Top Things to Know: Lower Extremity Peripheral Artery Disease: Contemporary Epidemiology, Management Gaps, and Future Directions
Prepared by Sally S. Wong, PhD, RD, CDN, FAHA – Senior Science and Medicine Advisor
- Lower extremity PAD affects more than 230 million adults worldwide and is associated with an increased risk of various adverse clinical outcomes (i.e., cardiovascular diseases such as coronary heart disease and stroke, and leg outcomes such as amputation).
- This scientific statement provides an update for health care professionals regarding contemporary epidemiology (i.e., prevalence, temporal trends, risk factors, and complications) of PAD, the current status of diagnosis (physiological tests and imaging modalities) and describes major gaps in the management of PAD (ie., medications, exercise therapy, and revascularization).
- Despite its high prevalence and the morbid and mortal outcomes, overall awareness regarding PAD is limited.
- Multiple factors likely contribute to this lack of PAD awareness: 1) the variability in the nomenclature and definition of PAD, which presents a challenge to effective communication about the disease; 2) variation in the clinical presentation of PAD; and 3) the lack of knowledge and appreciation among healthcare professionals and patients on the poor prognosis of PAD.
- Several socioeconomic factors are related to PAD. Adults with low household income, low education levels, and higher neighborhood deprivation have more than a 2-fold increase in the risk of PAD, even after adjustment for CVD risk factors. These associations are consistent across races.
- Evidence has supported traditional cardiovascular risk factors in PAD, such as diabetes, smoking, dyslipidemia, and hypertension. Sedentary lifestyle also increases the risk in the development of PAD.
- The 2016 AHA/ACC PAD Guideline recommended antiplatelet therapy, statins, and antihypertensive agents, glycemic control, and smoking cessation as the Class I (strong) and IIa (moderate) recommendations. Despite these evidence-based recommendations, patients with PAD remain undertreated.
- Supervised exercise is first line therapy to improve walking impairment in patients with PAD. However, recent evidence showed that most patients with PAD do not participate in supervised exercise programs.
- The majority of studies to date fail to account for anatomic factors that may influence PAD patient selection toward percutaneous vs. surgical intervention.
- Orchestrated efforts among different parties (i.e., health care professionals, researchers, expert organizations, health care organizations) will be needed to increase the awareness and understanding of PAD and improve diagnostic approaches, management, and the prognosis of PAD.
Citation
Criqui MH, Matsushita K, Aboyans V, Hess CN, Hicks CW, Kwan TW, McDermott MM, Misra S, Ujueta F; on behalf of the American Heart Association Council on Epidemiology and Prevention; Council on Arteriosclerosis, Thrombosis and Vascular Biology; Council on Cardiovascular Radiology and Intervention; Council on Lifestyle and Cardiometabolic Health; Council on Peripheral Vascular Disease; and Stroke Council. Lower extremity peripheral artery disease: contemporary epidemiology, management gaps, and future directions: a scientific statement from the American Heart Association [published online ahead of print July 28, 2021]. Circulation. doi: 10.1161/CIR.000000000000100