Do all patients with PVD need medication? 

Yes, the vast majority of patients with Peripheral Vascular Disease (PVD) require medication to manage their long-term health and reduce the risk of life-threatening events. Even if a patient has no symptoms, PVD is a clinical marker of systemic atherosclerosis, meaning the arteries in the heart and brain are also likely to be affected. In the UK, NICE guidelines recommend that almost all PVD patients be prescribed ‘Best Medical Therapy’, which typically includes a high-dose statin and an antiplatelet drug to stabilise plaque and prevent blood clots. 

Peripheral Vascular Disease (PVD) is a chronic condition that signifies a high cardiovascular risk profile. While lifestyle changes such as exercise and smoking cessation are essential, they are rarely sufficient on their own to address the underlying arterial damage. This article provides a clinical overview of why medication is a mandatory component of PVD care in 2025, the specific drug classes used, and how these treatments protect both your limbs and your life. 

What We’ll Discuss in This Article 

• The clinical reasoning behind Best Medical Therapy (BMT). 

• Why statins are prescribed regardless of your cholesterol level. 

• The role of antiplatelets in preventing ‘major adverse events’. 

• Managing comorbidities like hypertension and diabetes in PVD. 

• Medications specifically used to improve claudication distance. 

• Triggers for starting or adjusting vascular medications. 

• Differentiation between symptom-relief and risk-reduction drugs. 

The rationale for ‘Best Medical Therapy’ 

In the UK, when a patient is diagnosed with PVD, they are immediately placed on what clinicians call Best Medical Therapy (BMT). This is not just about treating the legs; it is about secondary prevention. Statistics show that patients with PVD are much more likely to die from a heart attack or stroke than from a limb-related issue. Medication is the primary tool used to lower this systemic risk. 

Nearly all PVD patients need medication because the condition indicates a high risk of heart attack and stroke. UK clinical standards require ‘Best Medical Therapy’, consisting of high-intensity statins to stabilise arterial plaque and antiplatelet medications to prevent clots. These drugs are necessary even for patients without leg pain, as they address the systemic nature of atherosclerosis across the entire body. 

Even if your cholesterol levels are within a ‘normal’ range, you will likely still be prescribed a statin. This is because statins have ‘pleiotropic effects’ they reduce inflammation within the artery walls and make the fatty plaques less likely to rupture. Ruptured plaque is what causes sudden blockages leading to heart attacks or acute limb ischaemia. 

Primary medications: Statins and Antiplatelets 

The two pillars of PVD medication are statins and antiplatelets. Statins, such as Atorvastatin, work by lowering LDL (bad) cholesterol and halting the progression of plaque. Antiplatelets, such as Clopidogrel or Aspirin, keep the blood ‘slippery’ and prevent platelets from sticking together to form a clot at the site of a narrowing. 

The primary medications for PVD are statins and antiplatelets. In the UK, Clopidogrel (75mg) is the first-line antiplatelet choice for PVD, as it has been shown to be more effective than Aspirin in this specific patient group. High-intensity statins, typically Atorvastatin (80mg), are used to lower cardiovascular mortality and are a non-negotiable part of the 2025 clinical pathway. 

Drug Class	Common Example	Primary Clinical Purpose
Statins	Atorvastatin, Rosuvastatin	Plaque stabilisation and LDL reduction.
Antiplatelets	Clopidogrel, Aspirin	Preventing blood clots and strokes.
ACE Inhibitors	Ramipril	Lowering blood pressure and protecting the heart.
Vasoactive Drugs	Naftidrofuryl oxalate	Improving walking distance (selected cases).

Managing underlying causes and triggers 

Medication is also used to treat the triggers that make PVD worse. If a patient has high blood pressure (hypertension) or diabetes, these conditions must be managed aggressively. High blood pressure puts mechanical stress on the arteries, while high blood sugar causes chemical damage to the vessel lining. 

Treating the causes of PVD, such as hypertension and diabetes, is a critical part of the medication plan. Blood pressure is typically targeted at below 140/90 mmHg (or 130/80 mmHg for diabetics) using ACE inhibitors. For diabetic patients, maintaining a target HbA1c is essential to prevent microvascular damage that can lead to non-healing foot ulcers and potential amputation. 

Failure to take these medications acts as a trigger for disease progression. Patients who are ‘non-adherent’ to their statin or blood pressure therapy are statistically more likely to move from stable claudication to critical limb ischaemia. Therefore, medication is not just a ‘support’ it is a preventative barrier against the most severe outcomes of the disease. 

Differentiation: Risk-Reduction versus Symptom-Relief 

It is vital for patients to differentiate between the medications that keep them safe and the ones that make them feel better. Most PVD drugs are for risk reduction and do not actually stop the leg pain. 

There is a clear difference between risk-reduction drugs (statins/antiplatelets) and symptom-relief drugs. Risk-reduction medications are mandatory for everyone to prevent death from heart attack or stroke. Symptom-relief drugs, like Naftidrofuryl, are optional and only used if supervised exercise hasn’t improved walking distance. Taking a statin won’t make your leg stop hurting, but it might save your life. 

Feature	Risk-Reduction Drugs (e.g. Statins)	Symptom-Relief Drugs (e.g. Naftidrofuryl)
Mandatory?	Yes, for almost all patients	No, only for selected symptomatic cases
Direct Pain Relief?	No	Yes (may improve walking distance)
Life-Saving?	Yes	No
Goal	Prevent heart attack, stroke, death	Improve quality of life/walking distance

Conclusion 

Almost all patients with PVD require a long-term medication plan involving statins and antiplatelet drugs. While these medications may not provide immediate relief for leg pain, they are essential for stabilising arterial plaque and preventing the life-threatening complications associated with atherosclerosis. Effective treatment also involves managing blood pressure and blood sugar to stop the disease from progressing. If you experience severe, sudden, or worsening symptoms, call 999 immediately. 

Authority Snapshot 

This article was written by Dr. Rebecca Fernandez, a UK-trained physician with an MBBS and experience in general surgery, cardiology, internal medicine, gynecology, intensive care, and emergency medicine. She has managed critically ill patients, stabilised acute trauma cases, and provided comprehensive inpatient and outpatient care. In psychiatry, Dr. Fernandez has worked with psychotic, mood, anxiety, and substance use disorders, applying evidence-based approaches such as CBT, ACT, and mindfulness-based therapies. Her skills span patient assessment, treatment planning, and the integration of digital health solutions to support mental well-being. This review was conducted by Doctor Stefan to ensure alignment with the MyPatientAdvice 2026 content framework and UK clinical safety standards.