Title : Peripheral artery disease: Unveiling its impact on cardiovascular events and outcomes
Abstract:
Peripheral artery disease (PAD) is a prevalent but underrecognized atherosclerotic disease that carries a powerful prognostic weight. Lower extremity PAD affects an estimated 8.5 million Americans over age 40 and roughly 202 million people globally. In India, PAD prevalence is similarly high (roughly 7–26% of adults), yet both awareness and diagnosis lag behind the disease’s true burden. Crucially, PAD is more than a limb disorder – it signifies extensive systemic atherosclerosis and confers a much higher risk of myocardial infarction, stroke, and death. Patients with PAD often have equivalent or greater cardiovascular risk than those with coronary disease, even though dramatic limb events like acute limb ischemia (ALI) occur infrequently.
Screening and diagnosis guidelines emphasize targeted detection: clinicians should evaluate at-risk patients (eg, age ≥65 or younger with diabetes, smoking, or known atherosclerotic disease) and use the ankle-brachial index (ABI) to confirm PAD. Physical exam (leg pulse palpation, bruits, foot inspection) complements history, as many PAD patients have atypical symptoms or are asymptomatic. Management focuses on aggressive risk factor reduction and functional improvement. All PAD patients should receive guideline-directed medical therapy: statin therapy is indicated for every patient and antiplatelet therapy (aspirin or clopidogrel) is class I recommended to reduce vascular events. A supervised exercise program is strongly recommended (Class I) to improve walking ability. Cilostazol may be used to improve claudication symptoms. Revascularization (endovascular or surgical) is reserved for lifestyle-limiting claudication or critical limb ischemia, managed within multidisciplinary vascular teams.
Recent evidence reinforces these principles globally. Indian experts highlight that many PAD cases remain asymptomatic and underdiagnosed, advocating active case-finding (eg, “PAD clinics”) and rigorous risk control. Implementing AHA/ACC recommendations together with local epidemiology can improve outcomes: early PAD detection prompts timely statin initiation, blood pressure and diabetes control, and antithrombotic therapy, reducing both limb complications and cardiovascular mortality.
