Questions that need to be answered: peripheral arterial disease

Questions that need to be answered before the ankle–brachial pressure index (ABPI) can be recommended for population screening

Answer is yes or probably yes:

1. Is ABPI a convenient, standardised and valid test that independently predicts events?

2. Are there population norms to guide the interpretation of the results of ABPI?

3. Is a low ABPI specific for increased cardiovascular risk?

4. Does measuring the ABPI provide clinically significant prognostic value above and beyond that provided by traditional risk factors?

Answer is unknown:

5. Will the results of the ABPI change clinical management?

6. What are the direct and indirect risks of screening (eg, false-positive and false-negative results)?

7. Does modification of the treatment plan on the basis of the results of the ABPI lead to clinical benefit?

8. Does the overall benefit of measuring ABPI outweigh the adverse consequences and costs associated with screening and follow-up?

Mosca L. C-reactive protein — to screen or not to screen? N Engl J Med 2002; 347: 1615-1617.

Fowkes F, Price J, Leng G. Targeting subclinical atherosclerosis. BMJ 1998; 316: 1764.

Leng G, Lee A, Fowkes F, et al. Incidence, natural history and cardiovascular events in symptomatic and asymptomatic Peripheral arterial disease in the general population. Int J Epidemiol 1996; 25: 1172-1181.

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