By Kym McNicholas, CEO of Global PAD Association
I've spent years telling the stories of peripheral artery disease patients who struggle to walk even short distances without leg pain—patients who can't shop for groceries, visit their grandchildren, or maintain their independence because of this debilitating disease. But now there may be hope on the horizon with the unveiling of the STRIDE Trial results at the American College of Cardiology conference just days ago. This breakthrough could fundamentally change how we treat diabetic patients with peripheral artery disease, poor circulation in mainly the legs. Left untreated PAD can lead to heart attack, stroke, and amputation.
A Long-Awaited Breakthrough
We’ve heard for awhile now that the semaglutide drugs (Ozempic®, WeGovy®, and Rybelsus®) have been game changers in helping patients to lower their blood sugar and lose weight. Researchers have now learned there’s an added bonus that may improve the prognosis for diabetics suffering from PAD, which is blocked arteries in mainly the legs. It may improve their walking distance without pain.
Why is this important?
One in three diabetics over age 50 has PAD. It causes debilitating leg cramps that stop patients suddenly in their tracks, and in late stages, serves up Charlie Horses that wake them out of a sound sleep. Even more, for patients with diabetes, the blocked arteries present mainly in the calf and foot, which are tough to treat because they’re smaller and more fragile. So they don’t tend to stay clear and open for long, leading to a revolving door of so-called roto-rooting procedures to keep opening them up, each one leading the patient closer to amputation. With amputation comes a significantly higher mortality rate. A major leg amputation and a patient could be dead in less than 18 months.
I think about Derrick, a 56-year-old man with Type 2 diabetes whose story I've shared often. For two years, Derrick, a type 2 diabetic, was losing his toes one by one. The doctors kept telling him amputation was his only option to relieve the wretched leg and foot pain and resolve non-healing wounds on his toes, attributing his circulation issues solely to diabetes.
"I was being amputated toe by toe by toe for two years before I found Dr. M and the amputations finally stopped," Derrick told me, his voice mixing relief with lingering disbelief. It wasn't until his wife Toni researched online that they discovered his condition had a name: peripheral artery disease. When the vascular surgeon suggested taking half of Derrick's leg next, Toni packed their car and drove him to see a limb salvage specialist—a decision that likely saved his leg and possibly his life.
Or Linda, who called our Leg Saver Hotline when the pain from her blocked arteries got so bad she cracked a tooth from clenching her jaw while trying to walk her grandchild to school one morning. After proper treatment, she called with an update: "I can finally sleep at night and actually took my son to Disney World for miles of walking around the park."
These stories highlight why the STRIDE results are so exciting.
The potential that a drug that could help improve the length and quality of life for these patients is extraordinary!
The Breakthrough STRIDE Trial
For the first time in over two decades, we have a new medication treatment approach for helping these diabetic patients with poor circulation. The STRIDE Trial, led by Dr. Marc Bonaca, showed that semaglutide (Ozempic®, WeGovy®, Rybelsus®) improved maximum walking distance by approximately 40 meters compared to placebo. For someone who could barely walk from their living room to their kitchen before, this improvement means regaining their life.
The surprising part was that Dr. Bonaca’s team found that patients' improved walking ability didn't strongly correlate with how much weight they lost. In other words, patients who lost more weight didn't necessarily experience greater improvement in their PAD symptoms compared to those who lost less weight. This suggests semaglutide appears to be working through other mechanisms, possibly by directly reducing inflammation in the arteries themselves. Researchers also believe these drugs may help improve a patient’s walking ability by simply lowering a patient’s A1C. High blood sugar makes blood thick and syrupy. Extra sugar molecules in the blood also have the potential to damage artery walls leading to plaque build-up.
All of these combined, researchers say led to eye-opening 54% reduction in the risk of PAD progression, surgical intervention, major adverse limb events, or death.
Wow, just thinking of the potential if semaglutide may actually slow disease progression and reduce the need for invasive procedures or amputations.
Just maybe, there might be a greater incentive for primary care doctors to diagnose sooner and insurance companies to support to cover early diagnostics for patients at great risk of PAD, especially diabetics.
