What does the future hold for the patient with peripheral arterial disease?

Individuals with peripheral arterial disease (PAD) have a significantly elevated risk of developing major cardiovascular complications, but, until recently, the atherosclerotic manifestation of PAD has largely been regarded as a local problem of limited blood supply in the lower limbs, and treatment has reflected this. The association between PAD and cardiovascular mortality suggests that treatment strategies should, however, take into account the systemic nature of atherosclerosis and focus on the management of recognized atherosclerotic risk factors.

This is reflected in national and international treatment guidelines, which recommend that patients with PAD should be targeted for aggressive atherosclerotic risk factor therapy. Although interventional and medical therapies are available, and are continuing to be developed, PAD patients are currently being undertreated, and there is, therefore, a need for unbiased and comprehensive reporting of treatment results and quality assurance, so that awareness is raised and the management of PAD is improved

Peripheral arterial disease (PAD), a disorder characterized by obstruction of arteries supplying the lower limbs, is an important manifestation of atherosclerosis, with a prevalence ranging from 3% for people under the age of 60, to 20% at age 75 and over. There is a higher incidence in men than in women up to the age of 70, after which the prevalence rates equalize. The most common symptom of PAD is intermittent claudication (IC), painful cramping in the leg or hip, particularly when walking, which eases when the muscles are rested.

Depending on the severity of symptoms (if any), mortality rates among patients with PAD have been shown to be 2–4 times greater than that of a sex- and age-matched control group without any atherosclerotic manifestations. This increased mortality may be attributed to the strong correlation between PAD and coronary heart disease (CHD), an association that is evident even in individuals without a history of CHD and without symptoms of claudication. Indeed, mortality rates among patients with PAD and patients with CHD are similar.

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Until recently, atherosclerotic manifestations in the lower limbs have been regarded as a local problem of limited blood supply. Thus, treatment has been directed towards improving blood supply, or towards lifestyle changes, such as smoking cessation and initiation of exercise programmes. In a few patients, these measures are supplemented with medicines that are intended to relieve symptoms – some proving more effective than others. However, the association between PAD and cardiovascular mortality suggests that treatment strategies should take into account the systemic nature of atherosclerosis and focus on the management of recognized atherosclerotic risk factors.