What is the diagnosis for a 46-year-old male presenting with sudden onset numbness in the right foot for 1 week, with Ankle-Brachial Index (ABI) values of 0.82 on the right and 0.88 on the left, and Computed Tomography Angiography (CTA) showing mild aortoiliac atherosclerosis, who has a history of Hypertension (HTN) and smokes 0.75 packs per day?

From the Guidelines

This patient's presentation suggests peripheral arterial disease (PAD) with mild to moderate disease based on the ankle-brachial index (ABI) values of 0.82 on the right and 0.88 on the left, and I strongly recommend initiating antiplatelet therapy with aspirin 81mg daily and cilostazol 100mg twice daily to improve symptoms and walking distance, as supported by the 2024 guidelines 1. The patient's symptoms of sudden onset numbness in the right foot, along with the reduced ABI values, are consistent with PAD, which is a common cardiovascular disease associated with increased risk of amputation, myocardial infarction, stroke, and death, as well as impaired quality of life, walking performance, and functional status 1. Key aspects of management include:

• Initiating antiplatelet therapy with aspirin 81mg daily and cilostazol 100mg twice daily to improve symptoms and walking distance
• Supervised exercise program consisting of 30-45 minutes of walking 3-5 times weekly, stopping when moderate pain occurs, then resuming after pain subsides
• Smoking cessation, which is critical, and the patient should be prescribed varenicline starting at 0.5mg daily for 3 days, then 0.5mg twice daily for 4 days, followed by 1mg twice daily for 12 weeks, along with behavioral counseling, as recommended by the 2024 ESC guidelines 1
• Blood pressure management, aiming for targets towards 120–129 mmHg, if tolerated, as recommended by the 2024 ESC guidelines 1
• A statin (atorvastatin 40-80mg daily) should be started regardless of lipid levels to reduce cardiovascular risk, with an ultimate LDL-C goal of <1.4 mmol/L (55 mg/dL) and a >50% reduction in LDL-C vs. baseline, as recommended by the 2024 ESC guidelines 1 The patient's foot numbness is likely due to ischemic neuropathy from compromised blood flow, as supported by the reduced ABI values, and the mild atherosclerosis seen on CTA and history of smoking are significant contributing factors to his PAD. Close follow-up in 4-6 weeks is recommended to assess symptom improvement and medication tolerance.

From the Research

Patient Presentation

The patient is a 46-year-old male presenting with sudden onset numbness in his right foot for 1 week, with no skin changes, swelling, or injury to the foot. His Ankle-Brachial Index (ABI) values are 0.82 on the right and 0.88 on the left, indicating some level of peripheral artery disease. A Computed Tomography Angiography (CTA) showed mild aortoiliac atherosclerosis. The patient has a history of hypertension (HTN) and smokes 0.75 packs of cigarettes per day.

Relevant Studies

• The use of aspirin for primary prevention of atherosclerotic cardiovascular disease (ASCVD) has been studied extensively. A meta-regression analysis published in 2020 2 found that aspirin was associated with a reduction in ASCVD events, but this benefit was offset by an increased risk of major bleeding.
• Another study published in 2025 3 found that aspirin may be beneficial for primary prevention of ASCVD in individuals with elevated lipoprotein(a) levels, with a reduction in risk of coronary heart disease events and ASCVD mortality.
• A review published in 2022 4 proposed a platelet-guided approach to the use of aspirin for primary prevention of cardiovascular disease, suggesting that individuals with hyperreactive platelets may benefit most from aspirin therapy.
• A systematic review published in 2016 5 found that aspirin, blood pressure-lowering therapy, and statins were all effective for primary prevention of ASCVD, while tobacco cessation drugs were effective for smoking cessation.
• An observational study published in 2013 6 found that the combined use of aspirin, a statin, and blood pressure-lowering agents was associated with a lower risk of vascular morbidity and mortality in patients with coronary artery disease.

Potential Treatment Options

• Aspirin therapy may be considered for primary prevention of ASCVD, particularly in individuals with elevated lipoprotein(a) levels or hyperreactive platelets.
• Blood pressure-lowering therapy and statins may also be effective for primary prevention of ASCVD.
• Tobacco cessation is crucial for reducing the risk of ASCVD, and tobacco cessation drugs may be effective for smoking cessation.
• The use of a polypill combining aspirin, a statin, and blood pressure-lowering agents may be considered for patients with established coronary artery disease.