Cardiovascular Prevention in Peripheral Artery Disease

Study Questions:

What are the trends in medical therapy and lifestyle counseling for patients with peripheral artery disease (PAD) in the United States (US) between 2005 and 2012?

Methods:

Using data from the National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey, the authors evaluated trends in the proportion of office visits with medication use and lifestyle counseling among patients with diagnosed PAD. Medication used was defined to include antiplatelet therapy, statins, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin-receptor blockers (ARB), or cilostazol. Lifestyle counseling was defined as exercise or diet counseling and smoking cessation.

Results:

Over the 8-year study period, the average number of ambulatory visits in the United States was 3,883,665 with a mean age of 69.2 years. Comorbid coronary artery disease (CAD) was present in 24.3% of visits. Medication use was low: any antiplatelet therapy in 35.7% (SE 2.7%), statin use in 33.1% (SE 2.4%), ACEI or ARB in 28.4% (SE 2.0%), and cilostazol in 4.7% (SE 1.0%) of visits. Exercise or diet counseling was used in 22% (SE 2.3%) of visits. Smoking cessation counseling or medication use occurred in 35.8% (SE 4.6%) of visits for current smokers. Patients with comorbid CAD were more likely to be prescribed antiplatelet therapy (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.8-3.9), statins (OR, 2.6; 95% CI, 1.8-3.9), ACEI/ARB (OR, 2.6; 95% CI, 1.8-3.9), and smoking cessation counseling (OR, 4.4; 95% CI, 2.0-9.6).

Conclusions:

The authors concluded that the use of guideline-recommended therapies in patients with PAD was much lower than expected.

Perspective:

Patients with PAD are at increased risk for cardiovascular events, including myocardial infarction and stroke (Circ Res 2015;111:1509-26). Therefore, PAD guidelines strongly recommend the use of cardiovascular-protective medications, such as antiplatelet medications, statins, and anti-hypertensives (e.g., ACEIs and ARBs) as well as tobacco cessation when applicable (J Am Coll Cardiol 2017;69:1465-508). Similarly, exercise has been shown to improve PAD symptoms as well as improve cardiovascular event risk. The low rates of medication use and lifestyle modification recommendations are a call to action for all clinicians who care for patients with PAD. We must do better to help prevent significant morbidity and mortality for the estimated 200 million patients with PAD globally.

Clinical Topics: Dyslipidemia, Prevention, Vascular Medicine, Nonstatins, Novel Agents, Statins, Diet

Keywords: Ambulatory Care, Angiotensin Receptor Antagonists, Angiotensin-Converting Enzyme Inhibitors, Antihypertensive Agents, Comorbidity, Coronary Artery Disease, Counseling, Diet, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Life Style, Myocardial Infarction, Peripheral Arterial Disease, Platelet Aggregation Inhibitors, Primary Prevention, Smoking Cessation, Stroke, Vascular Diseases


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