PAD Frequently Undiagnosed in Heart Disease Patients

Condition is overlooked in up to 15 percent of patients; systematic screening recommended

10 may 2009-- As many as one in six patients with coronary artery disease (CAD) may have overlooked peripheral arterial disease (PAD) despite specialist cardiovascular care, according to a study published in the May issue of Catheterization & Cardiovascular Interventions.

Issam D. Moussa, M.D., of the New York Presbyterian Hospital/Weill Cornell Medical Center in New York City, and colleagues assessed 800 patients without known PAD who were referred for coronary angiography.

Overall, the researchers found that the prevalence of overlooked PAD was 15 percent, and that the prevalence was highest among subjects over age 70 years and women (25.2 and 23.3 percent, respectively). They also found that subjects with multi-vessel CAD were twice as likely to have previously unrecognized PAD as those with single-vessel CAD.

"These findings extend the results of previous research and not only suggest a greater burden of atherosclerotic disease and later presentation, but also provide a possible explanation for the worse outcome of patients with concomitant CAD and PAD compared with those without PAD," the authors write. "Therefore, making a diagnosis of PAD in a patient with CAD should prompt the clinician to be more aggressive with risk factor intervention, foot protection, and a high clinical index of suspicion for progressive PAD symptoms. These patients must be viewed as exceptionally 'high risk.' Systematic, ankle-brachial index-based, PAD screening programs should be implemented in all patients with CAD."

This study was supported by Sanofi-Synthelabo.

Abstract
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