The burden of PAD: Diagnosis and contemporary medical management through risk-factor modification

Introduction: Peripheral arterial disease (PAD) of the lower extremity is primarily the clinical manifestation of systemic atherosclerosis and atherothrombosis. Hence there is a strong correlation between PAD and atherosclerotic disease in other vascular beds and consequently an increased risk of cardiovascular and cerebrovascular morbidity and mortality. Prevalence: Up to twelve million adults are estimated to have PAD in the US and the prevalence is set to rise with the aging population. Atherosclerosis is the major pathologic process in PAD development, and modifiable atherosclerotic risk factors include cigarette smoking, diabetes mellitus, dyslipidemia, and hypertension. Diagnosis: The early identification of this at risk population, especially asymptomatic patients with PAD, may be facilitated by the use of the simple and noninvasive ankle-brachial index (ABI) test. Management: The management of patients with PAD involves cardiovascular risk reduction via atherosclerotic risk factor modification strategies and treatment of claudication symptoms to improve ambulatory activity and quality of life. Cardiovascular risk modification includes implementation of exercise and smoking cessation programs, aggressive control of diabetes, hypertension and hyperlipidemia, and the use of antiplatelet agents, aspirin or clopidogrel, to prevent secondary ischemic events. Recommended therapies for claudication symptoms include cilostazol and pentoxifylline as an alternative. For severe claudication symptoms limiting functional ability, endovascular or surgical revascularization is recommended. Conclusion: Despite current guidelines, the management of PAD remains suboptimal. Increasing physician awareness and adherence to guideline recommendations may reduce the high rate of cardiovascular morbidity and mortality associated with PAD.