Peripheral artery disease of the lower extremities affects more than one in 10 people aged over 55 years.1 2 Half of those affected present with leg symptoms that limit physical activity and impair quality of life.1 The most feared complication is loss of limbs, but only 1-3% of those presenting with intermittent claudication progress to amputation over five years.3 Myocardial infarction and stroke resulting from progressive atherogenesis in other vascular beds are far more common—15% to 30% of people presenting with peripheral artery disease die within five years, mainly from cardiovascular causes.4

In the linked meta-analysis (doi:10.1136/bmj.b603), De Backer and colleagues assess the effects of the orally active vasodilator naftidrofuryl on pain-free walking distance in patients with intermittent claudication.5

The most important goal of medical treatment in patients with peripheral artery disease of the lower extremities is the prevention of systemic cardiovascular complications.6 Many treatments that prevent myocardial infarction and stroke also improve leg symptoms (table⇓), but specific treatments for intermittent claudication have been …