United Press International
04-30-09
NEW YORK, Apr 29, 2009 (UPI via COMTEX) -- Peripheral arterial disease of the legs is often overlooked even in patients with known heart disease under a cardiologist's care, U.S. researchers say.
Dr. Issam D. Moussa of New York Presbyterian Hospital/Weill Cornell Medical Center said the study involved nearly 800 patients with heart disease who were to undergo coronary angiography -- an examination of the blood vessels or chambers of the heart -- and/or intervention and were either at least 70 years old, or between the ages of 50-69 and had a history of diabetes and/or tobacco use.
Researchers determined if patients had peripheral arterial disease by calculating the Ankle-Brachial Index, the ratio of the blood pressure in the lower legs to blood pressure in the arms. Patients also answered questionnaires on peripheral arterial disease awareness and functional status.
The study, published in the May issue of Catheterization and Cardiovascular Interventions, showed that approximately 1 of 6 patients had previously unrecognized peripheral arterial disease, despite being under the care of a cardiovascular specialist. The researchers point out that this includes only those with previously undiagnosed peripheral arterial disease and does not represent the total prevalence of peripheral arterial disease in patients with heart disease, which is actually much higher.
URL: www.upi.com
Friday, May 15, 2009
Stroke Risk Of Peripheral Artery Disease Cut With Aspirin
A new study suggests that aspirin may cut the risk of stroke in patients with peripheral artery disease.
Although aspirin is effective in the prevention of cardiovascular events in patients with symptomatic coronary heart disease and cerebrovascular disease, its effect in patients with peripheral artery disease (PAD) has been uncertain.
To determine the effect of aspirin on cardiovascular event rates in patients with PAD, lead researcher Dr Jeffrey S. Berger, of the University of Pennsylvania, Philadelphia conducted a meta-analysis to evaluate available evidence from randomized controlled trials of aspirin therapy, with or without dipyridamole (an antiplatelet agent), that reported cardiovascular event rates.
"Results of this meta-analysis demonstrated that for patients with PAD, aspirin therapy alone or in combination with dipyridamole did not significantly decrease the primary end point of cardiovascular events, results that may reflect limited statistical power," wrote the authors.
Even though aspirin use is associated with a statistically nonsignificant decrease in the risk of a group of combined cardiovascular events but is associated with a significant reduction in the risk of one of these events, nonfatal stroke.
"Larger prospective studies of aspirin and other antiplatelet agents are warranted among patients with PAD in order to draw firm conclusions about clinical benefit and risks," the authors added.
The study appears in the issue of JAMA.
Source-ANI
TAN/M
Although aspirin is effective in the prevention of cardiovascular events in patients with symptomatic coronary heart disease and cerebrovascular disease, its effect in patients with peripheral artery disease (PAD) has been uncertain.
To determine the effect of aspirin on cardiovascular event rates in patients with PAD, lead researcher Dr Jeffrey S. Berger, of the University of Pennsylvania, Philadelphia conducted a meta-analysis to evaluate available evidence from randomized controlled trials of aspirin therapy, with or without dipyridamole (an antiplatelet agent), that reported cardiovascular event rates.
"Results of this meta-analysis demonstrated that for patients with PAD, aspirin therapy alone or in combination with dipyridamole did not significantly decrease the primary end point of cardiovascular events, results that may reflect limited statistical power," wrote the authors.
Even though aspirin use is associated with a statistically nonsignificant decrease in the risk of a group of combined cardiovascular events but is associated with a significant reduction in the risk of one of these events, nonfatal stroke.
"Larger prospective studies of aspirin and other antiplatelet agents are warranted among patients with PAD in order to draw firm conclusions about clinical benefit and risks," the authors added.
The study appears in the issue of JAMA.
Source-ANI
TAN/M
Wednesday, May 13, 2009
What is peripheral vascular disease?
