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Prevalence of Symptomatic Peripheral Arterial Disease, Modifiable Risk Factors, and Appropriate Use of Drugs in the Treatment of Peripheral Arterial Disease in Older Persons Seen in a University General Medicine Clinic

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.

Correspondence: 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.