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National Study Finds Peripheral Arterial Disease
Is Under-Diagnosed and Under-Treated

Condition Puts Patients at High Risk for Heart Disease and Stroke

Peripheral Arterial Disease (PAD), a predictor of heart disease and stroke, is more prevalent than previously thought and seriously under-treated, according to a national study reported in the September 19 Journal of the American Medical Association (JAMA). Characterized by clogged arteries and poor circulation in the legs, PAD affects 8 to 12 million Americans, who have at least four times the risk of suffering heart attack or stroke.

According to the authors of the study, called PAD Awareness, Risk and Treatment: New Resources for Survival (PARTNERS), PAD can be easily diagnosed and treated by primary care physicians, using many standard approaches to managing cholesterol and blood pressure, plus modifying high-risk behaviors such as smoking.

Michael Criqui, M.D., M.P.H.

Michael Criqui, M.D., M.P.H.

Co-chairs for the study were Alan T. Hirsch, M.D., Vascular Medicine Program, University of Minnesota Medical School, and William R. Hiatt, M.D., Division of Geriatrics and Cardiology, University of Colorado Health Sciences Center. The study epidemiologist was Michael Criqui, M.D., M.P.H., professor of family and preventive medicine, UCSD School of Medicine. In addition to his key role on the steering committee of the PARTNERS study, Criqui has played a prominent role for many years in PAD research and preventive cardiology. He has published many of the seminal papers in the area of peripheral arterial disease.

During the five-month study, nearly 7,000 individuals were followed in 350 primary care practices in 25 cities. Investigators targeted individuals considered at high risk for PAD – patients aged 70 and older, as well as those aged 50 through 69 who had a history of cigarette smoking and/or diabetes. The researchers found that 29 percent of the patients had PAD, but only 49 percent of these individuals’ primary care physicians were aware their patients had PAD. Even when physicians were aware, they tended to under-treat the condition, the study reported.

Historically, PAD has not been considered a disease of importance in primary care, say the study’s authors. Early diagnosis was not a focus and care was traditionally provided by vascular specialists. The study indicates that primary care practices are ideal sites to identify high risk patients, diagnose PAD and deliver long term treatment.

Criqui noted that many physicians still think of PAD as a leg problem and too often, only treat the classic leg pain that is experienced only by 10 percent of PAD patients.

A sample Doppler device for diagnosing peripheral arterial disease (PAD).

The ankle-brachial index (ABI) reading is easily measured with a Doppler device in a primary care setting.

“If you rely on leg pain alone to catch PAD, you miss the 90 percent of PAD patients who don’t have the typical pain,” Criqui said, adding that primary care physicians need to routinely screen individuals age 60 and over, as well as patients between ages 50 and 60 who have a history of smoking, heart disease, high blood pressure, high cholesterol and/or diabetes.

Criqui said PAD screening should be done with a Doppler device that measures the ankle-brachial index (ABI). Traditional blood pressure cuffs are used on both the arm and the ankle.

When individuals are identified with PAD, the PARTNERS investigators noted that aggressive treatment may include:

Additional co-investigators in the PARTNERS study were Judith G. Regensteiner, Ph.D., University of Colorado Health Sciences Center, Denver; Diane Treat-Jacobson, Ph.D., R.N., Susan H. Krook, Ph.D., and Donald B. Hunninghake, M.D., Vascular Medicine Program, University of Minnesota, Minneapolis; Mark A. Creager, M.D., Brigham and Women’s Hospital, Boston; Jeffrey W. Olin, D.O., Heart and Vascular Institute, Morristown, NJ; Anthony J. Comerota, M.D., Temple University Hospital, Philadelphia; M. Eileen Walsh, R.N., MSN, CVN, Jobst Center, Toledo, Ohio; and Mary M. McDermott, M.D., Northwestern University Medical Center, Chicago.


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Embargo: September 18, 2001; 4:00 p.m. C.D.T.

Contact:Sarah Youngerman, Academic Health Center, 612.624.4604 (pager: 612.899.6687); Tonya Femal, Academic Health Center, 612.625.2640; Deane Morrison, University News Service, 612-624.2346


PARTNERS project points to need for increased awareness and treatment recommendations that prevent heart attacks and stroke

MINNEAPOLIS / ST. PAUL (September 17, 2001) The results of the largest study ever done on peripheral artery disease (PAD) shows significant numbers of people with the disease are underdiagnosed and undertreated. The results, which are published in the September 19, 2001 issue of the Journal of American Medical Association (JAMA), revealed that almost 30 percent of the 6,417 study participants were diagnosed with PAD, more than half for the first time.

People with PAD are six times more likely to die from cardiovascular disease within 10 years than those who do not have PAD. It is believed that PAD affects between 8 and 12 million in the United States.

PAD is easily detected using a non-invasive technique measuring the systolic blood pressure in the legs and arms, to calculate the ankle-brachial index (ABI), according to Alan T. Hirsch, M.D., cardiologist and associate professor, University of Minnesota School of Medicine.

“Those diagnosed with PAD can reduces their risk for complications beginning with three steps: modify their diet and exercise program, those who smoke should quit and patients should work with their healthcare professional to control blood pressure and blood sugar levels.”

PAD is caused by a condition in which the arteries become narrowed due to the formation of plaque inside the artery walls. Symptoms may include pain, cramps or a tired feeling in the calf or thigh that occurs during walking and is relieved by rest. However, symptoms alone are not reliable indicators of the presence or progression of PAD, because more than two-thirds of those with PAD have no symptoms at all.

Left untreated, the plaque can rupture, leading to platelet-induced thrombosis or blood clot formation, a process known as atherothrombosis. Atherothrombosis can lead to serious health consequences including heart attack and stroke.

PARTNERS (PAD Awareness Risk and Treatment: New Resources for Survival) is a national program to assess awareness of PAD among patients and healthcare professionals across the United States. The project was modeled after a pilot study done at the University of Minnesota, which revealed similar results. Nearly 7,000 at-risk patients from 27 regional centers and 320 primary care practices were evaluated. “At risk” patients were defined as anyone 70 years of age and older or those between 50 and 69 years of age with a history of smoking and/or diabetes.

The PARTNERS study also suggests that there is more that can be done to raise awareness in both physicians and patients so that an early diagnosis and treatment recommendations can be outlined in the primary care setting. "There is almost no other disease that affects so many people, that creates so much suffering, yet that is so easy to diagnose and so easily treated," reminded Hirsch.

The PARTNERS study was supported by the Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership.