Circ: Millions of PAD patients not receiving adequate medical therapy

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The majority of patients with peripheral artery disease (PAD) are not adequately receiving risk-lowering medications, such as statins, ACE inhibitors/ARBs or aspirin, which could increase their risk of mortality, according to a study published online June 20 in Circulation. The researchers noted that evaluating patients’ ankle brachial index (ABI) could make physicians aware of the disease and more likely to prescribe medications.

"Individuals with PAD, a manifestation of systemic atherosclerosis, are known to be at significantly increased risk of adverse cardiovascular events regardless of symptoms," wrote Reena L. Pande, MD, of the Harvard Medical School and Brigham and Women’s Hospital  in Boston, and colleagues. Therefore, these patients could significantly benefit from these types of drug therapies.

Pande et al used the National Health and Nutrition Examination Survey from 1999 to 2004 to determine the number of U.S. adults with PAD who were not receiving the proper preventive medications and identify whether these types of treatment were associated with reduced mortality in PAD patients without known CV disease. The researchers assessed data from 7,458 patients.

ABI tests were used to identify patients with PAD but no known heart disease. PAD was defined as having an ABI that was less than or equal to 0.90. Of the 7,458 patients, PAD prevalence was 5.9 percent, equating to an estimated 7.1 million adult patients with PAD.

The results were striking. Nearly two in three patients, or five million patients, were not taking cholesterol-lowering medications and nearly three in four patients did not receive ACE inhibitors or ARBs to help lower blood pressure. Only 30.5 percent of patients were reported to be taking a statin, 24.9 percent reported taking an ACE inhibitor or ARB and 35.8 percent said they took aspirin. Two in three patients, or 4.5 million patients, were not taking aspirin medications to help lower the risk of heart attack.

"We found that taking two or more of these medications to be associated with a 65 percent lower rate of death from all causes," said Pande, the study’s lead author. "The study tells us that millions of individuals identified with PAD by a simple noninvasive screening test are not receiving medications that may reduce their risk of death."

After excluding patients with known CV disease, the researchers reported that PAD patients had higher mortality rates compared with those without PAD or CV disease, 16.1 percent versus 4.1 percent.

While the authors said that these data do not explain why patients are not receiving these risk-lowering medications, ABI screening may help better diagnose PAD and make physicians more apt to administer more of these types of therapies. The researchers concluded that because the study was observational, larger trials must be conducted to back up these data and to help physicians best treat PAD in asymptomatic patients.