Under-diagnosis of peripheral
arterial disease (PAD) is likely to serve as a barrier to effective prevention
of myocardial infarction and stroke, the main cardiovascular risks associated
with PAD, according to the PARTNERS program data released Sunday at the 73rd
annual meeting of the American Heart Association.
PAD is caused by a condition in which the arteries become narrowed due to
the formation of plaque inside the artery walls. Left untreated, the plaque
can rupture, leading to platelet-induced thrombosis or blood clot formation, a
process known as atherothrombosis. This can lead to serious health
consequences including heart attack, stroke and vascular death. People with
PAD are six times more likely to die from cardiovascular disease within
10 years of diagnosis than those without established PAD.
"PAD is prevalent but under-recognized by both physicians and patients,"
says Dr. Alan T. Hirsch, Director, Vascular Medicine Program, University of
Minnesota Medical School and Co-chair of the PARTNERS program. It is
estimated that nearly 25 million people in the U.S. and Europe may be affected
by PAD. According to Dr. Hirsch, PAD is easily diagnosed through an
ankle-brachial index (ABI) measurement, a non-invasive procedure that is
similar to the routine office blood-pressure test.
In the study known as the PARTNERS (PAD Awareness, Risk and Treatment:
New Resources for Survival) program, 6,417 "at-risk" patients -- defined by
age 70 years or older or patients 50 to 69 years of age with a history of
smoking and/or diabetes -- were screened to assess the prevalence of PAD in a
community-based patient population. PAD was defined by an ABI of less than or
equal to 0.90, a previous diagnosis of PAD, or prior limb arterial
revascularization procedure, such as leg bypass surgery or angioplasty.
"The main goals of the PARTNERS program was to assess the efficacy of a
PAD detection algorithm in office practice; to assess current rates of
physician and patient PAD awareness; and to evaluate relative atherosclerosis
risk factor profiles in patients with PAD or other forms of recognized
cardiovascular disease," said Dr. Hirsch.
Results revealed that 29 percent of patients had PAD -- 13 percent of this
community population had PAD alone, 16 percent had both PAD and another
manifestation of cardiovascular disease (CVD). Another 24 percent had
cardiovascular disease only. Forty-seven percent had neither PAD nor
cardiovascular disease, and served as a reference population to permit
comparisons about the impact of PAD on quality-of-life and treatment
Only 45 percent of those with PAD alone had been diagnosed with PAD prior
to the PARTNERS program. Sixty-five percent of patients with PAD and CVD had
an established diagnosis prior to PARTNERS. Patients who did not have a
diagnosis of PAD and/or CVD prior to PARTNERS are not likely to have been
apprised of their risk of heart attack and stroke.
In addition, the rates of hypertension, hyperlipidemia, diabetes and
tobacco use were high in the PAD population and less than half of all PAD
patients were aware of their diagnosis. When patients do not have awareness
of their diagnosis, they may not be able to form a partnership with their
community physician to provide life-long care for this disease.
"The results of the PARTNERS program confirm the need to raise awareness
and draw attention to the seriousness of peripheral arterial disease and for
us to take steps to increase the intensity of treatment for these patients at
risk," says Dr. Hirsch. Increased awareness, diagnosis, risk assessment, and
early treatment can offer the powerful benefits by preventing costly,
debilitating, and mortal events, especially myocardial infarction and stroke,
and also by improving quality of life.
PARTNERS was supported by the Bristol-Myers Squibb/Sanofi Pharmaceuticals