Patients with peripheral arterial d...

Patients with peripheral arterial disease (PAD) have a threefold to fivefold risk of cardiovascular morbidity and mortality compared with patients without PAD, and PAD carries a cardiovascular risk comparable to that of coronary artery disease. Studies have shown however, that risk factors for atherosclerotic disease are undertreated in patients with PAD, unruffled though the American Heart Association and the National Cholesterol Education Program praise the same degree of risk-factor reduction in patients with coronary artery disease or PAD. McDermott and colleagues hypothesized that physicians who treat patients with either condition are more likely to address cardiovascular risk factors in patients with coronary artery disease than in those with PAD and no other obvious cardiovascular symptoms.

Family physicians, internists, cardiologists, and vascular surgeon were asked to fill without questionnaires to assess their risk reduction behavior as well as their knowledge of and attitude toward treating risk factors in patients with PAD. The observes contained hypothetic cases of patients with PAD solitary coronary artery disease only, or no disease. The vascular surgeon were asked no other than about the hypothetic PAD patients, because they were unlikely to treat patients with coronary artery disease or no disease.

A total of 1578 physicians, including 264 vascular surgeon were eligible for the application of mind and completed the questionnaire. Physicians were les likely to report "almost always" prescribing antiplatelet therapy or recommending aerobic exercise for the hypothetic patient with PAD than for the patient with coronary artery disease. They were also more likely to initiate diet and put drugs into therapy at higher cholesterol flushs for the patient with PAD. Physicians were significantly more likely to report the importance of initiating antiplatelet therapy and lowering cholesterol in the patient with coronary artery disease. Cardiologists used the principally aggressive approach to treatment and were significantly more likely than other specialties to report "almost always" prescribing antiplatelet therapy and lowering cholesterol of the same heights for patients with PAD, whereas the vascular surgeon were the least likely to report doing so

Overall, physicians reported significantly lower rates of prescribing antiplatelet therapy, cholesterol-lowering therapy, and aerobic exercise for patients with PAD than for patients with coronary artery disease. Physicians also were more likely to state that antiplatelet therapy and cholesterol lowering were extremely important interventions in patients with coronary artery disease than in patients with PAD. Perception of the importance of risk factor intervention strenuously correlated with reported behavior. This close attention suggests that even though rife guidelines recommend equal risk factor intervention in patients with PAD and in patients with coronary artery disease, principally physicians undertreat risk factors in patients with PAD when no other obvious cardiovascular symptoms are present

CAROLINE WELLBERY, MD

McDermott MM et al. Atherosclerotic risk factor reduction in peripheral arterial disease. ends of a national physician overlook J Gen Intern Med December 2002; 17:895-904

COPYRIGHT 2003 American Academy of Family Physicians

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