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1 Department of Medicine, University of Iowa School of Medicine, Iowa City.
2 Department of Medicine, Divisions of Cardiology and Geriatrics, New York Medical College, Valhalla.
Address correspondence to Wilbert S. Aronow, MD, FGSA, Cardiology Division, New York Medical College, Macy Pavilion, Room 138, Valhalla, NY 10595. E-mail: wsaronow{at}aol.com
Background. Persons with peripheral arterial disease (PAD) have a high incidence of cardiovascular morbidity and mortality.
Methods. We investigated the prevalence of symptomatic PAD, modifiable risk factors, and use of drugs in persons 60 years and older seen in a university general medicine clinic. Symptomatic PAD was documented if the person had a documented history of surgery for PAD, if the person had intermittent claudication or other lower extremity symptoms associated with absent or weak arterial pulses or an ankle–brachial index of <0.90, if the person had an abdominal aortic aneurysm, or if the person had symptomatic documented extracranial carotid arterial disease.
Results. There were 620 women and 386 men, mean age 72 ± 9 years (range 60–95 years), and 95% were white. Symptomatic PAD was present in 103 of 386 men (27%) and in 106 of 620 women (17%) (p <.001). The prevalence of current cigarette smoking (31% versus 12% in those without PAD, p <.001) and ex-cigarette smoking (40% versus 26%) in those without PAD, p <. 001) was higher among persons with PAD. Compared with persons without PAD, those with PAD also had a higher prevalence of hypertension (90% versus 76% in persons without PAD, p <.001), diabetes mellitus (45% versus 22%, p <.001), dyslipidemia (88% versus 60%, p <.001), coronary artery disease (63% versus 25%, p <.001), and stroke (36% versus 11%, p <.001). In persons with PAD, antiplatelet drugs were used in 85%, lipid-lowering drugs for dyslipidemia in 67%, beta blockers in 60%, and angiotensin-converting enzyme (ACE) inhibitors or angiotensin-receptor blockers in 62%. The average of the last two blood pressures was <140/90 mmHg in 55% of persons with PAD treated for hypertension. The last hemoglobin A1c in diabetics was <7% in 52% of persons with PAD.
Conclusions. Older persons with PAD have a high prevalence of modifiable risk factors, CAD, and stroke. The use of antiplatelet drugs, lipid-lowering drugs for dyslipidemia, beta blockers, and ACE inhibitors or angiotensin-receptor blockers, reduction of blood pressure to <140/90 mmHg in hypertensive persons, and reduction of hemoglobin A1c in diabetics to <7% in older persons with PAD needs to be increased in all clinical settings.
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