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Query: UMLS:C0004153 (atherosclerosis)
 77,401 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Peripheral arterial disease (PAD), characterized by obstruction of the arteries in the lower limbs, is an important manifestation of atherosclerosis. There are >10 million individuals with PAD in the United States alone, and as the overall population in developed countries ages, PAD will become increasingly prevalent. Many individuals with PAD are asymptomatic and therefore remain undiagnosed and untreated. Most patients with PAD are at high risk for having a serious coronary or cerebrovascular event. Even for patients in whom symptoms, such as leg pain, are clearly evident, current treatment strategies tend to ignore the systemic nature of the disease and do not reduce overall atherosclerotic risk. Proven medical treatment options for patients with intermittent claudication include smoking cessation, exercise, and cilostazol. Pentoxifylline appears marginally effective. Several novel therapies for PAD are currently under investigation. Of particular interest are the observations from some studies that show that lipid-lowering therapy might be of benefit to PAD patients. The results of 2 ongoing prospective trials of dyslipidemic therapy in claudicants should further clarify the benefits of reducing serum lipid levels in patients with established PAD.
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PMID:Systemic atherosclerosis risk and the mandate for intervention in atherosclerotic peripheral arterial disease. 1159 99

Peripheral arterial disease (PAD) is a very common manifestation of atherosclerosis and is associated with a high risk of cardiovascular morbidity and mortality. Despite the magnitude of the problem, PAD is often under-recognized in clinical practice until its limb manifestations are severe or heart attack or stroke supervene. The PAD Awareness, Risk and Treatment: New Resources for Survival (PARTNERS) program, recently completed in the USA, had five aims: (1) creation of a method for detection of PAD in primary care practice; (2) assessment of the awareness of the PAD diagnosis in both patients and physicians; (3) assessment of the magnitude of the atherosclerotic risk factor burden and intensity of treatment of atherosclerotic risk factors in PAD patients; (4) assessment of the disease-specific and general quality of life of PAD patients in their communities; and (5) provision of an educational intervention to foster improved community-prescribed medical interventions for patients with PAD. Lack of public and physician interest in PAD contrasts with the high prevalence and poor medical prognosis of PAD. The intention of PARTNERS was to create a community-based program to measure current rates of PAD awareness, physician recognition and treatment intensity. Data obtained will form the basis of future clinical investigations to improve clinical care for PAD patients in the USA.
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PMID:PAD awareness, risk, and treatment: new resources for survival--the USA PARTNERS program. 1178 64

Peripheral arterial disease (PAD) involving the lower extremities is presumably a disease of the elderly. The awareness of PAD in the general population, and in younger adults in particular, is low. Atherosclerosis is the major cause of lower limb ischemia in the young. Young adults with clinical manifestations of premature lower extremity atherosclerosis (PLEA) typically have multiple cardiovascular risk factors and the majority are smokers, with strong family history of cardiovascular disease, and typically have chronic symptoms of claudication at diagnosis. Frequently these symptoms are either not reported in a timely manner by the patients or are attributed to other, presumably more common causes of leg pain in the young. More than 70% of patients with PLEA have angiographic evidence of severe aortoiliac disease. The results of surgical revascularizations in young adults are inferior to those reported in older patients. Younger adults typically require multiple revascularizations with relatively high amputation rate. We conclude that PAD should be considered in adults with multiple risk factors regardless of their age if appropriate symptoms are present. There is a need for increased public health awareness for premature lower extremity atherosclerosis.
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PMID:Premature lower extremity atherosclerosis: clinical aspects. 1181 36

