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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

Peripheral arterial disease (PAD) causes morbidity and is associated with mortality. B vitamin intake has been inversely associated with coronary heart disease, but their effects on PAD are not known. We examined prospectively the relationships between dietary folate, vitamin B-6 and B-12 and PAD risk in 51529 male U.S. health professionals, aged 40 to 75 y, who answered a detailed 131-item questionnaire to assess diet and vitamin supplement use. The study population consisted of 46036 men free of PAD, cardiovascular disease and diabetes at baseline followed for 12 y during which we documented 308 incident PAD cases. For every 400 microg/d increment of folate intake, the multivariate adjusted PAD risk decreased by 21% [relative risk (RR) = 0.79, 95% CI 0.64-0.96]. Men in the top category of folate intake (median = 840 micro g) were at 33% lower risk of PAD than men in the bottom category (median = 244 microg) (RR = 0.67, 95% CI 0.45-0.96, P-value, test for trend = 0.03) after multivariate adjustment. There were weak inverse associations between intake of vitamin B-6 and PAD risk (RR = 0.70, 95% CI 0.48-1.02, P-value, test for trend = 0.06) and B-12 (RR = 0.77, 95% CI 0.54-1.11, P-value, test for trend = 0.12). These results suggest that higher consumption of folate may contribute to the prevention of PAD.
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PMID:The use of B vitamin supplements and peripheral arterial disease risk in men are inversely related. 1294 78

Peripheral arterial disease (PAD) is a growing and often underdiagnosed health problem that predicts cardiovascular events and mortality. Estimating its prevalence in the general population is a major issue for assessing health needs and planning health services. The aim of this study was to determine the prevalence of PAD and its risk factors in an urban Mexican population. A random sample of 400 adult subjects was selected from a Family Medical Unit of the Mexican Institute of the Social Security. Clinical examination was performed and a questionnaire was applied to all subjects. After an overnight fast, serum glucose, triglyceride, and cholesterol concentrations were measured. Blood pressure was taken and the ankle-brachial index (ABI) was calculated by Doppler examination in both sides. PAD was diagnosed if one of the ABIs was less than 0.90. Prevalence was estimated with 95% confidence intervals (CI95%), and odds ratios (OR) with CI95% were obtained to assess association with some atherogenic risk factors in a multiple logistic regression analysis. The prevalence of PAD was 10.0% (CI95%, 7.24%-13.37%), and it was higher in men. Most subjects with PAD had no signs or symptoms, although the presence of either signs or symptoms was more frequent in subjects with PAD. The main risk factors related to PAD were serum triglycerides > or = 150 mg/dL (OR 2.25; CI95% 1.0-5.1), heavy smoking (OR 2.5; CI95% 0.9-6.7) and a history of diabetes mellitus for longer than 7 years (OR 1.9; CI95% 0.6-5.8). The prevalence of PAD is high in this Mexican urban population. Asymptomatic PAD may be highly frequent, and low-cost, noninvasive Doppler ultrasonography should be considered as an adequate screening procedure in primary care to detect individuals at high risk for major cardiovascular events.
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PMID:Prevalence of peripheral arterial disease and related risk factors in an urban Mexican population. 1475 89

Peripheral arterial disease is common, but the diagnosis frequently is overlooked because of subtle physical findings and lack of classic symptoms. Screening based on the ankle brachial index using Doppler ultrasonography may be more useful than physical examination alone. Noninvasive modalities to locate lesions include magnetic resonance angiography, duplex scanning, and hemodynamic localization. Major risk factors for peripheral arterial disease are cigarette smoking, diabetes mellitus, older age (older than 40 years), hypertension, hyperlipidemia, and hyperhomocystinemia. Nonsurgical therapy for intermittent claudication involves risk-factor modification, exercise, and pharmacologic therapy. Based on available evidence, a supervised exercise program is the most effective treatment. All patients with peripheral arterial disease should undergo aggressive control of blood pressure, sugar intake, and lipid levels. All available strategies to help patients quit smoking, such as counseling and nicotine replacement, should be used. Effective drug therapies for peripheral arterial disease include aspirin (with or without dipyridamole), clopidogrel, cilostazol, and pentoxifylline.
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PMID:Management of peripheral arterial disease. 1497 33

Peripheral arterial disease (PAD) is a manifestation of the atherosclerotic process and is associated with an increased risk of cerebrovascular disease, cardiovascular disease, and death. Clinicians should consider screening both asymptomatic and symptomatic patients with the ankle-brachial index, a test with a high sensitivity and specificity. For those patients with PAD, atherosclerotic risk factors (such as smoking, dyslipidemia, hypertension, and diabetes mellitus) should be aggressively treated. In addition to exercise therapy, there is evidence available to support the use of aspirin, clopidogrel, lipid-lowering agents, pentoxifylline, and cilostazol.
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PMID:Peripheral arterial disease. A systemic disease extending beyond the affected extremity. 1508 71

Peripheral arterial disease (PAD), when accompanied by claudication, is a disabling disease that affects 12 percent of the population of the United States (US). PAD is associated with increased mortality as well as decreased functional status and quality of life. Smoking cessation and treatment of diabetes are key aspects of risk factor modification for the PAD patient as well as controlling other cardiovascular risk factors. Typically, only the most severely diseased patients with PAD receive surgery for the indication of claudication and other therapeutic options are being sought. Exciting developments are taking place in the area of drug development for instance. The benefits of a supervised walking exercise program have been consistently demonstrated in persons with PAD and therefore, exercise rehabilitation constitutes an important form of therapy for these persons. Unfortunately, in the US, exercise rehabilitation is not always reimbursed which may lessen its utility presently. All therapies which are used to treat claudication should incorporate measures of functional status and quality of life in addition to treadmill walking in order to ascertain the benefit of a given treatment for patients with PAD.
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PMID:Exercise rehabilitation for the patient with intermittent claudication: a highly effective yet underutilized treatment. 1537 15

