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Peripheral arterial disease (PAD): secondary prevention
1Klinik am See, Fachklinik für Innere Medizin, Abteilung für Kardiologie/Angiologie, Rüdersdorf, Germany. heinz.voeller@klinikamsee.com
Deutsche Medizinische Wochenschrift (1946)
|September 13, 2002
Summary
Peripheral artery disease (PAD) affects millions, often asymptomatically, increasing cardiovascular risk. Early detection and comprehensive management of atherosclerosis risk factors are crucial for improving patient outcomes and life expectancy.
Area of Science:
- Vascular Medicine
- Cardiovascular Epidemiology
- Atherosclerosis Research
Background:
- Peripheral artery disease (PAD) prevalence increases with age, significantly impacting the elderly population.
- A substantial number of PAD cases remain asymptomatic, complicating early diagnosis and intervention.
- Atherosclerosis risk factors, including smoking and diabetes mellitus, are key contributors to PAD development.
Purpose of the Study:
- To highlight the rising prevalence of PAD in aging populations and its predominantly asymptomatic nature.
- To emphasize the importance of thorough patient evaluation, including risk factor assessment and noninvasive diagnostic methods.
- To discuss the prognostic implications of PAD, particularly the increased risk of cardiovascular and cerebrovascular events.
Main Methods:
- Review of current epidemiological data on PAD prevalence in Germany.
- Analysis of diagnostic approaches, including case history, pulse status, and noninvasive investigations like duplex sonography and ankle-brachial index (ABI) measurement.
- Evaluation of risk factors associated with atherosclerosis and their impact on PAD progression.
Main Results:
- An estimated 4.5 million people in Germany are affected by PAD, with prevalence rising in older demographics.
- Intermittent claudication is present in only one-third of patients; most cases are asymptomatic.
- Noninvasive methods can double or triple the detected prevalence; duplex sonography with ABI is highly accurate but underutilized.
Conclusions:
- PAD significantly shortens life expectancy by approximately ten years, with prognosis often dictated by cardiovascular comorbidities rather than the disease itself.
- Patients with PAD face a substantially elevated risk of cardiovascular and cerebrovascular incidents, with mortality increased up to sixfold in those with coronary heart disease.
- Effective management includes lifestyle modifications (smoking cessation, supervised exercise, glycemic and lipid control) and antiplatelet therapy; symptomatic treatments have shown limited efficacy.