Peripheral arterial disease (PAD) is a common but under-recognized problem affecting older patients. Intermittent claudication is the most frequent symptom of PAD, although the diagnosis of PAD is often overlooked until the patient presents with limb-threatening ischemia. Importantly, PAD is a marker for generalized atherosclerosis and is closely associated with coronary and cerebrovascular disease. The severity of PAD has been correlated with an increased risk of myocardial infarction, stroke, and cardiovascular death. The recognition and diagnosis of PAD, combined with its appropriate medical management, may well reduce the overall risk of cardiovascular morbidity. When diagnosed early, both exercise and pharmacotherapy can ameliorate symptoms of claudication, augment functional performance, and improve quality of life.
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PMID:Peripheral arterial disease: medical care and prevention of complications. 1209 54

The real prevalence of Peripheral Arterial Disease (PAD) is considerably underestimated if only symptomatic patients (i.e those with Intermittent Claudication) are taken into account instead of subjects with instrumental abnormalities such as a low Ankle-Branchial Index (ABI). The risk of both-fatal and non-fatal-cardiovascular events is particularly high in these patients either presenting with symptoms or asymptomatic. On the contrary the tendency to local worsening (need of revascularization or amputation of leg) is reduced. PAD is markedly prevailing in elderly, with a peak of incidence after the fifth decade of life. Owing to this, the prevalence is not significantly different in men compared to women. The risk factors related to PAD are the same as those observed in the other locations of atherosclerosis but cigarette smoking and diabetes seem to be more often associated to PAD than the remaining factors.
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PMID:PAD. Epidemiology and pathophysiology. 1235 42

Peripheral arterial disease (PAD) is a manifestation of systemic atherosclerosis strongly associated with cardiovascular (CV) morbidity and mortality. Approximately 12% of the US adult population is affected. Despite its prevalence, the disease has received little attention from clinicians. The primary causes of death in patients with PAD are myocardial infarction and stroke; thus, current treatment strategies for symptomatic PAD include aggressive modification of risk factors for CV disease such as cessation of smoking, treatment of hypertension and diabetes, and normalization of low-density lipoprotein cholesterol levels. All patients with PAD should be receiving antiplatelet therapy to prevent ischemic events. Medical treatment for patients with claudication includes exercise rehabilitation and drug therapy. Although many therapies for claudication have been thoroughly investigated, research continues on new treatments. In contrast, more prospective, randomized trials are needed to evaluate various therapies for treating patients with PAD.
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PMID:Treatment of peripheral arterial disease. 1242 82

Peripheral arterial disease (PAD) is a common manifestation of systemic atherosclerosis that is associated with a high risk of cardiovascular mortality and significant limitation in function because of limb ischemia. Patients with PAD should be considered to have significant coronary and cerebral arterial disease that requires aggressive risk factor management, including the prescription of antiplatelet drugs, to lower the subsequent risk of myocardial infarction, stroke, and death. In the population with PAD, level 1 and level 2 evidence supports the use of statin drugs for lipid management, angiotensin-converting enzyme-1 inhibitors for blood pressure control, and aspirin or clopidogrel as antiplatelet agents. Once this is accomplished, the severity of limb symptoms should be assessed, and a structured exercise program or the selected use of drugs such as cilostazol to treat claudication should be prescribed. In patients primarily considered for surgical treatment, antiplatelet and anticoagulant drug therapy can be used as a means of promoting graft patency, and beta-adrenergic blockers can be used as a means of reducing the perioperative risks associated with vascular surgery.
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PMID:Pharmacologic therapy for peripheral arterial disease and claudication. 1246 66

Peripheral arterial disease (PAD) is most frequently caused by atherosclerosis. The prevalence of intermittent claudication is about 3 to 6% of the men over 60 years. But recent epidemiological studies demonstrate that prevalence of asymptomatic forms is two to three fold higher--about 3.4 to 12.1%. The most relevant diagnostic criteria for asymptomatic PAD is probably the measure of the ankle/brachial index. Most important risk factors for PAD are smoking and diabetes mellitus. Improving symptoms or stabilization are a common fate (50%) in PAD. About 25% will experience revascularization procedures (angioplasty or surgery), 4% will have severe amputation and worsening symptoms occur in 15% of patients. Critical limb ischemia is mostly rare (1%). It is not surprising that fate of claudicant and mortality is determined by coronary events and cardiovascular diseases.
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PMID:[Epidemiology of and risk factors for lower limb arteriopathy obliterans]. 1255 2

