What we manage, and the treatment the guidelines direct
Reopening an artery is half the work. These are the treatments the American College of Cardiology and American Heart Association guidelines direct for each risk factor, and we prescribe or coordinate every one of them.
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Nicotine and tobacco use. Stopping is a Class 1 recommendation, the strongest the guidelines issue. What works is medication combined with counseling rather than either alone: varenicline, bupropion, or nicotine replacement, together with structured support. We prescribe, and the free national quitline is described below.
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Marijuana use. No guideline sets a drug treatment for cannabis, and we will not invent one. What we do is ask, tell you what the observational evidence shows about heart attack and stroke, advise stopping, and make sure the anesthesia team knows before any procedure, because regular use changes sedation requirements.
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High blood pressure. The 2025 guideline sets a treatment target below 130/80 for most adults. Lifestyle change comes first and continues alongside medication: weight loss, the DASH eating pattern, less sodium, less alcohol, and more activity. First-line medicines are a thiazide diuretic, an ACE inhibitor or ARB, or a long-acting dihydropyridine calcium channel blocker, chosen without regard to race. Stage 2 is started on two medicines in a single pill. In peripheral artery disease specifically, blood-pressure treatment carries a Class 1 recommendation with the same target.
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High cholesterol. For peripheral artery disease the 2024 guideline recommends a high-intensity statin aiming to cut LDL cholesterol by at least half, at Class 1 with the highest level of evidence. If the LDL stays at 70 or above on the highest statin dose you tolerate, adding ezetimibe, a PCSK9 inhibitor, or both is reasonable.
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Type 2 diabetes. Glycemic control is managed with the physician who prescribes it, and we tell them what we see in the small arteries of your foot, because that finding changes how tightly control needs to be held. For patients who have both peripheral artery disease and type 2 diabetes, the guideline directs the use of a GLP-1 agonist such as liraglutide or semaglutide, or an SGLT2 inhibitor, because those two classes reduce cardiovascular events beyond their effect on blood sugar.
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Chronic kidney disease. We plan around reduced kidney function from the start, using contrast-sparing technique and carbon dioxide angiography so the procedure itself does not cost you kidney function, and we coordinate with your kidney physician. Kidney-protective care →
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Antiplatelet and antithrombotic therapy. Generally a single antiplatelet medicine. For peripheral artery disease without high bleeding risk, the guideline supports low-dose rivaroxaban twice daily combined with low-dose aspirin to reduce both cardiovascular and limb events. The choice is individualized to what was treated and to your bleeding risk. Medical therapy →
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Walking and activity. Structured walking is treatment in its own right for claudication, within the limits your symptoms allow, and it improves both circulation and how far you can walk.
Sources: 2024 ACC/AHA multisociety guideline for lower extremity peripheral artery disease (doi:10.1161/CIR.0000000000001251); 2025 ACC/AHA guideline for high blood pressure in adults (ACC summary). This page describes how care is managed and is not a substitute for your own physician’s judgment about your medicines.
Tobacco and nicotine: the highest-yield change
Nothing damages your arteries, or undoes the benefit of treatment, faster than tobacco and nicotine. Quitting is the single most powerful step you can take for your legs, your heart, and your life, and it protects every procedure we perform.
Why we treat this as part of your care
Nicotine accelerates plaque, constricts blood vessels, slows wound healing, and raises the risk that a treated artery narrows again. Addressing it isn’t a lecture — it’s part of the treatment plan, because it changes how well everything else works. See the Nicotine & Your Arteries overview.
How we help you quit
Willpower alone is rarely the whole answer — and you have more options than most people realize. Two kinds of help, often combined, work better than either alone:
Counseling & support
Brief counseling, structured programs, quit lines, and text-message support all improve your odds — and they work best paired with medication.
Medications that make it easier
Options include over-the-counter nicotine replacement (patch, gum, lozenge, and more) and prescription medicines that reduce cravings. We’ll talk through what fits you and coordinate with your primary care physician when a prescription is right.
Even after years of smoking, quitting begins to help your circulation quickly.
Free help, any time
The national quitline — 1-800-QUIT-NOW (1-800-784-8669) — offers free, confidential coaching. We’ll also help connect you with support and, when appropriate, medication.