Millions of PAD patients not receiving secondary prevention therapies
MedWire News: Many peripheral artery disease (PAD) patients are not receiving secondary prevention therapies that could significantly reduce their risk for all-cause mortality, a study suggests.
Reena Pande (Harvard Medical School, Boston Massachusetts, USA) and colleagues analyzed data from the US National Health and Nutrition Examination Survey (NHANES) from 1999 to 2004, with follow-up through the end of 2006. Patients were diagnosed with PAD if their ankle-brachial index (ABI) was 0.90 or less in either leg.
The findings, published in the journal Circulation, revealed that of 7458 participants aged 40 years or older, 5.9% had PAD, corresponding to approximately 7.1 million adults in the USA.
Statin use was reported in only 30.5%, ACE inhibitor/angiotensin receptor blocker (ARB) use in 24.9%, and aspirin use in 35.8% of the PAD patients.
"Millions of individuals identified with PAD… are not receiving medications that may reduce their risk of death," commented Pande in a press statement.
After adjusting for age, gender, and race/ethnicity, PAD was associated with a 2.4-fold increased risk for all-cause mortality (p<0.0001). After excluding patients with diagnosed CVD, PAD patients had an almost two-fold higher mortality rate, at 16.1%, than patients without PAD or diagnosed CVD, at 4.1% (p=0.001).
After full adjustment including socioeconomic factors, use of multiple preventive treatments including ACE inhibitors, ARBs, and aspirin, was associated with a 65% lower risk for all-cause mortality among PAD patients without diagnosed CVD, compared with PAD patients not receiving treatment (p=0.02).
"These observational findings highlight the critical need for a large-scale clinical trial to determine whether the implementation of secondary prevention therapies in high-risk individuals identified by ABI screening as having PAD can reduce mortality and cardiovascular events," conclude the authors.
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By Piriya Mahendra