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Peripheral Arterial Disease Undertreated Around the World: Presented at ACC

By Jill Stein

ORLANDO, FL -- March 8, 2005 -- Appropriate medications to treat cardiovascular risk in patients with peripheral arterial disease (PAD) are underused worldwide, according to data reported here on March 8^th at the 54^th Annual Scientific Session of the American College of Cardiology.

Deepak Bhatt, MD, director of interventional cardiology, Cleveland Clinic Foundation, Cleveland, Ohio, United States, and colleagues investigated the PAD population of the Reduction of Atherothrombosis for Continued Health (REACH) registry, looking for cardiovascular risk factors and their role in the development of subsequent atherothrombotic disease.

"Peripheral arterial disease is a serious manifestation of atherothrombosis that is underdetected and undertreated," Dr. Bhatt explained. "Because it is often asymptomatic, diagnosis may be missed in roughly two-thirds of patients."

Peripheral arterial disease is also a strong marker for other cardiovascular diseases, increasing the risk of death due to myocardial infarction or stroke by approximately six fold, and symptom severity has been shown to correlate with poor outcome, he added.

The REACH registry is one of the largest and most geographically inclusive global registries of patients with or at risk of atherothrombosis. The aim of the registry is to improve the assessment and management of atherothrombotic diseases and their associated risk factors.

Dr. Bhatt and colleagues studied 11,770 patients from 43 countries who were part of the REACH registry and had symptomatic PAD. The researchers identified baseline characteristics and treatments across several geographic regions, and determined presence of polyvascular disease.

The most common manifestation of PAD was an ankle brachial index of less than 0.9. Among the group of patients who had PAD, the mean age was 68 years, 36% were female, 48% were diabetic, 78% were hypertensive, 64% were hypercholesterolemic, 28% were current smokers, and 42% were former smokers.

Compared with the population who had coronary artery disease only and cerebrovascular disease only, the PAD only population had a higher percentage of patients with diabetes and current smokers, whereas hypercholesterolemia was highest in the group with coronary artery disease only.

In the global registry population, excluding patients with known diabetes, 40% had fasting hyperglycemia. Overall, 35% had a glucose level between 100 g/dL and 126 mg/dL; 5% had glucose levels of 126 mg/dL or greater. At baseline, 82% were receiving antiplatelet therapy, and 67% were receiving statins. This pattern was evident in all geographic areas.

A significant number of patients with PAD (71%) had symptomatic polyvascular disease. Compared to patients with coronary artery disease only and cerebrovascular disease only, patients with PAD only were less likely to take antihypertensives, antiplatelet therapies, nitrates, and lipid-lowering therapies.

Overall, the results show that patients with symptomatic PAD have multiple risk factors for atherothrombosis, including prediabetes and undiagnosed diabetes, and have a high frequency of polyvascular disease, Dr. Bhatt noted. The data also show that the appropriate medications to treat cardiovascular risk in PAD patients are underused throughout the world.

He added that follow-up outcome data at 12 and 21 months are expected from the REACH registry to improve the understanding of the risk factors leading to atherothrombosis.


[Presentation title: Risk Profile and Undertreatment of Peripheral Arterial Disease -- 11,770 Patients from the International REACH Registry. Abstract 1070-121]

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