Peripheral arterial disease (PAD) due to atherosclerosis, although frequently ignored in clinical practice, results in significant cardiovascular morbidity and mortality and may progress due to uncontrolled atherosclerotic risk factors. Although treatment of claudication symptoms is important for improved lifestyle, treatment of risk factors will prolong life. Smoking cessation, blood pressure control, lipid modification and strict control of diabetes mellitus will reduce the risk of both macro and micro vascular disease progression. Risk factor modification in conjunction with antiplatelet treatment results in decreased heart attack, stroke and peripheral vascular events in patients with PAD.
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PMID:The effect of risk factor changes on peripheral arterial disease and cardiovascular risk. 1537 18

Peripheral arterial disease (PAD) is not an uncommon but a commonly neglected condition by many medical practitioners. Its prevalence steadily increases with age. In Germany almost one fifth of the patients aged > 65 years suffer from it. With increasing life expectancy the prevalence of PAD seems to be on the increase. PAD is a manifestation of diffuse and severe atherosclerosis. A very strong association exists between PAD and other atherosclerotic disorders such as coronary artery disease (CAD) and cerebrovascular disease (CVD). PAD is an independent predictor of high mortality in patients with CAD. Smoking, diabetes mellitus and advancing age are the cardinal risk factors. A relatively small number of PAD patients lose limbs by amputation. Most patients with PAD die of either heart attacks or strokes and they die of the former conditions far earlier than controls. Numerous authors have reported activation of the coagulatory system in PAD, possibly because of the diffuse pattern of the disease. Platelet hyperactivity in PAD may play a role in the process that leads to complications and disease progression. Thus, antiplatelet treatment in these patients may be essential to reduce their high mortality rate. Antiplatelet therapy for prevention of secondary vascular events is the cornerstone of pharmacological intervention in PAD. Based on current evidence, treating patients with PAD with antiplatelet drugs appears to be effective in reducing the risk of coronary and cerebrovascular events, in maintaining arterial and graft patency, and in slowing progression of disease. On the other hand, several studies indicated, that platelets in patients with PAD are relatively aspirin-resistant. The data from the CAPRIE Trial suggest a clinically and statistically significant better risk reduction with clopidogrel than with aspirin in patients with PAD. Aspirin alone should no longer be considered the optimal therapy for PAD.
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PMID:[Antiplatelet therapy in patients with peripheral arterial disease (PAD)]. 1548 53

Peripheral arterial disease (PAD) is not an uncommon but a commonly neglected condition by many medical practitioners. It is a disease that threatens not only the limb but also life itself! Atherosclerosis is the commonest cause of PAD in the western nations. The cardinal symptom is intermittent claudication (IC) but majority of the patients are asymptomatic. Ankle-brachial pressure index (ABI) is an effective screening tool for PAD. A diminished ABI (< 0.9) is a definite sign of PAD. Its prevalence steadily increases with age. In Germany almost a fifth of the patients aged over 65 years suffer from it. With increasing life expectancy the prevalence of PAD is on the increase. PAD is a manifestation of diffuse and severe atherosclerosis. It is a strong marker of cardiovascular disease; a very strong association exists between PAD and other atherosclerotic disorders such as coronary artery disease (CAD) and cerebrovascular disease (CVD). PAD is an independent predictor of high mortality in patients with CAD. Smoking, diabetes mellitus and advancing age are the cardinal risk factors. A relatively small number of PAD patients lose limbs by amputation. Most paitients with PAD die of either heart attacks or strokes and they die of the former conditions far earlier than controls. PAD still remains an esoteric disease and there is a significant lack of awareness of this condition by many physicians, and therefore under-diagnosed and underestimated. Measures to promote awareness of PAD among physicians and the society in general are needed. Since most patients are asymptomatic and carry potentially significant morbidity and mortality risks, screening for PAD should be made a routine practice at primary care level.
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PMID:Epidemiology of peripheral arterial disease. 1562 92

Peripheral arterial disease (PAD) is an under-recognized complication of diabetes. Recently, prevalence estimates in patients with diabetes over 50 years of age have been placed at 25% to 30%. The main reason for under-reporting is the largely asymptomatic nature of PAD in diabetes. Nonetheless, it is important to diagnose PAD because it is a marker of systemic atherosclerosis with excess cardiovascular risk, and it may identify a patient who may develop progressive disability and risk of limb loss. The most sensitive and specific diagnostic tool is an ankle-brachial index. Imaging studies are performed in patients who are candidates for revascularization. The most durable and effective revascularization procedure for PAD in diabetes is surgical bypass with saphenous vein as the conduit. Endovascular interventions are best used in patients with proximal disease with short-segment stenoses. The indications for revascularization have been immutable for decades, namely rest pain, ischemic ulceration, or gangrene. Presently, clinicians would include "selected" patients with intermittent claudication who have disabling symptoms and proximal disease above the inguinal ligament.
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PMID:Peripheral arterial disease: clinical assessment and indications for revascularization in the patient with diabetes. 1566 13


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