claudication, use of clopidogrel (75 mg/day) as an effective alternative to aspirin IIb Optimized antiplatelet therapy is recommended for all patients with claudication and after endovascular or open surgical procedure I-A Improves patency of venous and artificial lower limb vascular grafts II-B In infrainguinal endovascular intervention for lower limb claudication, aspirin with clopidogrel for at least 30 days is suggested IIb Use of aspirin monotherapy (75-325 mg/day) or clopidogrel monotherapy in claudication (75 mg/day) reduces AMI, stroke and vascular death I-A In asymptomatic Lower extremity PAD, antiplatelet use is reasonable to prevent risk of AMI, stroke and vascular death IIa-C In asymptomatic borderline ABI Lower extremity PAD, the advantage of antiplatelets is uncertain to prevent risk of AMI, stroke and vascular death IIb-B The efficacy of dual antiplatelet therapy (aspirin + clopidogrel) in reducing risk of CV events in symptomatic Lower extremity PAD is not well established IIb-B Dual antiplatelet therapy (aspirin + clopidogrel) may be reasonable to reduce risk of lower limb events in symptomatic Lower extremity PAD following limb revascularization IIb-C In patients with symptomatic Lower extremity PAD, antiplatelet monotherapy is indicated I-A In all patients with revascularized Lower extremity PAD, antiplatelet monotherapy is indicated I-C In infrared revascularized Lower extremity PAD, antiplatelet monotherapy is indicated I-A In patients with Lower extremity PAD requiring antiplatelet agents, clopidogrel may be preferable to aspirin IIb-B Following infrainguinal endovascular intervention with stenting for lower limb claudication, aspirin + clopidogrel for at least 30 days is suggested IIa-C After prosthetic bypass graft in infrapopliteal PAD (below the knee), the use of aspirin + clopidogrel IIb-B Anticoagulants They reduce the risk of limb loss and increase graft patency, but double the risk of bleeding compared with antiplatelet agents B-C Suggests against warfarin use only to reduce risk of CV events or vascular occlusions I-C The usefulness of oral anticoagulants in maintaining patency of vascular grafts is uncertain IIb-B Anticoagulation should not be used to reduce risk of CV events in Lower extremity PAD III-A Vitamin K antagonist may be considered after revascularization with infra-inguinal autologous venous graft. IIb-B 848