10 things you should know about PAD

According to recent reports, the incidence of peripheral arterial disease (PAD) has increased sharply over the past decade, perhaps as a result of the burgeoning senior population and widespread incidence of diabetes. In 2010, an estimated 202 million people worldwide were reported to be affected by PAD – a 23.5% increase from the 164 million PAD patients in 2000. Even as this condition, with its attendant risks for CV events and mortality, increases in prevalence, some cardiologists cite a “general lack of awareness” of the disease among health care providers. Although early detection can reduce the rate of amputations due to PAD, it often goes unrecognized until it is too late.

In this report, Cardiology Today presents 10 things to know about this insidious but ultimately manageable condition.

1. PAD is often inadequately recognized in women.

Even though PAD poses significant risks to women – those with this condition are two to three times more likely to suffer stroke or MI than women without PAD – this disease often goes undetected in this population. Moreover, women tend to be underrepresented in PAD research, accounting for only 20% of study populations. Read more

2. PAD and depression appear to be linked.

Recent findings have indicated that there is an association between PAD and symptoms of depression. However, researchers have noted that the direction of this causality is not yet understood. “We still don’t know which comes first,” researcher Marlene Grenon, MD, CM, said in a press release. Read more

3. Rates of PAD evaluation prior to amputation are low.

According to a recent study of 17,463 patients who underwent nontraumatic amputation related to PAD, only 68.4% underwent any sort of arterial testing beforehand. The researchers noted that because a PAD diagnosis is necessary to explore alternate treatment approaches, “the threshold for measurement with [ankle-brachial index] should be low,” although the index has not been validated as a screening tool for PAD. Read more

4. Conventional CV risk factors are predictive of PAD in patients with type 2 diabetes.

A large cohort study recently revealed that among patients with type 2 diabetes, traditional CV risk factors are largely predictive of the incidence of PAD. Specifically, these risk factors included changes in BMI, LDL and HDL cholesterol, systolic BP and pulse pressure. Read more

5. In black patients, PAD increases risk of mortality following CABG.

Results from a retrospective cohort study indicated that black patients with PAD are at a higher risk for death after CABG surgery than white patients. The researchers wrote that in light of these findings, black patients with PAD should be more closely monitored after undergoing CABG. Read more

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6. Patients with mild PAD symptoms may benefit from antiplatelet therapy and exercise.

A conservative treatment regimen of antiplatelet therapy and exercise may be beneficial treatment options for patients with mild or no symptoms of PAD. Additionally, medications such as cilostazol (Pletal, Otsuka Pharmaceuticals) have demonstrated some efficacy in this population, and agents that control lipids and BP may also mitigate PAD symptoms. Read more

7. Surgery or percutaneous intervention may be indicated for severe PAD symptoms.

Among patients whose PAD has taken a more severe form, such as critical limb ischemia, there may be a need for more aggressive management. For such patients, drug-eluting stents and other endovascular interventions have been shown to reduce the rate of PAD-related amputations. Read more

8. New atherectomy systems offer additional options for PAD treatment.

Atherectomy represents another interventional approach to treating PAD, and newer systems seem positioned to optimize this modality. The recent introduction of the Diamondback 360 (Cardiovascular Systems Inc.) 60 cm Peripheral Orbital Atherectomy System marks a new option for patients with critical limb ischemia. Read more

9. Stem cell therapy may hold promise for preventing PAD-related amputations.

A clinical trial to assess the potential of using endogenous stem cells to avoid leg amputations in end-stage PAD has been initiated at University Hospitals Case Medical Center. The study involved 152 patients randomly assigned to receive either the investigational stem cell treatment or placebo. Read more

10. Following a Mediterranean diet may decrease risk for PAD.

According to findings from the PREDIMED study, adherence to a Mediterranean-style diet supplemented with extra virgin olive oil or nuts is linked to a decreased risk of PAD. According to the researchers, PREDIMED was the first randomized primary prevention trial to suggest this correlation. However, the researchers also noted that additional trials with PAD as a prespecified endpoint are necessary to definitively establish causation. Read more