The month of September was PAD Awareness Month. It is an excellent opportunity to get the general public acquainted with this frequent but largely underdiagnosed condition. For MESI Ltd., however, early PAD detection and prevention are something we work and educate on every day.
For this reason, we will use the occasion of the recent PAD Awareness Month to review the integration of the latest PAD findings into health policies and guidelines. Today, we are focusing on the Scientific Statement from the American Heart Association on LEPAD (lower extremity peripheral artery disease). Published only a few months ago, the Statement brings the latest recommendations and guidelines of worldwide relevance, with the emphasis on screening and prevention as key in battling PAD.
A video says more than a thousand words, we are also presenting you a video lecture by Matjaž Špan, MD, discussing this Statement and successful lower extremity arterial assessment.
In this blog you will learn:
Founded in 1924, the American Heart Association educates the general public about healthy living, supports cardiovascular medical research, furthers cardiac care, and aims to influence medical and other stakeholders through guidelines on cardiovascular conditions and their prevention.
2021 marks five years since the publication of the 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease. In June this year, however, the American Heart Association published a Scientific Statement dedicated to PAD. It was made by a working group consisting of experts in cardiology, vascular medicine, vascular surgery and general internist medicine.
The aim of the Statement is to raise awareness and start the fight against PAD at primary care level. PAD is a condition impacting up to 230 million adult people globally. Although it is alarmingly prevalent and connected with high risk of e.g. stroke, coronary heart disease and amputations, neither patients nor doctors sufficiently consider its importance. As a result, PAD is understudied, underrecognised, underdiagnosed and undertreated. This is due to several factors:
The key recommendation of the Statement is that PAD screening with ABI be urgently implemented in high-risk populations. TBI or simultaneous measurement of ABI and TBI should be employed if suspecting medial artery calcification, e.g. in cases of chronic kidney disease (CKD) or diabetes.
Other key findings are that many PAD risks are the same as cardiovascular risks. The following certainly merit highlighting:
PAD is often underappreciated, but the Statement finds and warns that it is connected with severe complications:
PAD is gradual, but progressive in nature. For this reason, it is difficult to detect it without testing. The importance of timely lower extremity arterial assessment in connection with the Statement is discussed in this video by Matjaž Špan, MD, a specialist of cardiovascular and vascular surgery:
The message of the video and the Statement is that there are a number of implementation gaps regarding PAD control, especially at primary care level.
More should be done to raise PAD awareness of both doctors and patients. Exercise should be advocated as a strong factor in PAD prevention and preventive therapy. When the condition is diagnosed, however, supervised exercise therapy and home-based exercise are seriously underutilised in contrast to medical therapies for PAD.
High-risk populations should be screened for PAD at primary care level, using ABI. TBI should be more widely used, especially for ABI >1.4, with the emphasis on patients with diabetes or chronic kidney disease. TBI also merits more attention at research level.