Pharmacologic risk factor treatment of peripheral arterial disease is lacking and requires vascular surgeon participation
Pharmacologic risk factor treatment of peripheral arterial disease is lacking and requires vascular surgeon participation
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DOI：
10.1016/j.avsg.2007.01.008
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发表时间：
2007-03-01
影响因子：
1.5
通讯作者：
Abou-Zamzam, Ahmed M., Jr.
中科院分区：
文献类型：
--
作者：
Bianchi, Christian;Montalvo, Valerie;Abou-Zamzam, Ahmed M., Jr.
外周动脉疾病(PAD)患者心血管并发症的药物治疗可以对这些患者的预后产生深远的影响。美国心脏协会和美国心脏病学会(AHA/ACC)已经发布了高血压、高脂血症、糖尿病和烟草使用的治疗指南。患有PAD的患者通常在这些情况下没有得到足够的治疗。我们试图评估所有来血管外科诊所接受PAD治疗的新患者遵守这些既定指南的情况，并勾勒出血管外科医生参与这些治疗的机会。在血管外科诊所，一位工作人员血管外科医生对连续出现的有症状的、客观证实的PAD(踝臂指数为0.9)患者进行了评估。记录PAD危险因素、就诊前用药和既往心血管干预。对患者是否接受了适当的预防性药物治疗以及是否达到了AHA/ACC的目标进行了分层。在没有心血管病史的患者中，进行了这些疾病的筛查。在一年的时间里，对167名新患者进行了评估。客观诊断为间歇性跛行115例(69%)，严重肢体缺血52例(31%)。平均年龄为67.8岁，73名患者(44%)为现吸烟者。在最初的评估中，只有115名(69%)患者报告使用了抗血小板药物。有高血压诊断记录的患者有39例(71%)符合临床指南。18例(20%)糖尿病患者血糖控制较差(HGB-A1C和GT；7.0%)。有高脂血症病史的88名患者中有17名(19%)没有得到适当的治疗。血管外科医生的医疗干预导致31%的患者开始接受抗血小板治疗，29%的高血压治疗被修改，19%的已建立的脂肪治疗被修改，20%的患者开始脂肪治疗。新诊断高血压10例(6%)，高脂血症13例(7%)。尽管医学界对心血管疾病的预防有明确的指导方针，但在血管外科诊所就诊的有症状性PAD的患者中，有很大比例的患者没有接受适当的治疗，因为他们的合并症或没有达到既定的目标。血管外科医生通过系统地预防缺血事件，在促进血管健康方面发挥着重要作用。
The pharmacologic treatment of the cardiovascular comorbidities in patients with peripheral arterial disease ( PAD) can have a profound effect on the outcomes of these patients. Guidelines for the treatment of hypertension, hyperlipidemia, diabetes, and tobacco use have been published by the American Heart Association and American College of Cardiology (AHA/ACC). Patients with PAD are often under-treated for these conditions. We sought to evaluate the adherence to these established guidelines in all new patients presenting with PAD to a vascular surgery clinic and delineate the opportunity for vascular surgeon involvement in these treatments. Consecutive new patients with symptomatic, objectively proven PAD (ankle-brachial index < 0.9) were evaluated in a vascular surgery clinic by a staff vascular surgeon. PAD risk factors, pre-visit medications, and prior cardiovascular interventions were recorded. Patients were stratified whether they were receiving appropriate preventive pharmacotherapy and whether they were meeting AHA/ACC goals. In patients without prior cardiovascular history, screening for these conditions was performed. One hundred sixty-seven new patients were evaluated over a 1-year period. Objectively diagnosed PAD included intermittent claudication in 115 ( 69%) and critical limb ischemia in 52 (31%) patients. Average age was 67.8 years, and 73 patients (44%) were current smokers. At initial evaluation, only 115 ( 69%) patients reported antiplatelet use. Patients with a recorded diagnosis of hypertension met clinical guidelines in 39 instances (71%). Eighteen patients (20%) with diabetes mellitus had poor glycemic control (Hgb-A1C > 7.0%). Seventeen (19%) of 88 patients with a history of hyperlipidemia were not adequately treated. Vascular surgeon medical interventions resulted in 31% of patients being started on antiplatelet therapy, 29% of hypertension therapies were modified, 19% of established lipid therapy was modified, and lipid therapy was initiated in 20%. A new diagnosis of hypertension was made in 10 cases (6%) and hyperlipidemia in 13 cases (7%). Despite clear guidelines for the medical community regarding cardiovascular prevention, a large percentage of patients with symptomatic PAD presenting to the vascular surgery clinic are not receiving appropriate therapy for their comorbidities or are not meeting the established goals. Vascular surgeons have an important role in promoting vascular health through the systemic prevention of ischemic events.