Coronary artery disease (CAD) is a common comorbidity among patients with severe peripheral artery disease (PAD), and further complicates a patient's cardiovascular health. Both CAD and severe PAD are known determinants of major adverse cardiovascular events (MACE). Assessing MACE in patients with severe PAD and CAD remains a challenge due to the complex nature of both diseases.
Heart failure (HF) prevalence has increased progressively over the past several decades, primarily owing to a reduction in myocardial infarction (MI) mortality and the general US population's prolonged lifespan. Over 5.7 million people are currently living with HF in the United States. Among adults aged =40 years, it is estimated that =1 in 5 will be diagnosed with HF during their lifetime.
Coronary artery disease (CAD) and peripheral artery disease (PAD) each involve narrowing of arteries, the effects of which restrict blood flow to the heart and/or the extremeties. Approximately 6% of adults (i.e. adults aged=18 years) in the United States (US) have CAD, and about 6.2% (aged =40 years) have PAD2; corresponding values for older (i.e., aged =65 years) Americans are 45%3 and between 12-20%4, respectively.
Explaining the elements of trial design that allow for early trial discontinuation for efficacy, how such a decision is made, and the implications.
Describe the link between atherosclerosis and PAD, and explain the long-term risk of events that exists for patients with PAD.
The ankle-brachial index (ABI) is a well-accepted tool to assess severity of peripheral arterial disease (PAD). Categorization of ABI values to match clinical PAD severity (claudication, rest pain, and tissue loss) is based on limited data of a few hundred patients from 1970 and 1996. The American Heart Association guidelines recommended to change reporting of ABIs for cardiovascular risk stratification to normal, abnormal, borderline, and noncompressible. As such, reporting categories for ABI in PAD need re-evaluation.
Atherosclerotic peripheral arterial disease (PAD) is one of the most prevalent, morbid, and mortal diseases. The aim of this study was to evaluate mortality rates of patients with atherosclerotic PAD stratified according to age and diabetes and to determine predictors of death.
This animated video describes the disease process of abnormal blood clot formation resulting from atherosclerotic plaque ruptures and the importance of managing risk factors associated with thrombosis.
Describing and explaining the increased risk relationship between diabetes and CAD/PAD, including how diabetes impacts the vascular system, endothelial function and platelets.
Describing the role of chronic, systemic inflammation and its on patients with CAD and/or PAD, as well as the interaction between inflammation and smoking, inflammation and lipids.
Describing the link between smoking and PAD outcomes, and how physicians hold smoking cessation discussions with patients.
Secondary prevention therapies and positive lifestyle interventions benefit high-risk patients with PAD and concomitant CAD.
Desribing the prevalence of polyvascular disease, and implications for patients in terms of risk/outcomes.
Advocacy and education initiatives are key to improving awareness of PAD among patients and providers.
This discussion examines heart disease treatment guidelines as they apply to the growing elderly U.S. population.
This review describes the progression of the atherosclerotic lesion along with the main morphological characteristics that predispose to plaque rupture, discusses the multifaceted mechanisms that drive platelet activation and subsequent thrombus formation, and considers the current scientific challenges and future research directions.
In a recent report, epidemiologic features of chronic atrial fibrilation (AF) were described based on comprehensive biennial cardiovascular examinations of participants in the Framingham Heart Study.
Women have high rates of peripheral artery disease (PAD) despite fewer cardiovascular disease (CVD) risk factors, compared to men.
Lower extremity peripheral artery disease is the third leading cause of atherosclerotic cardiovascular morbidity, following coronary artery disease and stroke.
Peripheral arterial disease (PAD) is common and is a marker of systemic atherosclerosis.
Platelets are essential for primary hemostasis and repair of the endothelium, but they also play a key role in the development of acute coronary syndromes and contribute to cerebrovascular events.
Reviewing the prevalence and incidence of CAD and PAD, and the challenges that face physicians who manage patients at risk for these diseases.
