News | July 02, 2007

PAD Patients Have Higher Death, Cardiovascular Complications Rate

July 2, 2007 - New research published in the July issue of the Journal of Vascular Surgery indicates that arterial blockages in legs from peripheral arterial disease (PAD) represent such a high burden of atherosclerotic plaque that they may cause the blood flowing through "diseased" territory to become more "thick" and prone to form clots.

Three hundred and ninety-five patients were tested at the Vascular Laboratory of Gonda Vascular Center of the Mayo Clinic in Rochester, MN, for leg circulation with an ankle-brachial index (ABI), and for heart muscle circulation through dobutamine stress echocardiography (DSE), to determine which test better predicted death or subsequent cardiovascular diseases such as strokes and heart attacks. Patient treatment and follow-up occurred at the Mayo Medical Center.

"Patients with PAD had a very high rate of cardiovascular morbidityþufive years risk of heart attack (19.7 percent), stroke (13.5 percent) and mortality (42.3 percent)," said Waldemar E. Wysokinski MD, assistant professor of Medicine, Division of Cardiovascular Medicine, Mayo Clinic and Foundation for Education and Research, Rochester, MN. He added that low ABI was the strongest predictor of mortality in this group while abnormal DSE was not. No correlation between severity of leg and heart disease was found.

Researchers said patients had significantly better prognosis if treated with medications that stop atherosclerotic plaque formation (statins) and prevent arterial clot formation (aspirin). However, surgical or endovascular interventions (ballooning and/or stenting of blocked arteries) in leg and coronary arteries did not change life expectancy.

"Our report points out that atherosclerosis (hardening of the arteries) behaves like a cancer; it kills when it gets larger, so treatment must focus on prevention," said Dr. Wysokinski. "Poor circulation in lower extremities (manifested as leg muscle pain or other discomfort on walking) is not only a mobility problem, but more importantly is a signal that heart attack or stroke could be just around the corner. Individuals with PAD are among the highest-risk patients and a cost-effective strategy for evaluating their need for treatment."

Source: Society for Vascular Surgery

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