Why should cardiologist care about peripheral arterial disease in their cardiac patients?

Abstract

Identification of patients with PAD provides valuable prognostic information and the importance of prompt diagnosis and timely intervention in patients at risk of PAD and those with undiagnosed PAD cannot be ignored. The 5-year mortality rate for patients with PAD is � 30%, with 75% of deaths from cardiovascular causes which is overwhelming due to myocardial infarction and stroke. 4 Furthermore, patients with symptomatic PAD often experience diminished quality of life (QoL) and physical limitation which is on a par with other cardiovascular diseases such as heart failure and ischaemic heart disease. 5 Peripheral arterial disease is common among patients with coronary artery disease (CAD). 6 Patients with concomitant CAD and PAD have worse prognosis, lower QoL, and physical function than patients with either disease alone. In the REACH registry, major cardiovascular events at 1 year were 13% in patients with CAD alone and 23% (P , 0.001) in combined CAD and PAD. Patients with PAD have more severe CAD manifested by higher frequency of left-main and multivessel CAD suggesting greater burden of atherosclerosis. 7 Therefore, early diagnosis of PAD in patients with CAD should prompt aggressive risk factor modification to slow progression of atherosclerosis and prevent premature deaths, heart attack, and stroke. The deleterious nature of PAD is compounded by being an under-diagnosed and under-treated disease. Less than half of PAD patients are diagnosed because majority are