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Invited Commentary
August 2016

A Risk-Reduction Program for Patients With Peripheral Arterial Disease: Who Benefits and Why?

Author Affiliations
  • 1Division of Vascular and Endovascular Surgery, University of Virginia School of Medicine, Charlottesville
JAMA Surg. 2016;151(8):751. doi:10.1001/jamasurg.2016.0471

In their observational cohort study, Hussain et al1 present a thoughtful case for the efficacy of a guideline-based risk-reduction program, the Systematic Assessment of Vascular Risk (SAVR) program, for patients with peripheral arterial disease (PAD). Based on comparison with a group of patients from other tertiary centers not enrolled in the SAVR program, the authors attributed a 37% absolute reduction in death, acute myocardial infarction, and ischemic stroke, as well as a 53% reduction in major amputations and arterial bypass, to participation in the SAVR program. The authors substantiate their claims by demonstrating improvement in the risk profile and medication use of SAVR patients after enrollment in the program, albeit in a limited subset (99 of 459 patients). However, a variety of methodologic concerns leave us unconvinced that the superior long-term cardiovascular and limb outcomes are the result of the SAVR program itself.