Can peripheral arterial disease be early screened for in a podiatric setting?

NewsBot · Nov 20, 2012

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Can peripheral arterial disease be early screened for in a podiatric setting? A preliminary study in a cohort of asymptomatic adults.
Daddato S, Tartagni E, Dormi A, Ballarini G, Macciantelli M, Malagoni AM, Manfredini F, Manfredini R, Borghi C.
Eur Rev Med Pharmacol Sci. 2012 Nov;16(12):1646-50.

BACKGROUND:
Peripheral arterial disease (PAD) is a strong marker of cardiovascular disease but remains an under-diagnosed problem. Moreover, PAD frequently leads to foot problems requiring particular care and surveillance.

AIM:
The aims of this study were (1) to determine the prevalence of undiagnosed PAD in a cohort of asymptomatic subjects referred to a podiatric clinic and (2) to evaluate whether a four-item form assessing medical history for the presence of cardiovascular risk factors could identify subjects at high risk for asymptomatic PAD.

PATIENTS AND METHODS:
This study included 717 consecutive subjects (121 males, age 50.9±13.9 y) referring to a podiatric clinic who were asymptomatic for PAD and free of cardiovascular disease. The ankle brachial index (ABI) was measured in all subjects. Each subject also completed a self-administered form to identify cardiovascular risk factors.

RESULTS:
Among the entire cohort, the prevalence of PAD was 8.3% in males and 1.2% in females. Three subgroups were identified according to the number of risk factors reported (no risk factors, one risk factor, and two or more risk factors), and the prevalence of PAD differed between each subgroup (0.2%, 3.2%, and 18.9%, respectively; p < 0.001).

CONCLUSIONS:
In an unselected cohort of subjects referring to a podiatric clinic, who were asymptomatic for PAD and free from cardiovascular diseases, a remarkable prevalence of PAD was found among subjects reporting a minimum of two cardiovascular risk factors. In a podiatric setting, screening with a self-administered form for the presence of cardiovascular risk factors might lead to an early diagnosis of PAD.
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Admin2 · Nov 20, 2012

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David Smith · Nov 21, 2012

Full paper here

http://www.europeanreview.org/wp/wp-content/uploads/1646-1650.pdf

Dave Smith

NewsBot · Mar 1, 2015

A systematic review for the screening for peripheral arterial disease in asymptomatic patients
Fares Alahdab, MD, Amy T. Wang, MD, Tarig A. Elraiyah, MBBS, Rafael D. Malgor, MD, Adnan Z. Rizvi, MD, Melanie A. Lane, BA, Larry J. Prokop, MLS, Victor M. Montori, MD, MSc, Michael S. Conte, MD, Mohammad Hassan Murad, MD, MPH
JVS; March 2015Volume 61, Issue 3, Supplement, Pages 42S–53S

Background
Peripheral arterial disease (PAD) is common and associated with significant morbidity and mortality. PAD can be detected through a noninvasive measurement of the ankle-brachial index (ABI).

Methods
We conducted a systematic review of several electronic bibliographic databases for studies that evaluated ABI as a screening test for PAD in asymptomatic individuals. We conducted random-effects meta-analysis, reporting pooled hazard ratios (HRs) when appropriate.

Results
We included 40 individual studies, 2 systematic reviews, and 1 individual-patient data meta-analysis. We found no studies comparing ABI screening with no screening in terms of patient-important outcomes (mortality, amputations). The yield of PAD screening averaged 17% (range, 1%-42%) and was 1% to 4% in lower risk populations. Patients with PAD had higher adjusted risk of all-cause mortality (HR, 2.99; 95% confidence interval, 2.16-4.12) and of cardiovascular mortality (HR, 2.35; 95% confidence interval, 1.91-2.89). Data on benefits, harms, and cost-effectiveness of screening were limited; however, ABI screening was associated with additional prognostic information and risk stratification for heart disease. The overall quality of evidence supporting screening was low.

Conclusions
The current available evidence demonstrates that PAD is common in patients with multiple cardiovascular risk factors and is associated with significant morbidity and mortality, but it does not support the benefit of routine ABI screening.
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David Smith Well-Known Member

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