A Silent Epidemic - A New Hope For Early Detection
What's shocking is that despite affecting 230 million people globally, PAD remains largely unknown to the public. A recent national survey revealed that 70% of Americans have never heard of PAD—one of the leading causes of amputation with 400 amputations performed each day in the United States. Even more concerning, nearly 80% of Black and Hispanic adults report never having a doctor or healthcare provider discuss PAD with them, despite being at higher risk.
One of the most persistent challenges in PAD, that with it being lesser known with fewer medication options to treat sooner, has been late diagnosis. By the time many patients learn they have PAD, they're facing advanced disease with limited treatment options. Sometimes, it's too late to prevent amputation. With a medication showing specific benefits for PAD symptoms and possibly slowing disease progression, there's now a stronger case for early screening and diagnosis.
Many doctors still attribute leg pain in diabetic patients to neuropathy without checking for vascular issues. I can't help but think that with GLP-1 drugs like semaglutide now being so widely discussed for weight loss and diabetes management, adding PAD symptom improvement to their list of benefits might finally bring this "silent killer" the attention it deserves. If pharmaceutical companies were to include improved walking distance in their ubiquitous commercials, millions of Americans might finally learn about PAD and ask their doctors about proper testing.
Breaking the Intervention Cycle
The timing of these findings couldn't be more perfect. There's growing scrutiny over early interventions for PAD, particularly when patients haven't first tried supervised exercise therapy—what we often call "walking as medicine"—which should be the frontline treatment. Walking helps patients grow their own natural bypasses through collateral circulation.
The problem? Many patients simply can't walk enough to benefit because of debilitating pain. This is where semaglutide could be transformative—by reducing pain and improving walking ability, it could help patients actually engage in the exercise therapy they need without rushing to invasive procedures.
And let's be honest about those procedures—they aren't always durable. Stents can close, bypasses can fail. But if we can help patients walk more comfortably first, we might delay or even prevent the need for interventional procedures altogether. For vascular specialists who truly put patients first, having a medication option that bridges the gap between diagnosis and intervention represents a significant advance in the treatment pathway.
Real-World Considerations
But let's be realistic about the challenges:
Side Effects and Tolerability
Like all medications, semaglutide comes with potential side effects. The most common include nausea, vomiting, diarrhea, and abdominal pain. While these symptoms often improve over time, they can be difficult to tolerate for some patients. More serious but rare side effects can include pancreatitis, gallbladder problems, and retinopathy complications.
Cost and Access Challenges
Semaglutide medications like Ozempic® and Wegovy® are expensive, with monthly costs potentially exceeding $1,000 without insurance coverage. Even with insurance, copays can be substantial.
Supply challenges have also plagued these medications due to their popularity for weight loss. Many patients with diabetes have struggled to fill their prescriptions. This raises questions about availability for PAD patients if guidelines eventually recommend their use for this condition.
Questions to Ask Your Doctor
If you have PAD and type 2 diabetes and are interested in whether semaglutide might help your symptoms, consider asking your doctor:
1. Based on my PAD severity, would semaglutide potentially benefit me?
2. How would we measure improvement in my walking ability?
3. Given my medical history, what side effects should I watch for?
4. Will my insurance cover this medication for PAD symptoms?
5. Are there any clinical trials studying GLP-1 receptor agonists for PAD that I might qualify for?
Looking Forward
The STRIDE Trial represents an important first step, but many questions remain. Could semaglutide benefit non-diabetic PAD patients? Might other GLP-1 receptor agonists show similar benefits? How does the treatment compare to exercise therapy or revascularization?
For those interested in diving deeper into the STRIDE trial—including what triggered researchers' interest, the challenges they faced enrolling patients, and the broader implications of the study—our interview with lead investigator Dr. Marc Bonaca on The Heart of Innovation provides valuable insights. Dr. Bonaca joins myself and Interventional Cardiologist Dr. John Phillips to explore this groundbreaking research.
After years of limited progress in medication options for PAD, the STRIDE results offer real hope. For patients who've long been told there's little that can be done for their symptoms beyond risk factor management and invasive procedures, that matters more than you can imagine.
For more information on Peripheral Artery Disease, go to the Global PAD Association’s website, PADhelp.org or call the Leg Saver Hotline at 1(833) PAD-LEGS.
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