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Does screening for peripheral arterial disease improve risk stratification for patients at intermediate risk for coronary artery disease?

Greiver M - Open Med (2007)

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Many patients at intermediate risk of developing coronary artery disease (CAD) are seen in primary care... Statins decrease the relative risk of coronary events by approximately 30%... If a patient has a 5% risk of developing CAD in the next 10 years, using a statin for 10 years would only reduce his or her absolute risk by 1.5% (0.3 x 5%); 67 patients would have to be treated for 10 years to prevent 1 myocardial infarction and 66 of these patients would not benefit from the treatment... With statins costing about $1 per day, treating 67 patients for 10 years would translate to $245 000 in drug costs alone... Patients at high risk of developing CAD (Framingham 10-year risk >20%) derive greater benefit from statins, and there is more evidence to support treating them... A family history of early CAD (a first-degree relative who developed CAD at age 50 years or younger) doubles the calculated Framingham risk... A plethora of biomarkers, including C-reactive protein, B-type natriuretic peptide, aldosterone, renin, fibrinogen, D-dimer, plasminogen-activator inhibitor type 1, homocysteine and urinary albumin-to-creatinine ratio, 5 have been suggested as candidates to improve risk stratification... However, the accuracy of these biomarkers and the resulting risk adjustment is not clear, and a recent study found that even the use of multiple markers adds little to the Framingham score... Using at least two high-sensitivity C-reactive protein measurements has been found to be a reliable marker for a new risk calculator in women (the Reynolds score) but the additional complexity and expense of implementing this new score may limit its use in primary care... EBCT is expensive and as there are already long waiting lists for CT scans in Canada this is not an ideal test to use for screening at this time... Recommendations have been made that all patients aged 50 years and over with at least 1 cardiovascular risk factor and all patients aged 70 years and over should be screened for peripheral arterial disease (PAD) using the ankle-brachial index (ABI)(Figure 1)., PAD is a known risk factor for underlying cardiovascular disease, but neither history taking nor clinical examination is sensitive or specific enough for PAD screening... A systematic review found that with an ABI of 0.9 or less, the likelihood ratio of CAD is 2.5 and the likelihood ratio for death from coronary causes is 5.6... A prospective randomized controlled trial enrolling patients at intermediate risk of developing CAD who are randomly assigned to be screened or not screened with ABI would provide the best assessment of this test’s usefulness... Guidelines produced by specialty groups appear to recommend the use of ABI to screen for PAD in patients at intermediate risk of developing CAD,, but the producers of these guidelines are perhaps more likely to be biased toward intervention in their area of interest rather than routine screening in the general population.

No MeSH data available.


How to measure the ankle-brachial index (ABI). DP = dorsalis pedis. PT = posterior tibial. Reprinted with permission from Laine et al.9
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figure1: How to measure the ankle-brachial index (ABI). DP = dorsalis pedis. PT = posterior tibial. Reprinted with permission from Laine et al.9

Mentions: Recommendations have been made that all patients aged 50 years and over with at least 1 cardiovascular risk factor and all patients aged 70 years and over should be screened for peripheral arterial disease (PAD) using the ankle-brachial index (ABI)(Figure 1).8, 9 PAD is a known risk factor for underlying cardiovascular disease, but neither history taking nor clinical examination is sensitive or specific enough for PAD screening.10 The US Preventive Services Task Force does not currently recommend PAD screening in the general population (grade D recommendation), because there is the potential for a small degree of harm resulting from false-positive results and unnecessary investigations for PAD.11 Perhaps we should think of ABI as a tool for risk stratification for cardiovascular disease rather than solely as a screening or diagnostic test for PAD.


Does screening for peripheral arterial disease improve risk stratification for patients at intermediate risk for coronary artery disease?

Greiver M - Open Med (2007)

How to measure the ankle-brachial index (ABI). DP = dorsalis pedis. PT = posterior tibial. Reprinted with permission from Laine et al.9
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2801910&req=5

figure1: How to measure the ankle-brachial index (ABI). DP = dorsalis pedis. PT = posterior tibial. Reprinted with permission from Laine et al.9
Mentions: Recommendations have been made that all patients aged 50 years and over with at least 1 cardiovascular risk factor and all patients aged 70 years and over should be screened for peripheral arterial disease (PAD) using the ankle-brachial index (ABI)(Figure 1).8, 9 PAD is a known risk factor for underlying cardiovascular disease, but neither history taking nor clinical examination is sensitive or specific enough for PAD screening.10 The US Preventive Services Task Force does not currently recommend PAD screening in the general population (grade D recommendation), because there is the potential for a small degree of harm resulting from false-positive results and unnecessary investigations for PAD.11 Perhaps we should think of ABI as a tool for risk stratification for cardiovascular disease rather than solely as a screening or diagnostic test for PAD.

View Article: PubMed Central - HTML - PubMed

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

Many patients at intermediate risk of developing coronary artery disease (CAD) are seen in primary care... Statins decrease the relative risk of coronary events by approximately 30%... If a patient has a 5% risk of developing CAD in the next 10 years, using a statin for 10 years would only reduce his or her absolute risk by 1.5% (0.3 x 5%); 67 patients would have to be treated for 10 years to prevent 1 myocardial infarction and 66 of these patients would not benefit from the treatment... With statins costing about $1 per day, treating 67 patients for 10 years would translate to $245 000 in drug costs alone... Patients at high risk of developing CAD (Framingham 10-year risk >20%) derive greater benefit from statins, and there is more evidence to support treating them... A family history of early CAD (a first-degree relative who developed CAD at age 50 years or younger) doubles the calculated Framingham risk... A plethora of biomarkers, including C-reactive protein, B-type natriuretic peptide, aldosterone, renin, fibrinogen, D-dimer, plasminogen-activator inhibitor type 1, homocysteine and urinary albumin-to-creatinine ratio, 5 have been suggested as candidates to improve risk stratification... However, the accuracy of these biomarkers and the resulting risk adjustment is not clear, and a recent study found that even the use of multiple markers adds little to the Framingham score... Using at least two high-sensitivity C-reactive protein measurements has been found to be a reliable marker for a new risk calculator in women (the Reynolds score) but the additional complexity and expense of implementing this new score may limit its use in primary care... EBCT is expensive and as there are already long waiting lists for CT scans in Canada this is not an ideal test to use for screening at this time... Recommendations have been made that all patients aged 50 years and over with at least 1 cardiovascular risk factor and all patients aged 70 years and over should be screened for peripheral arterial disease (PAD) using the ankle-brachial index (ABI)(Figure 1)., PAD is a known risk factor for underlying cardiovascular disease, but neither history taking nor clinical examination is sensitive or specific enough for PAD screening... A systematic review found that with an ABI of 0.9 or less, the likelihood ratio of CAD is 2.5 and the likelihood ratio for death from coronary causes is 5.6... A prospective randomized controlled trial enrolling patients at intermediate risk of developing CAD who are randomly assigned to be screened or not screened with ABI would provide the best assessment of this test’s usefulness... Guidelines produced by specialty groups appear to recommend the use of ABI to screen for PAD in patients at intermediate risk of developing CAD,, but the producers of these guidelines are perhaps more likely to be biased toward intervention in their area of interest rather than routine screening in the general population.

No MeSH data available.