Letters to the Editor
551
Implications of the timely diagnosis of lower extremity peripheral arterial disease Kosmas I. Paraskevas a,⁎, Dimitri P. Mikhailidis b, Athanasios D. Giannoukas a, Frank J. Veith c,d a
Department of Vascular Surgery, Larissa University Hospital, Larissa, Greece Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK Divisions of Vascular Surgery, New York University Langone Medical Center, NY, USA d The Cleveland Clinic, Cleveland, USA b c
a r t i c l e
i n f o
Article history: Received 17 January 2014 Accepted 12 March 2014 Available online 19 March 2014 Keywords: Peripheral arterial disease Diagnosis Atherosclerosis Anklebrachial Index
The well-designed THINKPAD registry demonstrated that lower extremity peripheral arterial disease (LE-PAD) is underdiagnosed and undertreated among Cardiac Rehabilitation healthcare facilities in Italy [1]. The authors stress the need to increase physician awareness about the disease [1]. A few additional comments may be of interest. LE-PAD should not be considered simply as a disease of the arteries of the lower extremities, but as an indication of a high probability of generalized vascular atherosclerosis. Patients with LE-PAD also have a high prevalence of other arterial diseases, such as coronary and carotid artery diseases [2,3]. Furthermore, LE-PAD patients display worse cardiovascular (CV) risk profiles than other CV patients and often do not receive the appropriate medical treatment or are undertreated [1,4,5]. Therefore, the timely establishment of the diagnosis of LE-PAD is important for the initiation of the appropriate therapeutic measurements not only for the peripheral circulation, but also for the reduction of future CV events and CV mortality. It has been demonstrated that patients with LE-PAD are at increased risk of developing lung and other cancers [6]. The predisposing risk
⁎ Corresponding author at: Department of Vascular Surgery, Larissa University Hospital, Mezourlo 41100, Larissa, Greece. E-mail address: [email protected] (K.I. Paraskevas).
http://dx.doi.org/10.1016/j.ijcard.2014.03.074 0167-5273/© 2014 Elsevier Ireland Ltd. All rights reserved.
factors are often common for both diseases. Smoking, for instance, is one of the strongest risk factors for the development of LE-PAD. At the same time, smoking is also one of the strongest risk factors for the development of lung cancer [6]. Increased physician awareness is essential for the early diagnosis and initiation of the appropriate prevention measures. The THINKPAD registry also pointed out the sparse utilization of the ankle–brachial index (ABI) [1]. The ABI was performed in only 18.4% of the patients [1]. Physicians should keep in mind that the ABI is a marker not only of unrecognized LE-PAD, but also of generalized atherosclerosis and a predictor of CV events [7]. It was reported more than a decade ago that physician and patient awareness of LE-PAD is low and that LE-PAD patients often receive suboptimal treatment [8]. Despite that, the THINKPAD registry [1] shows that the situation today has not improved much. The THINKPAD registry [1] reminds us all that more efforts are required for the timely diagnosis and optimal management of LE-PAD. References [1] Ambrosetti M, Temporelli PL, Faggiano P, et al. Lower extremity peripheral arterial disease among patients admitted to cardiac rehabilitation: the THINKPAD registry. Int J Cardiol 2014;171(2):192–8. [2] Shah AM, Banerjee T, Mukherjee D. Coronary, peripheral and cerebrovascular disease: a complex relationship. J Indian Med Assoc 2010;108(5):292–4. [3] Ahn S, Park YJ, Min SI, et al. High prevalence of peripheral arterial disease in Korean patients with coronary or cerebrovascular disease. J Korean Med Sci 2012;27(6):625–9. [4] Argyriou C, Saleptsis V, Koutsias S, Giannoukas AD. Peripheral arterial disease is prevalent but underdiagnosed and undertreated in the primary care setting in central Greece. Angiology 2013;64(2):119–24. [5] Paraskevas KI, Mukherjee D, Whayne Jr TF. Peripheral arterial disease: implications beyond the peripheral circulation. Angiology 2013;64(8):569–71. [6] Paraskevas KI, Mikhailidis DP, Veith FJ. Patients with peripheral arterial disease, abdominal aortic aneurysms and carotid artery stenosis are at increased risk for developing lung and other cancers. Int Angiol 2012;31(4):404–5. [7] Paraskevas KI, Kotsikoris I, Koupidis SA, Giannoukas AD, Mikhailidis DP. Ankle–brachial index: a marker of both peripheral arterial disease and systemic atherosclerosis, as well as a predictor of vascular events. Angiology 2010;61(6):521–3. [8] Hirsch AT, Criqui MH, Treat-Jacobson D, et al. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA 2001;286(11):1317–24.
