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Editor's Correspondence
December 8/22, 2003

Cost-effective, Risk-Free, Evidence-Based Medicine

Arch Intern Med. 2003;163(22):2795. doi:10.1001/archinte.163.22.2795-a

I would like to comment on the Commentary by Belch et al.1 While a diagnosis of asymptomatic peripheral arterial disease (PAD) by an abnormal ankle-brachial index (ABI) may be prognostically useful, it does not appear to add value to readily available proven diagnostic and therapeutic protocols. Specifically, a good history review should direct one toward claudication and, if properly structured, takes less time than the 10 minutes for the ABI measurement, and is less expensive. Regarding all of the medical therapeutic manipulations suggested if the ABI is abnormal (ie, exercise, lowering lipid levels, treating hypertension and diabetes, using aspirin, and encouraging smoking cessation), shouldn't all of these be routinely addressed already in practice without performing an ABI measurement?

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