Lower extremity peripheral artery disease (PAD) is underdiagnosed and undertreated in the United States, despite its high prevalence and clinical importance, the American Heart Association (AHA) says in a new scientific statement.
“There continues to be a glaring need to recognize and treat peripheral arterial disease in the United States,” Michael H. Criqui, MD, MPH, chair of the writing group, told theheart.org | Medscape Cardiology.
“While there has been increased awareness and better uptake of therapies over the years, PAD still lags well behind the other major atherosclerotic diseases — that is coronary heart disease and ischemic stroke,” said Criqui, from the University of California, San Diego.
“What has increasingly been recognized is that if an individual has blocked arteries in the legs, they’re also very likely to have blocked arteries in the heart and the brain. PAD is a very strong independent predictor of having heart attacks and strokes and so it deserves attention for that reason alone,” said Criqui.
Difficulty walking itself is also a problem that can affect health because people may slow down and lose conditioning, so helping patients improve their mobility is critical,” said Criqui.
“The first step is recognizing PAD and getting patients on the correct medications or other therapy,” he added.
The scientific statement was published online July 28 in Circulation.
Orchestrated Efforts
Lower extremity PAD is a global public health issue that has been systematically understudied and underappreciated by healthcare professionals and patients, the writing group says.
There are likely multiple reasons for this, they point out, including limited availability of the first-line diagnostic test, the ankle-brachial index (ABI), in clinics; incorrect perceptions that a leg vascular disease is not fatal; and the belief that the diagnosis of PAD would not necessarily change clinical practice.
However, there is now a growing body of evidence that these perceptions are wrong. Still, several studies have consistently shown that many patients with PAD do not receive evidence-based therapies, the writing group notes.
The scientific statement provides an update on contemporary epidemiology (prevalence, temporal trends, risk factors, and complications) of PAD, the current status of diagnosis (physiological tests and imaging modalities), and major gaps in PAD management (medications, exercise therapy and revascularization).
“Orchestrated efforts” among healthcare providers, researchers, expert organizations, and healthcare organizations will be needed to increase awareness and understanding of PAD and improve the diagnostic approaches, management, and prognosis of PAD, the writing group says.
In 2018, the US Preventive Services Task Force concluded that there is insufficient evidence to recommend screening for PAD among individuals without symptoms indicative of PAD as part of cardiovascular risk assessment, as reported by theheart.org | Medscape Cardiology.
The AHA currently recommends screening for PAD with ABI in adults at high risk; namely, those 65 years and older and those between 50 and 64 years with traditional risk factors.
This research had no commercial funding. Criqui has disclosed no relevant financial relationships.
Circulation. Published online July 28, 2021. Full text
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