Dr. Issam D. Moussa of New York Presbyterian Hospital, Weill Cornell Medical College and colleagues studied 800 patients with ischemic heart disease and referred to a cardiologist. The patients were at least 70 years old, or between 50 and 69 years old with a history of tobacco use and/or diabetes mellitus. None of the patients were previously diagnosed with PAD.
Based on measurement of the ankle-brachial index and symptom evaluation, roughly one out in six CAD patients had PAD, “which was overlooked prior to enrollment in this screening program despite being under the care of a cardiovascular specialist,” the investigators report in May issue of Catheterization and Cardiovascular Interventions.
Common PAD symptoms such as limping and leg pain were generally not present in these patients. “The combination of physician lack of awareness and lack of symptoms among patients results in failure to diagnose PAD, even in patients who are at high risk,” Dr. Moussa and colleagues note.
“Clinical evaluation alone often lacks the sensitivity and specificity to optimally identify PAD, particularly in less advanced stages and in hospitalized patients with CAD,” they point out.
Previously undiagnosed PAD was more common in older patients and women.
Female gender was an independent predictor of identifying previously missed PAD, the investigators report. “This finding is provocative,” they say, since it contradicts the common view that PAD is more prevalent in men.
Summing up, Dr. Moussa and colleagues conclude that patients with concomitant CAD and PAD are at high risk for future cardiac events and, untreated, PAD can lead to critical limb ischemia restricting physical activity, mobility and overall quality of life.
The investigators also note that new guidelines from the American Heart Association and the American College of Cardiology advocate a more aggressive approach to PAD diagnosis, regardless of the degree of symptoms. “Our findings present a compelling argument to aggressively screen patients with CAD for the presence of PAD,” the team adds.
Catheter Cardiovasc Interv 2009;73:719-724.