The American Heart Association (AHA) has released a new scientific statement on lower extremity peripheral arterial disease (PAD), focusing on contemporary epidemiology, management gaps, and future directions.
The statement, authored by Michael H. Criqui, MD, a distinguished professor in the division of preventive medicine at the University of California, San Diego, and colleagues including Caitlin W. Hicks, MD, an assistant professor of vascular surgery at John Hopkins Medicine in Baltimore, has been published in Circulation.
Lower extremity PAD affects more than 230 million adults worldwide, the authors detail, adding that the condition is associated with an increased risk of various adverse clinical outcomes, including cardiovascular diseases such as coronary heart disease and stroke, and leg outcomes such as amputation.
Despite its prevalence and clinical importance, however, Criqui et al highlight a multifactorial under-appreciation of PAD by healthcare professionals and patients, combining limited availability of the first-line diagnostic test—the ankle-brachial index—in clinics, and incorrect perceptions that a leg vascular disease is not fatal and that the diagnosis of PAD would not necessarily change clinical practice. In addition, the authors relay that many patients with PAD are not receiving evidence-based therapies.
The AHA statement is designed to address these issues by providing an update for healthcare professionals regarding contemporary epidemiology (i.e., prevalence, temporal trends, risk factors, and complications) of PAD, the current status of diagnosis (physiological tests and imaging modalities), and describing major gaps in the management of PAD (i.e., medications, exercise therapy, and revascularization), Criqui and colleagues write.
In concluding their statement, the authors look to the future: “Orchestrated efforts among different parties (e.g., healthcare providers, researchers, expert organizations, and healthcare organizations) will be needed to increase the awareness and understanding of PAD and improve diagnostic approaches, management, and prognosis of PAD.”