title: Pharmacologic risk factor treatment of peripheral arterial disease is lacking and requires vascular surgeon participation.
abstract: The pharmacologic treatment of the cardiovascular comorbidities in patients with peripheral arterial disease (PAD) can have a profound effect on the outcomes of these patients. Guidelines for the treatment of hypertension, hyperlipidemia, diabetes, and tobacco use have been published by the American Heart Association and American College of Cardiology (AHA/ACC). Patients with PAD are often under-treated for these conditions. We sought to evaluate the adherence to these established guidelines in all new patients presenting with PAD to a vascular surgery clinic and delineate the opportunity for vascular surgeon involvement in these treatments. Consecutive new patients with symptomatic, objectively proven PAD (ankle-brachial index < 0.9) were evaluated in a vascular surgery clinic by a staff vascular surgeon. PAD risk factors, pre-visit medications, and prior cardiovascular interventions were recorded. Patients were stratified whether they were receiving appropriate preventive pharmacotherapy and whether they were meeting AHA/ACC goals. In patients without prior cardiovascular history, screening for these conditions was performed. One hundred sixty-seven new patients were evaluated over a 1-year period. Objectively diagnosed PAD included intermittent claudication in 115 (69%) and critical limb ischemia in 52 (31%) patients. Average age was 67.8 years, and 73 patients (44%) were current smokers. At initial evaluation, only 115 (69%) patients reported antiplatelet use. Patients with a recorded diagnosis of hypertension met clinical guidelines in 39 instances (71%). Eighteen patients (20%) with diabetes mellitus had poor glycemic control (Hgb-A1C > 7.0%). Seventeen (19%) of 88 patients with a history of hyperlipidemia were not adequately treated. Vascular surgeon medical interventions resulted in 31% of patients being started on antiplatelet therapy, 29% of hypertension therapies were modified, 19% of established lipid therapy was modified, and lipid therapy was initiated in 20%. A new diagnosis of hypertension was made in 10 cases (6%) and hyperlipidemia in 13 cases (7%). Despite clear guidelines for the medical community regarding cardiovascular prevention, a large percentage of patients with symptomatic PAD presenting to the vascular surgery clinic are not receiving appropriate therapy for their comorbidities or are not meeting the established goals. Vascular surgeons have an important role in promoting vascular health through the systemic prevention of ischemic events.
authors.affiliation: Department of Surgery, Loma Linda VA Health Care System, Loma Linda, CA 92357, USA. Christian.Bianchi@va.gov
authors.forename: Christian
authors.initials: C
authors.lastname: Bianchi
authors.forename: Valerie
authors.initials: V
authors.lastname: Montalvo
authors.forename: Harry W
authors.initials: HW
authors.lastname: Ou
authors.forename: Vicki
authors.initials: V
authors.lastname: Bishop
authors.forename: Ahmed M
authors.initials: AM
authors.lastname: Abou-Zamzam
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D050197:Atherosclerosis / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D002140:California / Q000453:epidemiology; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D010349:Patient Compliance / Q000706:statistics & numerical data; D016491:Peripheral Vascular Diseases / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control / Q000601:surgery; D010819:Physician's Role; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D016540:Smoking Cessation / Q000706:statistics & numerical data; D013043:Specialties, Surgical / Q000706:statistics & numerical data*; D014656:Vascular Surgical Procedures / Q000706:statistics & numerical data*
chemical_list: D000959:Antihypertensive Agents; D002317:Cardiovascular Agents; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents; D010975:Platelet Aggregation Inhibitors