Peripheral arterial disease (PAD) is an atherosclerotic disease characterized by blockages in the arteries that supply the legs and is known to affect more than 9 million Americans and 12% to 29% of the elderly.1-3 The prevalence of PAD rises with age, and this prevalence is anticipated to rise in the decades ahead.

PAD is associated with a fivefold increased risk of heart attack and a two- to threefold greater risk of stroke and total mortality.4 The international REACH registry recently evaluated cardiovascular outcomes in more than 68,000 individuals and demonstrated that one in five patients with PAD will suffer a heart attack or stroke, be hospitalized, or die due to cardiovascular events within 1 year.5 In patients with PAD, combined rates of heart attack, stroke, and hospitalization are equal to or greater than rates in patients with established coronary artery disease.5,6 PAD also fosters major morbidity by causing claudication, functional impairment, disability, and amputation.

Fortunately, cardiovascular events can be reduced and quality of life improved through the use of evidence-based PAD diagnostic and treatment guidelines. However, despite its seriousness and prevalence, PAD is often undiagnosed, undertreated, and unknown to most Americans.7,8

A NATIONAL MOVEMENT TAKES OFF
Established in 2004 under the auspices of the nonprofit Vascular Disease Foundation, the PAD Coalition is a collaborative network of more than 75 medical organizations, government agencies, and corporations committed to improving the health and health care of patients with or at risk for PAD. The Coalition was formed after clear consensus emerged that only a broad-based alliance of health organizations and government agencies could adequately address this daunting public health challenge. Today, the PAD Coalition represents more than 1,020,000 health care providers dedicated to the practice of primary care, internal medicine, cardiovascular medicine, vascular surgery, interventional radiology, endocrinology, physical medicine, and other specialties.

The Coalition's mission is to improve the prevention, early detection, treatment, rehabilitation, and survival rates for people with or at risk for PAD. To accomplish this mission in full alignment with the expanding PAD science base, the Coalition has maintained a partnership with the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health, the HHS Office of Public Health and Science, the Centers for Disease Control and Prevention, and the Indian Health Service.

To date, the Coalition has made great strides to help individuals with or at risk for PAD and the clinicians who care for them. This article includes highlights of activities to date.

DEFINING THE PAD KNOWLEDGE GAP
To obtain baseline data on the American public's awareness of PAD and its risk factors, symptoms, and consequences, the Coalition conducted a cross-sectional, population-based telephone survey of 2,501 adults over age 50.8 The survey found that public awareness of PAD (26%) is markedly lower than other cardiovascular diseases such as stroke (74%), coronary artery disease (67%), and heart failure (67%), although the risk for PAD is equal to or greater than the risk for these conditions. Survey respondents were much more aware of relatively rare diseases that affect far fewer people, including Lou Gehrig's disease (36%), multiple sclerosis (42%), and cystic fibrosis (29%) (Figure 1).

According to the survey, few Americans know that having PAD significantly increases one's risk for heart attack, stroke, amputation, and death. Only one in four adults familiar with PAD associate the disease with an increased risk of heart attack, only 28% associate PAD with an increased risk of stroke, and only 14% link PAD with either amputation or death. This survey will be repeated in future years to evaluate national awareness efforts.

WORKING TO INCREASE AWARENESS OF PAD
Together with the NHLBI, the PAD Coalition launched a national campaign in 2006 to raise PAD awareness. Titled Stay in Circulation: Take Steps to Learn About PAD, the campaign encourages men and women over age 50 to be alert to PAD symptoms, talk to their health care providers about their risks, and ask about the simple diagnostic test, the ankle-brachial index. New campaign materials include radio and print public service announcements, brochures, a video of patient stories, and a community tool kit to aid partners with awareness activities at the local level. Campaign tools can be accessed online at www.aboutpad.org.

The Stay in Circulation campaign has partnered with nationwide senior centers, pharmacy chains, and churches to reach high-risk individuals with PAD information at the community level. A phase 2 component of our consumer advertising campaign will launch this summer. Funding is being sought to extend the campaign through bus, subway, and airport advertising.

PROVIDING EDUCATIONAL TOOLS FOR THE HEALTH CARE COMMUNITY
To complement national public awareness efforts, the Coalition is providing clinical practice tools and educational resources to health care providers. A variety of resources on the intersocietal PAD guidelines,13 including a professional education slide library, laminated wall chart, and summary guides, have been developed to foster the improved diagnosis and treatment of PAD. Coalition leaders also present at national medical meetings, and hands-on training sessions in performing the ankle-brachial index have been offered. A series of reproducible patient education handouts are also available on the Coalition's Web site; health care providers are encouraged to reproduce these tools for use with patients.

Last year, the Coalition launched the PAD Education Network, a membership program for medical practices, specialty clinics, hospitals, health plans, and health systems committed to the care of patients with PAD. Members receive PAD clinical practice tools, resources to build referral networks, video programs for PAD patient education, and tools to recognize one's participation in the Coalition.

ADVOCATING FOR EVIDENCE-BASED POLICIES TO IMPROVE HEALTH CARE FOR PEOPLE WITH PAD
The Coalition is also engaged in advocacy efforts to improve access to evidence-based diagnostic methods and treatments for people with or at risk for PAD. Primary focus areas include broadening reimbursement for the ABI, obtaining reimbursement for exercise therapy, and ensuring a federal commitment to PAD research funding. In February, the Coalition convened an advocacy summit to reassess our public policy priorities in light of the new administration and current economic situation.

SPURRING INTERNATIONAL EFFORTS
The Coalition's membership also includes Canadian medical societies that are working to extend PAD messages throughout Canada. A PAD awareness study was conducted among the Canadian population to obtain baseline data to guide educational efforts.14 Additionally, a similar effort in Europe is currently being planned by a group of European PAD experts and professional societies.

We recognize that awareness and education are vital, and a long-term effort is necessary to affect public health. We challenge readers of Endovascular Today to identify one or more tasks that you can do to support the Coalition's mission. See Joining Forces With the PAD Coalition for tips. Together, the vascular community can help the Coalition accomplish significant goals that will improve the health and well-being of all people affected by PAD. We look forward to working with you on this most important effort.

The PAD Coalition is grateful for the support provided by our platinum national sponsors, the Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership and Cordis Corporation, and other corporate partners including Abbott Vascular; AnGes, Inc.; AstraZeneca; Bard Peripheral Vascular; Baxter Healthcare; BioMedix; Cook Medical; W. L. Gore & Associates; Medtronic; Novo Nordisk; Omron;ÊSummit Doppler; and Vermillion, Inc.

Marge Lovell, RN, is a clinical trials nurse at the London Health Sciences Centre, London, ON, Canada, and the PAD Coalition Chair. Ms. Lovell may be reached at marg.lovell@lhsc.on.ca.

Joseph Caporusso, DPM, is in private practice in McAllen, Texas, and is the PAD Coalition Vice Chair. Dr. Caporusso may be reached at jcaporusso@aol.com.

Gwen Twillman is the PAD Coalition Executive Director. Ms. Twillman may be reached at (301) 524-1535; gtwillman@padcoalition.org.

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