Too little focus on
lifestyle, preventing symptoms in peripheral artery
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[May 11, 2017] By
(Reuters Health) - Many patients with
peripheral artery disease, a common cause of chronic disability and
mobility limitations in the elderly, aren't counseled on lifestyle
changes and medications that can help prevent symptoms from worsening, a
U.S. study suggests.
Researchers examined data from 2005 to 2012 in a nationally
representative sample of 1,982 patients with peripheral artery
disease (PAD), which restricts blood flow to the limbs and
extremities. They found consistently low use of recommended
medications and lifestyle counseling to relieve symptoms and prevent
complications like infections, open sores, strokes and heart
"Patients with PAD tend to receive less guideline-recommended
treatment than patients with coronary artery disease, even though
PAD is an even bigger risk factor for death," said study co-author
Dr. Joseph Ladapo of the David Geffen School of Medicine at the
University of California, Los Angeles.
"The surprising finding is that the quality of care patients with
PAD receive did not appear to improve over time," Ladapo said by
About 200 million people worldwide have peripheral artery disease,
researchers note in the Journal of the American College of
Often, patients with the condition find it painful to walk and
experience significant limitations in daily life as symptoms worsen,
Ladapo said. Medications to prevent blood clots, control blood
pressure and lower cholesterol can help stall the course of the
disease, as can diet and exercise changes.
During the eight-year study period, the estimated number of annual
clinic visits for PAD climbed from 2.7 million at the start to 3.4
million by the end.
Overall, just 36 percent of patients took aspirin or other drugs
recommended to prevent blood clots, only 33 used statin medications
to lower cholesterol and 28 percent got medications commonly
recommended to control blood pressure, the study found.
The picture for lifestyle modifications looked even worse: a mere 22
percent of patient visits included exercise or diet counseling and
for smokers, just 36 percent of visits included counseling or
medication to help with cessation.
Slightly more than 20 percent of patients saw cardiologists for the
condition, and this proportion was little changed over the study
About 24 percent of the patients in the study had coronary artery
disease in addition to PAD, and they tended to be more likely to see
cardiologists and to receive more recommended medications and
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For example, the subset of patients with coronary artery disease
were more than twice as likely to take anti-clotting drugs and
medications to lower blood pressure and cholesterol than the people
in the study who only had PAD.
One limitation of the study is that researchers lacked data on the
severity of patients' symptoms or other medical conditions that
might influence whether they took certain recommended medications,
the authors note.
Still, the results add to evidence suggesting that doctors need to
do a better job of educating patients with PAD about medication and
lifestyle changes that can often improve their mobility and quality
of life, said Dr. William Hiatt, author of an accompanying editorial
and a researcher at the University of Colorado School of Medicine in
"These patients are all symptomatic - when they walk their leg
starts to cramp up and they rest to relieve discomfort," Hiatt said
in a phone interview. "The problem is they don't realize it's
blockage due to systematic (hardening of arteries) and they don't
get help because they chalk it up to old age."
SOURCE: http://bit.ly/2q6AsUK and http://bit.ly/2qUaqXn Journal of
the American College of Cardiology, online May 1, 2017.
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