Contemporary risk assessment and cardiovascular outcomes in peripheral arterial disease

The term peripheral arterial disease (PAD) is often used to describe atherosclerosis involving the arteries supplying the lower extremities. Risk factors that predispose to the development and progression of both symptomatic and asymptomatic PAD include age, ethnicity, smoking, diabetes mellitus, hyperlipidemia, and hypertension. In addition, emerging biomarkers of inflammation, oxidative stress, thrombosis and metabolism have also been discovered to be predictive of future PAD events. Since traditional risk factors for PAD predispose to the development of systemic atherosclerosis, identification of PAD increases the likelihood of coexistent coronary heart and cerebrovascular disease. Even after adjustment for risk factors, PAD appears to increase the risk for ischemic manifestations involving these other vascular territories with about a 2-fold increase in myocardial infarction and perhaps stroke. The most dramatic consequence of PAD is impaired survival with a 2- to 3-fold increased risk of 5- to 10-year mortality. Not only is the risk of adverse cardiovascular and cerebrovascular complications elevated in patients with severe PAD, but it is also markedly elevated in those with asymptomatic disease. The focus in the management of PAD should be on early diagnosis and efforts to reduce the risk of adverse events by risk factor modification and antiplatelet therapy.