Peripheral arterial disease: epidemiology and drug therapy

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 less than 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.