Great article on medicinenet.com
Peripheral vascular disease (PVD) refers to diseases of the blood vessels (arteries and veins) located outside the heart and brain. While there are many causes of peripheral vascular disease, doctors commonly use the term peripheral vascular disease to refer to peripheral artery disease (peripheral arterial disease, PAD), a condition that develops when the arteries that supply blood to the internal organs, arms, and legs become completely or partially blocked as a result of atherosclerosis.
Peripheral vascular disease (PVD) refers to diseases of the blood vessels (arteries and veins) located outside the heart and brain. While there are many causes of peripheral vascular disease, doctors commonly use the term peripheral vascular disease to refer to peripheral artery disease (peripheral arterial disease, PAD), a condition that develops when the arteries that supply blood to the internal organs, arms, and legs become completely or partially blocked as a result of atherosclerosis.
Tuesday, May 12, 2009
About Peripheral Arterial Disease
(from: http://www.sirweb.org/patients/peripheral-arterial-disease/)
PAD is a common circulation problem in which the arteries that carry blood to the legs or arms become narrowed or clogged. This interferes with the normal flow of blood, sometimes causing pain, but often causing no symptoms at all. The most common cause of PAD is atherosclerosis, often called "hardening of the arteries." Atherosclerosis is a gradual process in which cholesterol and scar tissue build up, forming a substance called "plaque" that clogs the blood vessels. In some cases, PAD may be caused by blood clots that lodge in the arteries and restrict blood flow. Left untreated, this insufficient blood flow will lead to limb amputation in some patients.
In atherosclerosis, the blood flow channel narrows from the buildup of plaque, preventing blood from passing through as needed, restricting oxygen and other nutrients from getting to normal tissue. The arteries also become rigid and less elastic, and are less able to react to tissue demands for changes in blood flow. Many of the risk factors-high cholesterol, high blood pressure, smoking and diabetes-may also damage the blood vessel wall, making the blood vessel prone to diffuse plaque deposits.
PAD Symptoms
The most common symptom of PAD is called claudication, which is leg pain that occurs when walking or exercising and disappears when the person stops the activity.
Other symptoms of PAD include: numbness and tingling in the lower legs and feet, coldness in the lower legs and feet, and ulcers or sores on the legs or feet that don't heal.
Many people simply live with their pain, assuming it is a normal part of aging, rather than reporting it to their doctor.
Prevalence
PAD is a disease of the arteries that affects 10 million Americans.
PAD can happen to anyone, regardless of age, but it is most common in men and women over age 50.
PAD affects 12-20 percent of Americans age 65 and older.
PAD Treatments
Lifestyle
Often PAD can be treated with lifestyle changes. Smoking cessation and a structured exercise program are often all that is needed to alleviate symptoms and prevent further progression of the disease.
Angioplasty and stenting
Interventional radiologists pioneered angioplasty and stenting, which was first performed to treat peripheral arterial disease. Using imaging for guidance, the interventional radiologist threads a catheter through the femoral artery in the groin to the blocked artery in the legs. Then he or she inflates a balloon to open the blood vessel where it is narrowed or blocked. In some cases this is then held open with a stent, a tiny metal cylinder. This is a minimally invasive treatment that does not require surgery, just a nick in the skin the size of a pencil tip.
PAD is a common circulation problem in which the arteries that carry blood to the legs or arms become narrowed or clogged. This interferes with the normal flow of blood, sometimes causing pain, but often causing no symptoms at all. The most common cause of PAD is atherosclerosis, often called "hardening of the arteries." Atherosclerosis is a gradual process in which cholesterol and scar tissue build up, forming a substance called "plaque" that clogs the blood vessels. In some cases, PAD may be caused by blood clots that lodge in the arteries and restrict blood flow. Left untreated, this insufficient blood flow will lead to limb amputation in some patients.
In atherosclerosis, the blood flow channel narrows from the buildup of plaque, preventing blood from passing through as needed, restricting oxygen and other nutrients from getting to normal tissue. The arteries also become rigid and less elastic, and are less able to react to tissue demands for changes in blood flow. Many of the risk factors-high cholesterol, high blood pressure, smoking and diabetes-may also damage the blood vessel wall, making the blood vessel prone to diffuse plaque deposits.
