Stephen J.LurieMD, PhD, Senior EditorIndividualAuthor
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.
Fried RE. Diagnosis and Treatment of Peripheral Arterial Disease. JAMA. 2002;287(3):313-316. doi:10.1001/jama.287.3.313