末の周回動脈疾患 末を脅かす慢性イシュケミア: レビュー
Tamar S Polonsky1, Mary M McDermott2,3
1Department of Medicine, University of Chicago Medicine, Chicago, Illinois.
JAMA
|June 1, 2021
まとめ
周辺動脈疾患 (PAD) は世界中で何百万人もの人に影響し,心血管疾患や機能低下のリスクを高めています. 効果的な治療には,高用量スタチン,抗血栓治療,運動プログラムが含まれます.
科学分野:
- 血管医学
- 心血管の健康
- 公衆衛生
背景:
- 周辺動脈疾患 (PAD) は 世界中で2億3千万人に 影響する広範囲にわたる疾患です
- 流行率は年齢とともに著しく増加し,80歳以上の人の20%までに影響します.
- PADは全因死亡率,心血管死亡率,重症冠動脈事件の2倍のリスクと関連しています.
研究 の 目的:
- 周辺動脈疾患の世界的な影響と臨床的影響を要約する.
- 断続的なクラディケーションを含む診断方法と症状の表現を強調する.
- PADの管理における現在の治療戦略とその有効性を検討する.
主な方法:
- 診断は足首-腕指数 (ABI) に基づいており,PADを示す値は<0.90である.
- 臨床的な表現には,典型的な断続的なクラウディケーションが含まれますが,多くの患者は無症状または異常な足の症状があります.
- 機能的低下は6分の歩行能力の変化によって評価される.
主要な成果:
- ABI < 0. 90は,重要な動脈狭窄に対する高い特異性と敏感性を持っています.
- 症状の変動にもかかわらず,PAD患者は歩行能力の低下を強いられる.
- PADの患者の11%が 末を脅かす慢性的な不血症に進行する.
結論:
- PADは,心血管疾患の発生率と機能低下を著しく増加させる.
- 最適な治療には,高用量のスタチン,抗血栓/抗血小板療法,運動が含まれます.
- コーチングによる家庭での運動プログラムは 歩行距離の改善を 顕著に示しています
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