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Commentary |

Critical Issues in Peripheral Arterial Disease Detection and Management:  A Call to Action

Jill J. F. Belch, MD; Eric J. Topol, MD; Giancarlo Agnelli, MD; Michel Bertrand, MD; Robert M. Califf, MD; Denis L. Clement, MD; Mark A. Creager, MD; J. Donald Easton, MD; James R. Gavin III, MD, PhD; Philip Greenland, MD; Graeme Hankey, MD; Peter Hanrath, MD; Alan T. Hirsch, MD; Jürgen Meyer, MD; Sidney C. Smith, MD; Frank Sullivan, PhD; Michael A. Weber, MD ; for the Prevention of Atherothrombotic Disease Network
Arch Intern Med. 2003;163(8):884-892. doi:10.1001/archinte.163.8.884.
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THIS CALL-TO-ACTION document is an initiative of the Prevention of Atherothrombotic Disease Network, an international, multidisciplinary network, adjoined by the mutual goal of increasing awareness, detection, and treatment rates of peripheral arterial disease (PAD) and increasing awareness of the interrelationship between PAD and the risk of ischemic events. Although the prevalence of PAD in Europe and North America is estimated at approximately 27 million people, PAD remains a largely underdiagnosed and undertreated disease. Several recent epidemiologic studies have revealed PAD detection rates of 20% to 30% when specific at-risk populations were screened. In an effort to guide diagnostic and treatment protocols, the Prevention of Atherothrombotic Disease Network has recommended 5 action items. These are to (1) increase awareness of PAD and its consequences; (2) improve the identification of patients with symptomatic PAD; (3) initiate a screening protocol for patients at high risk for PAD; (4) improve treatment rates among patients who have been diagnosed with symptomatic PAD; and (5) increase the rates of early detection among the asymptomatic population.

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Figure 1.

The 10-year survival rate for patients with and without peripheral arterial disease, as evidenced by the San Diego Artery Study.23

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Figure 2.

The survival rate over 15 years for patients with symptomatic peripheral arterial disease (PAD) vs control patients. Depicted is the relationship between the presence of symptomatic PAD and survival rate.24,25

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Figure 3.

The 5-year mortality rates for common pathological conditions. The outcome from time of diagnosis of peripheral arterial disease (PAD) was found to be worse than the outcome for breast cancer and Hodgkin disease.27,28

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Figure 4.

Common peripheral arterial disease (PAD) risk factors. Depicted is the range of odds ratios for developing symptomatic PAD. Excluding unmodifiable factors, the most important risk factors for developing intermittent claudication are diabetes and smoking.24,25

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