AHA Announces Data Showing Millions of PAD Patients Are Not Receiving Medical Therapy

June 20, 2011—The American Heart Association (AHA) announced the publication of a study concluding that adults with peripheral artery disease (PAD) are not receiving the medications needed to reduce their risk of heart attack, stroke, and death. Reena L. Pande, MD, et al published the study, which is available online ahead of print in Circulation.

According to the AHA, the study found that of the estimated 7.1 million adults with PAD in the United States, a large majority are not taking cholesterol-lowering medications, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers for lowering blood pressure, or aspirin.

“We found that taking two or more of these medications was associated with a 65% lower rate of death from all causes,” commented Dr. Pande. “The study tells us that millions of individuals that have been identified with PAD by a simple noninvasive screening test are not receiving medications that may reduce their risk of death.”

The data used for this analysis did not provide information that would explain reasons why these patients were not receiving the risk-lowering therapies, but the study suggests that identification of PAD using ankle-brachial index screening might allow physicians to be more aware of the patient's PAD diagnosis and then be more likely to prescribe these medications.

Dr. Pande noted that these findings are observational and that the conclusions from this study need to be repeated in larger trials that are specifically designed to validate these results. These findings would allow scientists and physicians to begin examining how to address the issue of providing risk-lowering treatments for asymptomatic patients with PAD.

As detailed in Circulation, the investigators analyzed data from the National Health and Nutrition Examination Survey from 1999 to 2004 with mortality follow-up through December 31, 2006. PAD was defined as an ankle-brachial index ≤ 0.9. Of the 7,458 eligible participants who were 40 years of age or older, weighted PAD prevalence was 5.9% ± 0.3%, corresponding to approximately 7.1 million adults with PAD. Statin use was reported in only 30.5% ± 2.5%, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use in 24.9% ± 1.9%, and aspirin use in 35.8% ± 2.9%. This corresponds to 5 million adults with PAD who are not taking statins, 5.4 million not taking angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and 4.5 million not receiving aspirin. 

After adjustment for age, sex, and race/ethnicity, PAD was associated with all-cause mortality (hazard ratio, 2.4; 95% confidence interval [CI], 1.9–2.9; P < .0001). Even after exclusion of individuals with known cardiovascular disease, subjects with PAD had higher mortality rates (16.1% ± 2.1%) than subjects without PAD or cardiovascular disease (4.1% ± 0.3%), with an adjusted hazard ratio of 1.9 (95% CI, 1.3–2.8; P = .001). Among PAD subjects without cardiovascular disease, the use of multiple preventive therapies was associated with a 65% lower all-cause mortality rate (hazard ratio, 0.35; 95% CI, 0.2–0.86; P = .02).