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Secondary Prevention in Peripheral Arterial Disease Patients Needs Improvement: Presented at ACC
By Jill Stein
ATLANTA, GA -- March 19, 2002 -- Patients with severe peripheral arterial disease (PAD) who undergo surgical revascularization are less likely to have a lipid profile performed or to undergo treatment with aspirin than are patients with coronary artery disease (CAD) undergoing revascularization. They also have a lower chance of succeeding with smoking cessation attempts.
These findings were reported at the 51st Annual Scientific Session of the American College of Cardiology (ACC) by Dr. Pavel Levy, of Wake-Forest University School of Medicine, in Winston-Salem, North Carolina. Dr. Levy and colleagues conducted a retrospective, case-control study to determine whether PAD patients are less likely to be adequately managed for secondary prevention than CAD patients.
The trial included 360 patients who underwent their first surgical revascularization for either CAD or PAD at their institution between 1994 and 1999. Patients were randomized by the type of revascularization (either coronary artery bypass graft surgery [CABG; n=180] or lower extremity revascularization [n=180]) and by the year of surgery.
All the abstracted data were available prior to the index operation and included cardiovascular risk factors, fasting lipid profiles, and current medications.
Patients with PAD had lower use of aspirin (0R=0.4, p=0.001). Lipid abnormalities were evaluated in only six percent of the PAD sample compared to 71 percent of the CABG group. As well, in PAD patients, both aspirin and lipid-lowering therapies were strongly associated with a prior history of CAD.
Dr. Levy said that inequalities in the medical management of patients with severe PAD compared to patients with CAD reflect the lack of standardized clinical management guidelines and lower awareness regarding secondary prevention of PAD. This, in turn, may at least partially explain the observed previously high cardiovascular morbidity and mortality in PAD patients.
Peripheral arterial disease is among the major manifestations of atherosclerotic cardiovascular disease, and approximately 30 percent of patients with cardiovascular disease may have PAD only. Between eight and 12 million Americans are presumed to have PAD, and as the population ages, the incidence of PAD is expected to increase.
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