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Slide 1 :
PADA Call to Action
Slide 2 :
PAD: A Call to Action
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Major manifestations of atherothrombosis include
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Prevalence of metabolic syndrome in each patient group (%) Cross-Sectional survey of 1,045 vascular disease patients 0 20 40 60 CHD Stroke AAA PAD Olijhoek JK et al. Eur Heart J 2004; 25: 342-348. Metabolic syndrome is more common in PAD than in CHD or stroke AAA = Abdominal Aortic Aneurysm
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Prevalence of PAD increases with age Figure adapted from Creager M, ed. Management of Peripheral Arterial Disease. Medical, Surgical and Interventional Aspects. 2000. 1 Meijer WT et al. Arterioscler Thromb Vasc Biol 1998; 18: 185-192. 2.Criqui MH et al. Circulation 1985; 71: 510-515. Patients with PAD (%) Rotterdam Study (ABI Test <0.9)1 San Diego Study (PAD by noninvasive tests)2
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Mortality is very high in patients with severe PAD Relative 5-year mortality 1. Criqui MH. Vasc Med 2001; 6 (suppl 1): 3–7. 2. McKenna M et al. Atherosclerosis 1991; 87: 119–28. 3. Ries LAG et al. (eds). SEER Cancer Statistics Review, 1973–1997. US: National Cancer Institute; 2000.
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Resnick HE et al. Circulation 2004; 109: 733-739. There is a strong two-way association between decreased ABI and increased risk for cardiovascular death1 Baseline ABI* Percent 0 20 40 60 <0.60 (n=25) 70 50 30 10 0.60-<0.70 (n=21) 0.70-<0.80 (n=40) 0.80-<0.90 (n=130) 0.90-<1.0 (n=195) 1.0-<1.10 (n=980) All-cause mortality CVD Mortality *Mean participant follow-up 8.3 years
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Guidance for PAD diagnosis STEP 1 Assess patient for risk factors smoking diabetes hypertension age: men >55 years and women >65 years hyperlipidaemia history of cardiovascular disease Assess patient for leg symptoms intermittent claudication critical limb ischaemia Tools: PAD checklist, Rose questionnaire, Edinburgh questionnaire STEP 2 If suspicion of PAD, perform an ABI to confirm diagnosis using a hand-held Doppler
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Only 1 in 10 patients with PAD has classical symptoms of intermittent claudication Only 1 in 10 of these patients has classical symptoms of intermittent claudication (IC) 1 in 5 people over 65 has PAD† † ABI<0.9 Diehm C et al. Atherosclerosis 2004; 172; 95-105.
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A screening ABI should be performed in patients with diabetes The American Diabetes Association recommends screening for PAD in patients with diabetes 1. American Diabetes Association. Diabetes Care 2003; 26: 3333-3341. 2. Estes JM, Pomposelli FB Jr. Diabet Med 1996: 13: S43- S57. Those <50 years of age who have other risk factors associated with PAD Smoking Hypertension Hyperlipidaemia Duration of diabetes >10 years Those >50 years of age If normal an exercise test should be carried out The ABI test should be repeated every 5 years Foot care is also important in diabetic patients as PAD is a major contributor to diabetic foot problems2
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Risk factor management approach Smoking cessation Weight reduction Total cholesterol <175 mg/dL / <4.5 mmol/L LDL cholesterol <100 mg/dL / <2.6 mmol/L Glycosylated haemoglobin <7.0% Blood pressure (BP) <140/90 mm Hg For patients with diabetes BP < 130/80mm Hg Platelet inhibition Hiatt WR. N Engl J Med 2001; 344: 1608-1621.
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Key learning points Ensure aggressive and early risk management of patients who are at high risk but may be asymptomatic Screen patients with diabetes >50 years of age, and those <50 years of age who have additional risk factors associated with PAD Only 1 in 10 patients with PAD have typical claudication1 Patients with diabetes are at high risk of PAD It is important to improve the management of PAD to protect patients from an increased risk of ischaemic events REMEMBER ACTION 1. Diehm C et al. Atherosclerosis 2004; 172: 95-105.
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Overall learning points PAD is a reliable warning sign that a patient is at high risk for life threatening cardiovascular and cerebrovascular events PAD is easily overlooked by both patients and physicians – assess whether patients presenting with symptoms or associated risk factors have PAD Treatments are available to protect the patients with PAD from future MI or stroke
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Help protect patients with PAD from their increased risk of MI or stroke
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AAA = Abdominal Aortic Aneurysm. Prevalence of PAD increases with age. Figure adapted from Creager
AAA = Abdominal Aortic Aneurysm. Prevalence of PAD increases with age. Figure adapted from Creager M, ed. Management of Peripheral Arterial Disease. ...