Risk factor modification in intermittent claudication: effect on life expectancy and walking capacity

Peripheral arterial disease (PAD) is among the common manifestations of systemic atherosclerosis. In the U.S.A. it is estimated that this disorder affects 8–10 million adults, with resultant increased risk for cardiovascular morbidity and mortality. Thus, 50% of patients with PAD will have a fatal or non-fatal cardiovascular event within 5 years. The initial treatment goal in patients with PAD is to identify their risk factors for atherosclerosis and then to initiate risk factor modification. These patients should all be placed on antiplatelet therapy as well. However, these interventions typically do not result in an immediate change in the symptoms of PAD, mainly intermittent claudication, and additional interventions are necessary to treat this disabling symptom. These include a formal exercise programme; with regard to pharmacological therapies cilostizol is available in the U.S.A., and several medications that are effective including propionyl-l- carnitine are available in Europe.