PAD Symptoms
The most common symptom of PAD is called claudication, which is leg pain that occurs when walking or exercising and disappears when the person stops the activity.
Other symptoms of PAD include: numbness and tingling in the lower legs and feet, coldness in the lower legs and feet, and ulcers or sores on the legs or feet that don't heal.
Many people simply live with their pain, assuming it is a normal part of aging, rather than reporting it to their doctor.
Prevalence
PAD is a disease of the arteries that affects 10 million Americans.
PAD can happen to anyone, regardless of age, but it is most common in men and women over age 50.
PAD affects 12-20 percent of Americans age 65 and older.
PAD Treatments
Lifestyle
Often PAD can be treated with lifestyle changes. Smoking cessation and a structured exercise program are often all that is needed to alleviate symptoms and prevent further progression of the disease.
Angioplasty and stenting
Interventional radiologists pioneered angioplasty and stenting, which was first performed to treat peripheral arterial disease. Using imaging for guidance, the interventional radiologist threads a catheter through the femoral artery in the groin to the blocked artery in the legs. Then he or she inflates a balloon to open the blood vessel where it is narrowed or blocked. In some cases this is then held open with a stent, a tiny metal cylinder. This is a minimally invasive treatment that does not require surgery, just a nick in the skin the size of a pencil tip.
PAD Fast Facts
Many people mistake the symptoms of PAD for something else.
PAD often goes undiagnosed by healthcare professionals.
People with PAD are at higher risk for heart attack and stroke.
Left untreated, PAD can lead to gangrene and amputation.
If you smoke, you have an especially high risk for PAD.
If you have diabetes, you have an especially high risk for PAD.
People with high blood pressure or high cholesterol are at risk for PAD.
PAD is easily diagnosed in a simple, painless way.
You can take control by leading a heart-healthy lifestyle and following the recommendations of your healthcare professional.
Most cases of PAD can be managed with lifestyle changes and medication.
PAD often goes undiagnosed by healthcare professionals.
People with PAD are at higher risk for heart attack and stroke.
Left untreated, PAD can lead to gangrene and amputation.
If you smoke, you have an especially high risk for PAD.
If you have diabetes, you have an especially high risk for PAD.
People with high blood pressure or high cholesterol are at risk for PAD.
PAD is easily diagnosed in a simple, painless way.
You can take control by leading a heart-healthy lifestyle and following the recommendations of your healthcare professional.
Most cases of PAD can be managed with lifestyle changes and medication.
Thursday, May 7, 2009
Screening for peripheral arterial disease
(On lifelinescreening.com)
We screen for peripheral arterial disease (PAD), more commonly known as hardening of the arteries, by using the ankle-brachial index (ABI). This screening is painless, quick, and non-invasive. It will identify most cases of peripheral arterial disease.
What you can learn
The ankle-brachial index measures the ratio between the pressure in your arms and that in your legs. This ratio indicates how well blood flows to the legs. A ratio of less than 0.90 indicates plaque buildup and possible peripheral arterial disease. A ratio of 0.90 or greater is considered normal.
The screening is simple and painless. After removing your socks and shoes, you will have pressure cuffs placed around your upper arms and ankles. A small ultrasound device will then measure the systolic blood pressures in your limbs.
Who should have peripheral arterial disease screening
Anyone who has risk factors for PAD should have this screening. Are you at risk? Find out.
How often to get screened
This is a personal decision based on your risk factors and previous screening results. Many of our customers have an annual screening as part of their regular healthcare regimen.
How to prepare
Wear a short-sleeved shirt or blouse.
Do not wear pantyhose.
We screen for peripheral arterial disease (PAD), more commonly known as hardening of the arteries, by using the ankle-brachial index (ABI). This screening is painless, quick, and non-invasive. It will identify most cases of peripheral arterial disease.