The role of coagulation and platelet activation, and their relationship to cardiovascular events.
Bleeding has recently emerged as an important outcome in the management of acute coronary syndromes (ACS), which is relatively frequent compared with ischaemic outcomes and has important implications in terms of prognosis, outcomes, and costs.
This study investigated the characteristics, evaluation, prognostic impact, and treatment of coronary artery disease (CAD) in patients with heart failure and preserved ejection fraction (HFpEF).
To objectively assess the presence of polyvascular disease in patients with peripheral arterial disease and its relation to inflammation and clinical risk factors.
The authors compared the peripheral vascular function of veterans and non-veterans with peripheral artery disease (PAD) and claudication.
This article describes the characteristics of thrombus formation on atherosclerotic plaques, the clinical expression of atherothrombosis in vascular disease, and some of the most recent therapeutic approaches in cardiovascular disease.
This article compares myocardial infarction (MI) and mortality rates between patients with nonobstructive CAD, obstructive CAD, and no apparent CAD in a national cohort.
Acute coronary syndrome (ACS) is a medical emergency. Patients who survive the initial event remain at risk of recurrent cardiovascular events.
While we in the medical community can appropriately pat ourselves on the back for winning numerous battles, the war on atherosclerosis is not over. We have not cured atherosclerosis.
Describe the CAPRIE and CREDO studies and the increasing importance of identifying patients with PAD and managing their their atherosclerotic and thrombotic risk.
Describing MALE (ALI, CLI, amuptation,etc.) and their outcomes, and how patients at risk are managed.
This article highlights a cross-sectional, population-based telephone survey of a nationally representative sample of 2501 adults greater than or equal to 50 years of age, with oversampling of blacks and Hispanics.
The burden of peripheral artery disease is shifting rapidly from high-income to low-income and middle-income countries. This article examines the epidemiology of PAD and, where feasible, takes a global perspective.
Lower extremity atherosclerotic peripheral artery disease has a very high prevalence in most nations and in the United States. Lower extremity PAD is now known to be associated with equal morbidity and mortality and comparable (or higher) health economic costs as coronary heart disease (CHD) and ischemic stroke. Yet where surveyed, the public and clinicians (as well as health payers and government agencies) do not yet fully recognize the risks associated with PAD.
The objective of the study was to determine if there are sex-based differences in the prevalence and clinical outcomes of subclinical peripheral artery disease (PAD).
This resource discusses the background and progression of Peripheral Artery Disease (PAD) and Coronary Artery Disease (CAD) and their association with arterial thrombosis.
Lower extremity peripheral artery disease is the third leading cause of atherosclerotic cardiovascular morbidity, following coronary artery disease and stroke.This study provides the first comparison of the prevalence of peripheral artery disease between high - income countries (HIC) and low - income or middle - income countries (LMIC), establishes the primary risk factors for peripheral artery disease in these settings, and estimates the number of people living with peripheral artery disease regionally and globally.
This article describes peripheral arterial disease (PAD) in African Americans, and compares findings in African Americans and whites with PAD.
This brief video gives an overview of both Coronary Artery Disease (CAD) and Peripheral Artery Disease (PAD), the causes of these diseases, and their prevalence.
Recent developments in guideline-recommended therapy and medical care for patients with PAD.
This article reviews recommendations on duration of dual antiplatelet therapy (aspirin plus a P2Y12 inhibitor) in patients with coronary artery disease.
Non–ST-segment elevation acute coronary syndromes (NSTE-ACS) are the leading cause of morbidity and mortality from cardiovascular disease worldwide.
The Trans-Atlantic Inter-Society Consensus Document on Management of Peripheral Arterial Disease (TASC) was published in January 2000 and had a major impact on vascular care amongst specialists.
These guidelines, based on systematic methods to evaluate and classify evidence, provide a cornerstone of quality cardiovascular care.
These guidelines should be applied to patients with stable known or suspected coronary artery disease (SCAD).
