Prevalence of symptomatic peripheral arterial disease, modifiable risk factors, and appropriate use of drugs in the treatment of peripheral arterial disease in older persons seen in a university general medicine clinic.
BACKGROUND
Persons with peripheral arterial disease (PAD) have a high incidence of cardiovascular morbidity and mortality.


METHODS
We investigated the prevalence of symptomatic PAD, modifiable risk factors, and use of drugs in persons 60 years and older seen in a university general medicine clinic. Symptomatic PAD was documented if the person had a documented history of surgery for PAD, if the person had intermittent claudication or other lower extremity symptoms associated with absent or weak arterial pulses or an ankle-brachial index of <0.90, if the person had an abdominal aortic aneurysm, or if the person had symptomatic documented extracranial carotid arterial disease.


RESULTS
There were 620 women and 386 men, mean age 72+/-9 years (range 60-95 years), and 95% were white. Symptomatic PAD was present in 103 of 386 men (27%) and in 106 of 620 women (17%) (p<.001). The prevalence of current cigarette smoking (31% versus 12% in those without PAD, p<.001) and ex-cigarette smoking (40% versus 26%) in those without PAD, p<.001) was higher among persons with PAD. Compared with persons without PAD, those with PAD also had a higher prevalence of hypertension (90% versus 76% in persons without PAD, p<.001), diabetes mellitus (45% versus 22%, p<.001), dyslipidemia (88% versus 60%, p<.001), coronary artery disease (63% versus 25%, p<.001), and stroke (36% versus 11%, p<.001). In persons with PAD, antiplatelet drugs were used in 85%, lipid-lowering drugs for dyslipidemia in 67%, beta blockers in 60%, and angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers in 62%. The average of the last two blood pressures was <140/90 mmHg in 55% of persons with PAD treated for hypertension. The last hemoglobin A1c in diabetics was <7% in 52% of persons with PAD.


CONCLUSIONS
Older persons with PAD have a high prevalence of modifiable risk factors, CAD, and stroke. The use of antiplatelet drugs, lipid-lowering drugs for dyslipidemia, beta blockers, and ACE inhibitors or angiotensin-receptor blockers, reduction of blood pressure to <140/90 mmHg in hypertensive persons, and reduction of hemoglobin A1c in diabetics to <7% in older persons with PAD needs to be increased in all clinical settings.
Ness
Jose
J
Department of Medicine, University of Iowa School of Medicine, Iowa City, USA.
Aronow
Wilbert S
WS
Newkirk
Erin
E
McDanel
Deanna
D
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D003327:Coronary Disease / Q000150:complications; D048909:Diabetes Complications; D005260:Female; D006785:Hospitals, University; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications; D006973:Hypertension / Q000150:complications; D007383:Intermittent Claudication / Q000150:complications; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000188:drug therapy* / Q000453:epidemiology* / Q000209:etiology; D015995:Prevalence; D011674:Pulse; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D020521:Stroke / Q000150:complications
D000319:Adrenergic beta-Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors