Cardiovascular diseases (CVDs), of which Peripheral artery disease (PAD) is also a part, are the leading cause of mortality worldwide and in 2016 alone accounted for more than 17.9 million deaths (31% of all deaths globally), about 85% of which were due to heart attack and stroke.
How many of those are due to PAD is difficult to estimate, let alone calculate, at least on a global level, as this insidious disease often goes undiagnosed despite being comorbid to many lethal CVDs, like stroke and coronary artery disease (CAD).
The asymptomatic nature of PAD makes timely and accurate diagnosis only on the basis of a physical examination a tall order and misdiagnosis is common, especially if performed by a less experienced examiner. Fortunately, there are more advanced diagnostic methods and tools with high accuracy and specificity, specifically the ABI (ankle-brachial index) measurement, which lends itself to screening of large numbers of potential patients. However, for the screening processes to be cost-effective, clinicians should first identify at-risk individuals on the basis of well-established risk factors for PAD.
The most prominent risk factor for PAD (and atherosclerosis in general) is tobacco smoking; it dramatically increases the incidence of PAD in men, while female smokers are even worse affected as they are at a 20-fold increased risk (over a 13-year period) in comparison with non-smokers.
Another one is diabetes since the most common symptom of PAD (intermittent claudication) and one that greatly affects the patient’s quality of life (diminished physical activity) is 3.5 times more prevalent in male diabetics and 8.6 times more in female diabetics than in the non-diabetic populations. Lastly, hyperlipidaemia, hypertension and weight (obesity) round the list of risk factors with emphasis on obesity, which contributes to a 3 to 5-fold increase in incidence of PAD.
Preventive screening of patients for PAD (on the basis of the ABI measurement) has the benefit of improving the accuracy of cardiovascular risk prediction beyond the FRS (Framingham risk score) and can, indirectly, predict the risk of total and cardiovascular mortality. Even more, timely identification of PAD has a positive effect on morbidity.
One study showed that early identification of PAD on the basis of ABI and the presence of intermittent claudication and subsequent lifestyle change intervention significantly improved the frequency and time of physical activity (important part of conservative management of PAD due to its antiatherogenic effect) and even contributed to smoking cessation in some patients who participated in the study. A study conducted in Germany and encompassing elderly individuals demonstrated the improvement of cardiovascular risk factors after 2 years of treatment after an initial diagnosis of PAD on the basis of ABI measurement.
Screening for PAD on the basis of ABI has many benefits, with special consideration for individuals in at-risk groups for PAD.