Guidelines summarize and evaluate available evidence with the aim of assisting health professionals in selecting the best management strategies for an individual patient with a given condition. Guidelines and their recommendations should facilitate decision making of health professionals in their daily practice. However, the final decisions concerning an individual patient must be made by the responsible health professional(s) in consultation with the patient and caregiver as appropriate.
Critical limb ischemia (CLI) is prevalent in approximatley 1.3% of the adult population, and a specific association between diabetes and CLI has been long established. Comorbid diabetes has been estimated to be prevalent in up to 30% of the CLI population.
Peripheral artery disease (PAD) is manifested over a continuum of severity, with severe PAD patients at greater risk for comorbid coronary artery disease, diabetes, and renal disease and related complications. Increased number of comorbidities contributes to greater healthcare resource utilization (HRU) and healthcare costs (HC). An aging population, with increased prevalence of severe PAD and associated comorbidities, may increase these costs.
Coronary Artery Disease (CAD) accelerates the progression of heart failure (HF) with sytsolic dysfunction (SD), leading to poor prognosis and a substantial increase in morbidity and mortality. New-onset HF patients with CAD had a substantial burden of all-cause mortality, myocardial infarction (MI) and ischemic stroke (IS), all of which decline over time.
Describe the risk and outcomes among patients with CAD and CVD, and the impact that antiplatelet therapies have on patient mortality.
Patients with peripheral artery disease (PAD) are at heightened risk of acute limb ischemia (ALI), a morbid event that may result in limb loss.
Long-term progression of peripheral arterial disease (PAD) as initial manifestation of atherosclerotic arterial disease is not well described.
In patients with symptomatic peripheral artery disease with a history of limb revascularization, the optimal antithrombotic regimen for long-term management is unknown.
Dual antiplatelet therapy with clopidogrel plus acetylsalicylic acid (ASA) is superior to ASA alone in patients with acute coronary syndromes and in those undergoing percutaneous coronary intervention.
Peripheral artery disease (PAD) is common and imposes a high risk of major systemic and limb ischemic events.
Contemporary data on clinical outcomes after utilization of atherectomy in lower extremity endovascular revascularization are sparse. The study cohort was derived from Healthcare Cost and Utilization Project nationwide inpatient sample database from the year 2012.
The optimal antiplatelet regimen after in‑coronary intervention among patients presenting with complex coronary artery lesions or acute coronary syndrome (ACS) has remained unclear. This study sought to evaluate the clinical outcomes of triple antiplatelet treatment (TAPT) (cilostazol added to aspirin plus clopidogrel) in these patients.
Little is known regarding the contemporary outcomes of older patients with peripheral artery disease (PAD) undergoing major lower extremity (LE) amputation in the United States. The authors sought to characterize clinical outcomes and factors associated with outcomes after LE amputation in patients with PAD.
Review facts about the prevalence rate of PAD among the African American population.
This article analyzes two potential pathways for racial disparities: primary amputation, defined as a major amputation performed without any prior attempt at revascularization, and repeat amputation, defined as a major amputation subsequent to a previous through - foot or major amputation.
This report, which uses 2007 - 2011 Medicare data, looks at the scope of diabetes and peripheral arterial disease in the U.S., with a focus on geographic variations in both preventative services and interventional, while recognizing the ultimate goal of avoiding amputation and preserving the ability to walk for patients.
Studies have observed a decrease in hospitalizations for congestive heart failure (CHF), likely due to policy changes. Little is known about the nationwide estimates of emergency department (ED) visits and subsequent hospitalizations for patients with shortness of breath (SOB) and a history of CHF
In the United States, up to 50% of patients do not adhere to chronic disease therapy, leading to an estimated $100-289 billion in preventable healthcare costs per year. Cardiovascular and diabetes medications are the most commonly used drugs in the U.S., yet adherence to these medications is suboptimal
Describing what is known about the challenges in maintaining patient adherence to medications following PCI, including approaches that are known to effectively improve patient adherence.