551
Implications of the timely diagnosis of lower extremity peripheral arterial disease Kosmas I. Paraskevas a,⁎, Dimitri P. Mikhailidis b, Athanasios D. Giannoukas a, Frank J. Veith c,d a
Department of Vascular Surgery, Larissa University Hospital, Larissa, Greece Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK Divisions of Vascular Surgery, New York University Langone Medical Center, NY, USA d The Cleveland Clinic, Cleveland, USA b c
a r t i c l e
i n f o
Article history: Received 17 January 2014 Accepted 12 March 2014 Available online 19 March 2014 Keywords: Peripheral arterial disease Diagnosis Atherosclerosis Anklebrachial Index
The well-designed THINKPAD registry demonstrated that lower extremity peripheral arterial disease (LE-PAD) is underdiagnosed and undertreated among Cardiac Rehabilitation healthcare facilities in Italy [1]. The authors stress the need to increase physician awareness about the disease [1]. A few additional comments may be of interest. LE-PAD should not be considered simply as a disease of the arteries of the lower extremities, but as an indication of a high probability of generalized vascular atherosclerosis. Patients with LE-PAD also have a high prevalence of other arterial diseases, such as coronary and carotid artery diseases [2,3]. Furthermore, LE-PAD patients display worse cardiovascular (CV) risk profiles than other CV patients and often do not receive the appropriate medical treatment or are undertreated [1,4,5]. Therefore, the timely establishment of the diagnosis of LE-PAD is important for the initiation of the appropriate therapeutic measurements not only for the peripheral circulation, but also for the reduction of future CV events and CV mortality. It has been demonstrated that patients with LE-PAD are at increased risk of developing lung and other cancers [6]. The predisposing risk
⁎ Corresponding author at: Department of Vascular Surgery, Larissa University Hospital, Mezourlo 41100, Larissa, Greece. E-mail address: [email protected] (K.I. Paraskevas).
http://dx.doi.org/10.1016/j.ijcard.2014.03.074 0167-5273/© 2014 Elsevier Ireland Ltd. All rights reserved.
factors are often common for both diseases. Smoking, for instance, is one of the strongest risk factors for the development of LE-PAD. At the same time, smoking is also one of the strongest risk factors for the development of lung cancer [6]. Increased physician awareness is essential for the early diagnosis and initiation of the appropriate prevention measures. The THINKPAD registry also pointed out the sparse utilization of the ankle–brachial index (ABI) [1]. The ABI was performed in only 18.4% of the patients [1]. Physicians should keep in mind that the ABI is a marker not only of unrecognized LE-PAD, but also of generalized atherosclerosis and a predictor of CV events [7]. It was reported more than a decade ago that physician and patient awareness of LE-PAD is low and that LE-PAD patients often receive suboptimal treatment [8]. Despite that, the THINKPAD registry [1] shows that the situation today has not improved much. The THINKPAD registry [1] reminds us all that more efforts are required for the timely diagnosis and optimal management of LE-PAD. References [1] Ambrosetti M, Temporelli PL, Faggiano P, et al. Lower extremity peripheral arterial disease among patients admitted to cardiac rehabilitation: the THINKPAD registry. Int J Cardiol 2014;171(2):192–8. [2] Shah AM, Banerjee T, Mukherjee D. Coronary, peripheral and cerebrovascular disease: a complex relationship. J Indian Med Assoc 2010;108(5):292–4. [3] Ahn S, Park YJ, Min SI, et al. High prevalence of peripheral arterial disease in Korean patients with coronary or cerebrovascular disease. J Korean Med Sci 2012;27(6):625–9. [4] Argyriou C, Saleptsis V, Koutsias S, Giannoukas AD. Peripheral arterial disease is prevalent but underdiagnosed and undertreated in the primary care setting in central Greece. Angiology 2013;64(2):119–24. [5] Paraskevas KI, Mukherjee D, Whayne Jr TF. Peripheral arterial disease: implications beyond the peripheral circulation. Angiology 2013;64(8):569–71. [6] Paraskevas KI, Mikhailidis DP, Veith FJ. Patients with peripheral arterial disease, abdominal aortic aneurysms and carotid artery stenosis are at increased risk for developing lung and other cancers. Int Angiol 2012;31(4):404–5. [7] Paraskevas KI, Kotsikoris I, Koupidis SA, Giannoukas AD, Mikhailidis DP. Ankle–brachial index: a marker of both peripheral arterial disease and systemic atherosclerosis, as well as a predictor of vascular events. Angiology 2010;61(6):521–3. [8] Hirsch AT, Criqui MH, Treat-Jacobson D, et al. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA 2001;286(11):1317–24.
