Peripheral Arterial Disease: Epidemiology and Drug Therapy

Mary McGrae McDermott, MD

Disclosures

Am J Geriatr Cardiol. 2002;11(4) 

In This Article

Abstract and Introduction

Lower-extremity peripheral arterial disease (PAD) is common among older men and women, affecting 20%-30% of older men and women in general medicine practices. History and physical examination are insensitive measures of PAD. However, PAD can be noninvasively and reliably diagnosed in the office with the ankle-brachial index, a ratio of Doppler-recorded systolic pressures in the lower and upper extremities. An ankle-brachial index <0.90, consistent with PAD, is associated with increased risk of cardiovascular morbidity and mortality in addition to functional impairment. Drug therapy in PAD is directed at reducing the increased risk of cardiovascular events and improving walking impairment. Intensive atherosclerotic risk factor intervention and angiotensin-converting enzyme inhibitors are recommended for reducing cardiovascular event rates in persons with PAD. Components of an effective exercise intervention and drug therapy to reduce claudication-related walking impairment in PAD are also reviewed.

Lower-extremity peripheral arterial disease (PAD) is common among older men and women, affecting 10%-15% of community-dwelling individuals age 65 and older and 18%-29% of patients age 50 and older in general medicine practices.[1,2,3,4,5,6] PAD is associated with increased risk of cardiovascular morbidity and mortality.[7,8,9,10] Over a 5-year period, 25%-35% of persons with PAD will suffer a heart attack or stroke and an additional 25% will die, usually from cardiovascular causes.[9] While most men and women with PAD will never require lower-extremity revascularization or amputation, PAD is associated with slower walking speed, poorer walking endurance, and reduced physical activity levels, as compared to individuals without PAD.[11,12,13,14] Severe PAD may also be associated with a higher incidence of walking-related disability compared to absence of PAD.[15] This review summarizes the epidemiology, diagnosis, clinical significance, and medical treatment of PAD.

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