Assess the impact of digital technologies on patients with PAD and CAD, specifically focusing on the potential of new, wearable technologies that may induce positive changes in lifestyle that will reduce risk of adverse outcomes.
How medical imaging is applied in the diagnosis and management of PAD, including core tools, basic language, and core understanding of the differences in devices and results.
Aspirin resistance and clopidogrel resistance are terms used to describe a reduction in the medication's efficacy in inhibiting platelet aggregation despite regular dosing. This review gives context to the clinical role and implications of antiplatelet resistance in peripheral arterial disease.
During the past 15 years, the number of major dysvascular amputations (defined as amputations above the ankle) performed annually has decreased. However, major amputation (MA) continues to be a primary therapy and is frequently the only treatment offered for critical limb ischemia.
Describe the overall study aims, and the methods of the subanalysis, and the results of the subanalysis focused on DAPT following PCI with stent implantation in patients with PAD.
Describe challenges in achieving optimal adherence to medical recommendations among patients with CAD and/or PAD, and means of increasing adherence through patient engagement.
Describe how physicians manage cardiovascular risk, including therapies to reduce cholesterol, manage blood pressure, and reduce thromotic risk, as well as lifestyle changes such as smoking cessation, diet and exercise.
A review of current recommendations and research for managing the lifestyle risk factors of PAD
Describing how physicians manage patients with prior atherothrombotic events in order to prevent further disease progression.
African Americans are more than twice as likely as non-Hispanic whites to suffer from PAD. Review the management of PAD in African Americans.
Trends in the risk of amputation remain unexplored in recent years. The resource examines trends in lower extremity amputation rates, diagnostic and therapeutic vascular procedures, and the use of preventive measures aimed at limiting the use of amputation procedures in the United States between 1996 and 2011.
Discuss various studies that have assessed the optimal duration of DAPT following DES implanatation, and relate present recommendations.
Describing the various lifestyle interventions available to improve outcomes among patients with CAD and/or PAD.
This article categorizes the risk of cardiovascular events in stable outpatients with various initial manifestations of atherothrombosis using simple clinical descriptors.
The prevalence of peripheral arterial disease (PAD) increases with age. PAD in elderly persons may be asymptomatic, may be associated with intermittent claudication, or may be associated with critical limb ischemia.
It remains uncertain whether patients with atrial fibrillation requiring longterm oral anticoagulation and with stable coronary artery disease should receive antiplatelet therapy in addition to oral anticoagulation.
The benefit of aspirin among patients with stable atherosclerosis without a prior ischemic event is not well defined. Aspirin is of benefit in outpatients with atherosclerosis with prior ischemic events, but not in those without ischemic events.
Peripheral artery disease is considered to be a manifestation of systemic atherosclerosis with associated adverse cardiovascular and limb events. Data from previous trials have suggested that patients receiving clopidogrel monotherapy had a lower risk of cardiovascular events than those receiving aspirin. The authors compared clopidogrel with ticagrelor, a potent antiplatelet agent, in patients with peripheral artery disease.
The authors carried out a meta-analysis summarizing the efficacy and safety of direct factor Xa inhibitor (DXI) in patients receiving guideline-based antiplatelet therapy (GBAT) after an acute coronary syndrome.
Dual antiplatelet therapy with clopidogrel plus low-dose aspirin has not been studied in a broad population of patients at high risk for atherothrombotic events.
Read about the effects of antiplatelet therapy among patients at high risk of occlusive vascular events.
Peripheral vascular interventions have been traditionally performed in the inpatient setting. However, there has been a recent shift away from hospital-based vascular interventions toward outpatient-based procedures. Data are scarce on the efficacy and safety of such procedures being performed in the outpatient setting. This study evaluates the safety and efficacy of peripheral vascular interventions performed in a private, outpatient catheterization laboratory.
This resource identifies the signs and symptoms of peripheral artery disease and distinguishes them from other diseases that can mimic PAD. Diagnose PAD using the history, findings on physical examination, and ankle brachial index, and formulate an integrated treatment program to improve the symptoms and quality of life and decrease the high cardiovascular event rate.
