Key result
Aggressive risk modification linked to improved walking distance in claudicants, with ~17% ischemic events.
Why the study?
Peripheral arterial disease is underdiagnosed and undertreated despite high vascular morbidity and mortality, and secondary prevention does not meet standards of care for ischemic heart disease.
Does aggressive risk modification improve walking distance and reduce vascular events in patients with peripheral arterial disease?
Observational (n=200)
Does aggressive risk modification improve walking distance and reduce vascular events in patients with peripheral arterial disease?
p-value: p=0.001
Aggressive risk modification in patients with peripheral arterial disease is associated with significant improvements in walking distance and high rates of achieving secondary prevention targets.
Supports risk modification clinics to improve walking distance in claudicants; leaves open effects on ischemic events without randomized confirmation.
Peripheral arterial disease (PAD) is underdiagnosed and undertreated. This is despite the high vascular morbidity and mortality rates associated with PAD. There is also evidence that quitting smoking, improving the lipid profile, lowering the blood pressure, and administering antiplatelet drugs reduce the risk of vascular events in these patients. Secondary prevention for patients with PAD is yet to meet the standard of care for those with ischemic heart disease. The authors surveyed 200 claudicants attending a vascular clinic with additional follow-up in a risk modification clinic. After a median follow-up of 28 months (range: 6-65) there was a significant (p = 0.001) improvement in walking distance; 34 patients (17%) had a vascular ischemic event. Of those, 11 patients (5.5%) had worsening intermittent claudication and 9 had a stroke/transient ischemic attack; 9 events (4.5%) were fatal. The lipid targets were met in 76% the patients. Half the smokers quit smoking and 94% of the patients were taking antiplatelet drugs or anticoagulants. Blood pressure reached the accepted target in 87% of the patients. Secondary prevention in patients with PAD may reduce the risk of vascular events. Aggressive risk modification is therefore recommended.
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Youssef et al. (2005) conducted an observational in Peripheral Arterial Disease (n=200). Risk modification clinic follow-up was evaluated on Walking distance (p=0.001). Risk modification clinic follow-up in 200 claudicants was associated with a significant improvement in walking distance (p=0.001), with 17% experiencing a vascular ischemic event over 28 months.
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