Analyzing Cardiovascular Risks With PAD

Peripheral arterial disease (PAD) is a highly prevalent but largely undiagnosed condition that affects an estimated 27 million people in Europe and North America. Caused by atherosclerotic occlusion of the leg arteries, PAD is associated with an increased risk of cardiovascular and cerebrovascular events, including death, myocardial infarction (MI), and stroke. It’s also associated with a higher total mortality compared with other manifestations of atherosclerosis. Despite an expanding treatment armamentarium for the condition, PAD patients continue to be undiagnosed and face a high incidence of cardiovascular events. A definitive diagnosis of PAD may not always be evident, even in symptomatic patients. For example, similar symptoms may be caused by arthritis of the hip or knee joint or by sciatica. A typical symptom is claudication in the legs—exertional pain while walking, particularly walking longer distances and up inclined surfaces. However, some patients may experience atypical claudication. Instead of describing their symptoms as exertional pain, patients may report that their legs are easily fatigued or cramp during the day with activity. This can easily be mistaken for old age; therefore, greater physician awareness of PAD overall and improved knowledge of atypical claudication may enhance the detection of PAD. Patients with asymptomatic PAD are still at increased risk of cardiovascular events, particularly MI and stroke. Other than the systemic risk associated with PAD, limb-threatening ischemia and amputation may also occur. However, the risk of developing limb-threatening ischemia is relatively low in patients with asymptomatic PAD. The CHARISMA Trial In an effort to improve the medical treatment of PAD, the Clopidogrel for High Atherothrombotic Risk and Ischemic Stabilization, Management and Avoidance (CHARISMA) trial...