Peripheral arterial disease, which is caused by atherosclerotic stenosis or occlusion of the leg arteries, is an important manifestation of systemic atherosclerosis. The age-adjusted prevalence of symptomatic and asymptomatic peripheral arterial disease is approximately 12% in the general population. The overall prevalence and incidence of the disease is likely to increase with the aging of the population. Peripheral arterial disease is a relatively benign condition in terms of local disease. Five years after the diagnosis, 75% of the patients remain clinically stable. On the contrary, life expectancy, even in the absence of any history of myocardial infarction or ischemic stroke, has decreased by 10 years. These patients have approximately the same relative risk of death from cardiovascular causes as do patients with history of coronary or cerebrovascular disease. Moreover, the severity of peripheral arterial disease is closely associated with the risk of myocardial infarction and death from vascular disease. The lower the ankle-brachial index, the greater the risk of cardiovascular events. Furthermore, peripheral arterial disease is a significant independent predictor for cardiovascular mortality also in coronary patients. The risk factors associated with peripheral arterial disease are essentially the same as for coronary heart disease: older age, cigarette smoking, diabetes mellitus, hypertension, and hyperlipidemia. The excess morbidity and mortality for cardiovascular disease in these patients has not been fully explained. Patients with peripheral arterial disease show a systemic endothelial dysfunction and an increase in the serum concentration of activated white blood cells, endothelin, and C-reactive protein that may trigger acute coronary syndromes. In peripheral arterial disease the functional status is often severely impaired. Peak exercise performance has decreased to about 50% of that of age-matched controls, equivalent to moderate-severe heart failure. Epidemiological studies support the concept that patients affected by peripheral arterial disease, without established coronary heart disease, have a coronary heart disease high risk equivalent. In spite of this, peripheral arterial disease remains an underdiagnosed and undertreated disease. As the role of cardiologists is expanding, the purpose of this review was to awaken the clinician to the significance of lower limb atherosclerotic occlusive diseases.
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PMID:[Why are cardiologists to be concerned about obliterating arterial disease of the lower leg?]. 1278 66

Atherosclerosis is a progressive, disseminated condition that affects all the vascular beds. Peripheral arterial disease (PAD), a manifestation of atherosclerosis, measured non-invasively in the legs by ankle-brachial index (ABI) is associated with increased cardiovascular morbidity and mortality. Though several studies in the western industrialised countries have shown that PAD is widely prevalent in the general older population at risk, not much data are available in the South East Asian developing countries. We have conducted an epidemiological survey on the prevalence of PAD in high-risk patients at an urban hospital in Malaysia. A total of 301 consecutive patients aged 32-90 years were recruited during their follow-up clinic visits for established cardiovascular disease, ischaemic stroke or diabetes mellitus > or = 5 years. All participants underwent ABI measurement and were subjected to the Edinburgh claudication questionnaire to assess leg symptoms. The prevalence of PAD in our high-risk population was 23%, of which only 27% were symptomatic with the classical intermittent claudication. All the patients with PAD were diagnosed at the time of the study. PAD was found in 33% of patients with pre-existent cardiovascular disease, 28% in patients with ischaemic stroke and 24% in diabetic patients. PAD was also highly prevalent among the younger patients. Our study has shown that PAD is highly prevalent among high-risk Malaysian patients and is not necessarily a disease of older age. Only 27% of these patients were symptomatic. All the subjects with PAD were diagnosed at the time of the study, which would suggest it is an unrecognised and underdiagnosed condition, even in patients with atherosclerotic risk factors.
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PMID:Prevalence of peripheral artery disease in urban high-risk Malaysian patients. 1284 39


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