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January 16, 2002

Diagnosis and Treatment of Peripheral Arterial Disease

Author Affiliations

Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor

JAMA. 2002;287(3):313-316. doi:10.1001/jama.287.3.313

To the Editor: In his Editorial1 accompanying the article by Dr Hirsch and colleagues,2 Dr Ouriel recommends screening for PAD by ABI measurement to identify patients who should be treated to reduce their risk of cardiovascular events. Such an approach is not supported by the results of Hirsch et al, since ABI measurements led to a new diagnosis of vascular disease in only 7% of the patients. The other 93% either had known vascular disease or no vascular disease. Among the 7% with newly diagnosed vascular disease, ample reasons to receive measures to prevent cardiovascular events already existed: 33% had diabetes, 60% were current or former smokers, 74% had hyperlipidemia, and 81% had hypertension. These patients needed more thoughtful medical care, not another test. The same can be said for the patients with known vascular disease, some of whom received insufficient treatment to prevent vascular events; whether or not such treatment would be more avidly pursued in the presence of PAD is moot.

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