What you can learn
The ankle-brachial index measures the ratio between the pressure in your arms and that in your legs. This ratio indicates how well blood flows to the legs. A ratio of less than 0.90 indicates plaque buildup and possible peripheral arterial disease. A ratio of 0.90 or greater is considered normal.
The screening is simple and painless. After removing your socks and shoes, you will have pressure cuffs placed around your upper arms and ankles. A small ultrasound device will then measure the systolic blood pressures in your limbs.
Who should have peripheral arterial disease screening
Anyone who has risk factors for PAD should have this screening. Are you at risk? Find out.
How often to get screened
This is a personal decision based on your risk factors and previous screening results. Many of our customers have an annual screening as part of their regular healthcare regimen.
How to prepare
Wear a short-sleeved shirt or blouse.
Do not wear pantyhose.
Tuesday, May 5, 2009
Putting your best foot forward
Diabetes Watch
Focusing on preventive foot care in hemodialysis patients
by: Zahid Ahmad, MD
Nephronline.com - Article May 2009
With changes in overall care, mortality in the dialysis patient population has improved. But comorbid conditions have limited the impact. One such area that remains under the radar for patients with diabetes and end-stage renal disease is morbidity and mortality related to peripheral vascular disease and foot care.
For the most part, at this stage, foot care attracts attention only after a problem has already arisen. There are no screening protocols in dialysis centers to identify the problem earlier on. As a result, preventive strategies to reduce morbidity and mortality related to this issue remains unaddressed. The magnitude of this problem is unrealized until you add to the equation that the majority of hemodialysis patients are diabetics as well. Currently, there is a high-risk of lower extremity amputations in hemodialysis patients.
Early risk factors for diabetic foot complications may be disregarded, and this may lead to amputation-a failure for both the patient and physician. Diabetic foot complications, including amputation, add significantly to the morbidity and mortality of the patient with diabetes and CKD. However, of all the long-term complications of diabetes, foot complications may be the most preventable.
And diabetic foot examinations reduce the risk of amputation. For two decades, the United States Department of Health and Human Services (DHHS) has used health promotion and disease prevention objectives to improve the health of the American people. The overall goal for diabetes in Healthy People 2010 is, "Through prevention programs, reduce the disease and economic burden of diabetes and improve the quality of life for all persons who have or are at risk for diabetes." A specific objective contained within this goal targets a 55% reduction in the rate of lower extremity amputations in persons with diabetes. This would amount to 1.8 lower extremity amputations per 1,000 patients with diabetes per year, down from 4.1 per 1,000 patients that occurred in 1997, according to DHHS. Several clinical studies in the nondialysis diabetic population have shown that coordinated programs to screen for high-risk feet and to provide regular foot care decreased lower extremity amputation rates. In a controlled study, 45 hemodialysis patients were assigned to intensive education and care management that included preventive foot care, and 38 HD patients were assigned to usual care. Over the 12-month follow-up period, there were no amputations in the study group while there were five lower extremity amputations and two finger amputations in the control group.
The American Diabetes Association says that "all individuals with diabetes should receive a thorough foot examination at least once yearly to identify high-risk foot conditions." The ADA goes on to recommend more frequent evaluation for people with one or more risk factors and a visual foot inspection at every visit with a health care professional for diabetic patients with neuropathy.
Preventive foot care for hemodialysis patients is lost in efforts and time spent to provide care in other much politicized areas of care. But ignoring prevention in this area leads to significant morbidity and mortality. There are no randomized controlled trials of intensive education and care management versus usual care of feet in diabetic dialysis patients. Nonetheless, diabetic dialysis patients are likely to benefit from examination of the foot as part of the routine dialysis care. Given the fact that prevention can be easily done in a hemodialysis center by nursing staff, there is little reason not to introduce it. Three times a week contact between hemodialysis nurses and patient is a potential opportunity to assess risks, educate, and provide early intervention for foot issues in the dialysis population. Simple measures such as routine foot screening and education for this high risk population can prevent ulcer-initiating events and detect small ulcers when they may heal with proper intervention. Preventive strategies should include protocol- based strategy for referral to a specialist. Computerized networks should allow this to happen seamlessly and effortlessly to the benefit of all involved in hemodialysis care. In this regard, all involved in medical care of hemodialysis patients can no longer afford to ignore the importance of preventive care of hemodialysis patients.."
