Screening for PAD and CVD Risk With ABI: USPSTF Recommendation

Authors:
US Preventive Services Task Force.
Citation:
Screening for Peripheral Artery Disease and Cardiovascular Disease Risk Assessment With the Ankle-Brachial Index: US Preventive Services Task Force Recommendation Statement. JAMA 2018;320:177-183.

The following are points to remember from this US Preventive Services Task Force (USPSTF) Recommendation Statement about screening for peripheral artery disease (PAD) and cardiovascular disease (CVD) risk assessment with the ankle-brachial index (ABI):

  1. PAD is a common manifestation of atherosclerosis in the lower limbs. In severe cases, it can impair walking and lead to tissue loss, infection, or amputation.
  2. Patients with PAD are at increased risk for CVD events. This likely represents the systemic nature of atherosclerosis.
  3. The USPSTF reviewed the evidence on whether screening for PAD with the ABI in asymptomatic adults reduces morbidity or mortality from PAD or CVD.
  4. The USPSTF concluded that the current evidence is insufficient and that a balance between benefit and harms of screening for PAD in asymptomatic adults cannot be assessed.
  5. Two good-quality studies showed no benefit of using the ABI to manage daily aspirin therapy in unselected patients. Also, two studies showed no benefit from prescribed exercise therapy, based on screening ABI results.
  6. While no studies addressed the harms of screening, the potential exists for overdiagnosis, labeling, and opportunity costs. There is also the potential risk for exposure to gadolinium or contrast dye during conformational tests.
  7. When deciding whether to screen for PAD with the ABI in asymptomatic patients, clinicians should consider the potential preventable burden of PAD, the potential harms of screening, and other methods for assessing CVD risk (e.g., blood pressure, diabetes, and lipid screening).
  8. Large, population-based randomized trials of screening versus no screening are needed to determine whether screening for PAD with an ABI will improve clinical outcomes. While one large population-based study in Denmark has published preliminary results in favor of screening, it was limited to men aged 65-74 years only and also included screening for abdominal aortic aneurysms and high blood pressure. Two other studies of a screening “bundle” are ongoing.
  9. The American College of Cardiology and American Heart Association have previously released a joint practice guideline recommending ABI screening among high-risk patients, including patients 65+ years of age, patients 50+ years of age with other atherosclerotic risk factors or a family history of PAD, and adults <50 years of age with diabetes and at least one other atherosclerotic risk factor.

Clinical Topics: Anticoagulation Management, Dyslipidemia, Noninvasive Imaging, Prevention, Vascular Medicine, Atherosclerotic Disease (CAD/PAD), Lipid Metabolism, Exercise, Hypertension

Keywords: Ankle Brachial Index, Anticoagulants, Aortic Aneurysm, Abdominal, Aspirin, Atherosclerosis, Blood Pressure, Blood Pressure Determination, Diabetes Mellitus, Diagnostic Imaging, Exercise Therapy, Gadolinium, Hypertension, Lipids, Peripheral Arterial Disease, Risk Assessment, Risk Factors, Secondary Prevention, Vascular Diseases


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