pad_slides - PAD A Call to Action PAD: A Call to Action ­...

Info iconThis preview shows page 1. Sign up to view the full content.

View Full Document Right Arrow Icon
This is the end of the preview. Sign up to access the rest of the document.

Unformatted text preview: PAD A Call to Action PAD: A Call to Action ­ What is peripheral arterial disease (PAD)? and why is it so dangerous? ­ Diagnosing PAD in the primary care setting ­ The importance of aggressive risk management of PAD ­ Evidence base for protecting patients with PAD Major manifestations of Major manifestations of atherothrombosis include Cerebrovascular disease Coronary artery disease Renal artery stenosis Visceral arterial disease Peripheral arterial disease – Intermittent claudication – Critical limb ischemia Metabolic syndrome is more common in PAD than in CHD or stroke Cross-Sectional survey of 1,045 vascular disease patients 60 57% Prevalence of metabolic 40 syndrome in each patient group (%) 40% 43% 45% 20 0 CHD Olijhoek JK et al. Eur Heart J 2004; 25: 342-348. Stroke AAA AAA = Abdominal Aortic Aneurysm PAD Prevalence of PAD increases with Prevalence of PAD increases with age Rotterdam Study (ABI Test <0.9)1 San Diego Study (PAD by noninvasive tests)2 Patients with PAD (%) 60 50 40 30 20 10 0 55-59 60-64 65-69 70-74 75-79 Age group (y) Figure adapted from Creager M, ed. Management of Peripheral Arterial Disease. Medical, Surgical and Interventional Aspects. 2000. 1 Meijer WT et al. Arterioscler Thromb Vasc Biol 1998; 18: 185-192. 2.Criqui MH et al. Circulation 1985; 71: 510-515. 80-84 85-89 Mortality is very high in patients with Mortality is very high in patients with severe PAD Patients (%) Relative 5-year mortality 50 45 40 35 30 25 20 15 10 5 0 3 8 4 4 4 8 15 Breast cancer1 Colon/rectal cancer1 Severe PAD2 1. Criqui MH. Vasc Med 2001; 6 (suppl 1): 3–7. 2. McKenna M et al. Atherosclerosis 1991; 87: 119–28. 3. Ries LAG et al. (eds). SEER Cancer Statistics Review, 1973–1997. US: National Cancer Institute; 2000. Non-Hodgkin’s lymphoma3 There is a strong two­way association between decreased ABI and increased risk for cardiovascular death1 70 60 All-cause mortality Percent 50 CVD Mortality 40 30 20 10 0 ) ) 80 95 1 =9 = n= n= (n (n n= ( ( ( 0 0 0 10 .7 60 .8 90 1. . . 0 1. 0 -< < < -< <0 <0 0090 060 . 7 . 1. 8 0 0 0. 0. ) 25 ) 21 = (n ) 40 ) 30 1 Baseline ABI* Resnick HE et al. Circulation 2004; 109: 733-739. *Mean participant follow-up 8.3 years Guidance for PAD diagnosis Guidance for PAD diagnosis STEP 1 Assess patient for risk factors – smoking – diabetes – hypertension – age: men >55 years and women >65 years – hyperlipidaemia – history of cardiovascular disease Assess patient for leg symptoms – intermittent claudication – critical limb ischaemia Tools: PAD checklist, Rose questionnaire, Edinburgh questionnaire STEP 2 If suspicion of PAD, perform an ABI to confirm diagnosis using a hand­held Doppler Only 1 in 10 patients with PAD has Only 1 in 10 patients with PAD has classical symptoms of intermittent claudication 1 in 5 people over 65 † has PAD Only 1 in 10 of these patients has classical symptoms of intermittent claudication (IC) † ABI<0.9 Diehm C et al. Atherosclerosis 2004; 172; 95-105. The American Diabetes Association recommends screening for PAD in patients with diabetes A screening ABI should be performed in patients with diabetes A screening ABI should be performed in patients Those >50 years of age • If normal an exercise test should be carried out • The ABI test should be repeated every 5 years every • Those <50 years of age who Those have other risk factors associated with PAD associated • Smoking Smoking • Hypertension Hypertension • Hyperlipidaemia Hyperlipidaemia • Duration of diabetes >10 years >10 Foot care is also important in diabetic patients as PAD is a major contributor to diabetic foot problems 2 1. American Diabetes Association. Diabetes Care 2003; 26: 3333-3341. 2. Estes JM, Pomposelli FB Jr. Diabet Med 1996: 13: S43- S57. Risk factor management approach Risk factor management approach Smoking cessation Weight reduction Total cholesterol <175 mg/dL / <4.5 mmol/L LDL cholesterol <100 mg/dL / <2.6 mmol/L Glycosylated haemoglobin <7.0% Blood pressure (BP) <140/90 mm Hg – For patients with diabetes BP < 130/80mm Hg Platelet inhibition Hiatt WR. N Engl J Med 2001; 344: 1608-1621. Key learning points Key learning points REMEMBER Only 1 in 10 patients with PAD have typical PAD claudication1 claudication Patients with diabetes are Patients at high risk of PAD at It is important to improve It the management of PAD to the protect patients from an protect increased risk of ischaemic events events 1. Diehm C et al. Atherosclerosis 2004; 172: 95-105. ACTION Ensure aggressive and early Ensure risk management of patients who are at high risk but may be asymptomatic be Screen patients with diabetes Screen >50 years of age, and those <50 years of age who have additional risk factors associated with PAD associated Overall learning points Overall learning points PAD is a reliable warning sign that a patient is at high PAD risk for life threatening cardiovascular and cerebrovascular events cerebrovascular PAD is easily overlooked by both patients and PAD physicians – assess whether patients presenting with symptoms or associated risk factors have PAD symptoms Treatments are available to protect the patients with Treatments PAD from future MI or stroke PAD Help protect patients with PAD from their increased risk of MI or stroke ...
View Full Document

This note was uploaded on 12/24/2011 for the course STEP 1 taught by Professor Dr.aslam during the Fall '11 term at Montgomery College.

Ask a homework question - tutors are online