Dr. Ahmad is assistant professor of medicine at University of Oklahoma, specializing in interventional nephrology in the Section of Nephrology & Hypertension.
Focusing on preventive foot care in hemodialysis patients
by: Zahid Ahmad, MD
Nephronline.com - Article May 2009
With changes in overall care, mortality in the dialysis patient population has improved. But comorbid conditions have limited the impact. One such area that remains under the radar for patients with diabetes and end-stage renal disease is morbidity and mortality related to peripheral vascular disease and foot care.
For the most part, at this stage, foot care attracts attention only after a problem has already arisen. There are no screening protocols in dialysis centers to identify the problem earlier on. As a result, preventive strategies to reduce morbidity and mortality related to this issue remains unaddressed. The magnitude of this problem is unrealized until you add to the equation that the majority of hemodialysis patients are diabetics as well. Currently, there is a high-risk of lower extremity amputations in hemodialysis patients.
Early risk factors for diabetic foot complications may be disregarded, and this may lead to amputation-a failure for both the patient and physician. Diabetic foot complications, including amputation, add significantly to the morbidity and mortality of the patient with diabetes and CKD. However, of all the long-term complications of diabetes, foot complications may be the most preventable.
And diabetic foot examinations reduce the risk of amputation. For two decades, the United States Department of Health and Human Services (DHHS) has used health promotion and disease prevention objectives to improve the health of the American people. The overall goal for diabetes in Healthy People 2010 is, "Through prevention programs, reduce the disease and economic burden of diabetes and improve the quality of life for all persons who have or are at risk for diabetes." A specific objective contained within this goal targets a 55% reduction in the rate of lower extremity amputations in persons with diabetes. This would amount to 1.8 lower extremity amputations per 1,000 patients with diabetes per year, down from 4.1 per 1,000 patients that occurred in 1997, according to DHHS. Several clinical studies in the nondialysis diabetic population have shown that coordinated programs to screen for high-risk feet and to provide regular foot care decreased lower extremity amputation rates. In a controlled study, 45 hemodialysis patients were assigned to intensive education and care management that included preventive foot care, and 38 HD patients were assigned to usual care. Over the 12-month follow-up period, there were no amputations in the study group while there were five lower extremity amputations and two finger amputations in the control group.
The American Diabetes Association says that "all individuals with diabetes should receive a thorough foot examination at least once yearly to identify high-risk foot conditions." The ADA goes on to recommend more frequent evaluation for people with one or more risk factors and a visual foot inspection at every visit with a health care professional for diabetic patients with neuropathy.
Preventive foot care for hemodialysis patients is lost in efforts and time spent to provide care in other much politicized areas of care. But ignoring prevention in this area leads to significant morbidity and mortality. There are no randomized controlled trials of intensive education and care management versus usual care of feet in diabetic dialysis patients. Nonetheless, diabetic dialysis patients are likely to benefit from examination of the foot as part of the routine dialysis care. Given the fact that prevention can be easily done in a hemodialysis center by nursing staff, there is little reason not to introduce it. Three times a week contact between hemodialysis nurses and patient is a potential opportunity to assess risks, educate, and provide early intervention for foot issues in the dialysis population. Simple measures such as routine foot screening and education for this high risk population can prevent ulcer-initiating events and detect small ulcers when they may heal with proper intervention. Preventive strategies should include protocol- based strategy for referral to a specialist. Computerized networks should allow this to happen seamlessly and effortlessly to the benefit of all involved in hemodialysis care. In this regard, all involved in medical care of hemodialysis patients can no longer afford to ignore the importance of preventive care of hemodialysis patients.."
Dr. Ahmad is assistant professor of medicine at University of Oklahoma, specializing in interventional nephrology in the Section of Nephrology & Hypertension.
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