260. The Internist's Guide to Peripheral Arterial Disease
Nov 24, 2024
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In this conversation, Dr. Beth Abramson, a Cardiologist at Unity Health and Associate Professor of Medicine at the University of Toronto, shares her expertise on peripheral arterial disease (PAD). She discusses the critical impact of PAD on health, particularly in individuals over 50. The importance of the Ankle Brachial Index as a diagnostic tool is emphasized, alongside strategies for managing cardiovascular risks like smoking cessation and hypertension. The role of personalized treatment and lifestyle changes for patients with asymptomatic PAD is also highlighted.
Understanding the importance of screening and diagnosing peripheral arterial disease (PAD) can significantly reduce the risk of cardiovascular events in at-risk populations.
Effective management of PAD requires a comprehensive approach, including smoking cessation, lipid-lowering therapy, and individualized exercise programs to improve patient outcomes.
Deep dives
Understanding Peripheral Arterial Disease (PAD)
Peripheral arterial disease (PAD) is a significant vascular condition that increases the risk of serious cardiovascular events, including heart attack and stroke. It often goes undiagnosed and undertreated, with patients frequently presenting with symptoms like claudication but failing to recognize the severity of their condition. A majority of patients may not exhibit classic symptoms, leading to misdiagnosis as other lower extremity pain sources such as neuropathy or arthritis. Therefore, it is crucial for healthcare providers, especially internists, to understand PAD's implications and actively inquire about symptoms in at-risk populations, particularly those over 50 or with risk factors such as diabetes and smoking.
Diagnostic Approach and Screening for PAD
The Ankle Brachial Index (ABI) is the preferred initial test for confirming a diagnosis of PAD, being a simple, inexpensive, and non-invasive procedure that measures blood pressure in the ankle and arm. An ABI reading below 0.9 is suggestive of PAD, indicating a significant risk for cardiovascular events. However, certain populations, such as those with arterial calcinosis, may show false-normal ABI results, necessitating further testing using alternative indices. Routine screening is recommended for specific high-risk groups, such as individuals over 50 with diabetes, to facilitate early detection and management of PAD.
Management and Therapeutic Interventions in PAD
Smoking cessation is the most critical intervention for reducing the risk of PAD and associated cardiovascular events, highlighting the need for healthcare providers to actively engage in discussions with patients about quitting smoking. Management strategies for patients with PAD emphasize intense lipid-lowering therapy, aiming for LDL levels significantly below established thresholds, as patients with PAD are at a substantially higher cardiovascular risk. The addition of antiplatelet and low-dose anticoagulant therapy, as demonstrated by findings from the COMPASS trial, can also significantly lower the incidence of major adverse cardiac events. Comprehensive management includes lifestyle modifications, effective blood pressure control, and individualized exercise programs to enhance patient quality of life, especially for those experiencing claudication.
In this episode, Dr. Maya Stein (General Internal Medicine fellow) interviews Dr. Beth Abramson (Cardiologist) on the 2022 CCS guidelines for peripheral arterial disease.