Critical issues in peripheral arterial disease detection and management - A call to action

Peripheral arterial disease is a powerful indicator of systemic atherothrombotic disease and a critical public health issue affecting an estimated 27 million people.1 It is imperative to increase the awareness of PAD as a distinct atherothrombotic syndrome that predicts stroke, MI, and death, and to publicize the protective benefits of early diagnosis and treatment. A diagnosis of PAD mandates aggressive risk factor management and pharmacologic therapy, including antiplatelet agents. Risk factor management is similar to that for other cardiovascular or cerebrovascular conditions, such as CHD, and includes addressing lifestyle factors, such as smoking cessation, treating associated conditions (eg, diabetes and hypertension), lowering lipids to an acceptable level, and preventing ischemic events with aggressive antiplatelet therapy.10,11,41-44 Although the Prevention of Atherothrombotic Disease Network recommends improving diagnosis of PAD in the asymptomatic population, it advocates waiting for further evidence before unequivocally recommending treatment owing to limited clinical evidence in this population. The results of 2 upcoming trials will help elucidate the potential benefits of antiplatelet agents in the asymptomatic population. The POPADAD study, which has completed its initial recruitment and thus providing data on PAD diagnostic rates, includes patients with diabetes who have no clinical manifestation of vascular disease. The AAA trial includes high-risk patients with asymptomatic disease. The POPADAD study and AAA trial have enrolled patients based on the singular criterion of decreased ABI; results are expected in 3 1/2 years and 4 years, respectively.3 In the interim, the Network recommends focusing on improving the treatment of patients with diagnosed, symptomatic PAD, since they have the highest clinical risk for ischemic events.