Contemporary Risk Assessment and Cardiovascular Outcomes in Peripheral Arterial Disease
Jayanta R. Das and Robert T. Eberhardt
Affiliation: Boston Medical Center, 88 East Newton Street, C818, Boston, MA 02118, USA.
Keywords: Peripheral arterial disease, Atherothrombosis, Cardiovascular, Cerebrovascular, Outcomes, Risk factors.
The term peripheral arterial disease (PAD) is often used to describe atherosclerosis involving the arteries
supplying the lower extremities. Risk factors that predispose to the development and progression of both symptomatic and
asymptomatic PAD include age, ethnicity, smoking, diabetes mellitus, hyperlipidemia, and hypertension. In addition,
emerging biomarkers of inflammation, oxidative stress, thrombosis and metabolism have also been discovered to be
predictive of future PAD events. Since traditional risk factors for PAD predispose to the development of systemic
atherosclerosis, identification of PAD increases the likelihood of coexistent coronary heart and cerebrovascular disease.
Even after adjustment for risk factors, PAD appears to increase the risk for ischemic manifestations involving these other
vascular territories with about a 2-fold increase in myocardial infarction and perhaps stroke. The most dramatic
consequence of PAD is impaired survival with a 2- to 3-fold increased risk of 5- to 10-year mortality. Not only is the risk
of adverse cardiovascular and cerebrovascular complications elevated in patients with severe PAD, but it is also markedly
elevated in those with asymptomatic disease. The focus in the management of PAD should be on early diagnosis and
efforts to reduce the risk of adverse events by risk factor modification and antiplatelet therapy.
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