Many believe that variation in vascular practice may affect limb salvage rates in patients with severe peripheral arterial disease. However, the extent of variation in procedural vascular care obtained by patients with critical limb ischemia (CLI) remains unknown.
This Dartmouth Atlas of Health Care series reports on unwarranted regional variation in the care of several conditions for which surgery is one important treatment option.
Chronic heart failure (HF) affects 5 million patients in the United States and is responsible for &1 million hospitalizations and 300,000 deaths annually.
This article evaluates the efficacy of conservative adjuvant therapy after revascularisation procedures in patients with peripheral arterial disease.
Dual antiplatelet therapy with aspirin and clopidogrel is standard for prevention of thrombotic complications of percutaneous coronary intervention (PCI).
This study evaluated the efficacy and safety of ticagrelor on major cardiovascular (CV) events and major adverse limb events in patients with PAD and a prior MI.
Atherosclerotic peripheral arterial disease is associated with an increased risk of myocardial infarction, stroke, and death from cardiovascular causes.
Vorapaxar is a novel antagonist of protease-activated receptor-1, the primary receptor for thrombin on human platelets that is also present on vascular endothelium and smooth muscle.
Gastrointestinal complications are an important problem of antithrombotic therapy. Proton-pump inhibitors (PPIs) are believed to decrease the risk of such complications, though no randomized trial has proved this in patients receiving dual antiplatelet therapy.
Dual antiplatelet therapy with clopidogrel plus low-dose aspirin has not been studied in a broad population of patients at high risk for atherothrombotic events.
Thrombin potently activates platelets through the protease-activated receptor PAR-1. Vorapaxar is a novel antiplatelet agent that selectively inhibits the cellular actions of thrombin through antagonism of PAR-1.
The role of antithrombotic therapy in secondary prevention after myocardial infarction is well established.
Antiplatelet treatment with aspirin and oral anticoagulants reduces reocurrence of ischaemic events after myocardial infarction.
Oral anticoagulants have been used in patients with vascular disease for over 40 years, yet their role in the secondary prevention of recurrent cardiovascular (CV) events remains controversial.
Treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) or low-dose aspirin is associated with increased risk of upper gastrointestinal bleeding.
In patients who have vascular disease or high-risk diabetes without heart failure, angiotensin-converting–enzyme (ACE) inhibitors reduce mortality and morbidity from cardiovascular causes, but the role of angiotensin-receptor blockers (ARBs) in such patients is unknown.
Antiplatelet agents are a cornerstone of therapy for patients with atherosclerotic vascular disease. There is presently a lack of comprehensive guidelines focusing on the use of antiplatelet drugs in patients currently manifesting or at elevated risk of cardiovascular disease.
Peripheral artery disease affects >200 million people worldwide and is associated with significant limb and cardiovascular morbidity and mortality.
This article reviews the best evidence for medical treatment of PAD.
This guideline focuses on antithrombotic drug therapies for primary and secondary prevention of cardiovascular disease as well as for the relief of lower-extremity symptoms and critical ischemia in persons with peripheral arterial disease (PAD).
This review provides a succinct and updated appraisal of the long-term effects of chronic oral anticoagulation in the setting of coronary artery disease.
This article determines the effects of antiplatelet therapy among patients at high risk of occlusive vascular events.
PPIs have become one of the most commonly used medications worldwide, as they are the treatment of choice for several acid-related gastrointestinal disorders.
Proton pump inhibitors (PPIs) are among the most commonly used drugs worldwide and have been linked to acute interstitial nephritis. Less is known about the association between PPI use and chronic kidney disease (CKD).
Medications that influence the risk of dementia in the elderly can be relevant for dementia prevention. Proton pump inhibitors (PPIs) are widely used for the treatment of gastrointestinal diseases but have also been shown to be potentially involved in cognitive decline.
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