AHA president calls for vascular disease action

PresAddressREAL_ToddBuchananPeripheral artery disease is one of the key clinical manifestations of systemic atherosclerosis. Like other vascular diseases, PAD is frequently ignored, misdiagnosed and mistreated, contributing to the development and progression of cerebrovascular and cardiovascular disease.

“Two vascular disorders, atherosclerosis and thrombosis, are the principal underpinnings of heart disease and stroke, the two leading causes of death in the world,” said AHA President Mark A. Creager, MD, FAHA, during his Nov. 8 Presidential Address at Scientific Sessions 2015 in Orlando, Florida. “These disorders also cause PAD, which affects about 8 million people in the United States. PAD limits the ability to walk or, worse yet, results in limb loss. As a manifestation of the systemic burden of atherosclerosis, PAD is strongly associated with stroke, heart attack, life-threatening kidney and intestinal problems, and numerous other serious health issues.”

Thrombosis carries similarly dire consequences. Venous thromboembolism affects about 900,000 people annually in the United States. Pulmonary embolisms kill about 30,000 Americans every year.

Vascular disease, and PAD in particular, is prevalent in rich and poor populations, and men and women. The risk of PAD is increased by tobacco use, diabetes, hypertension and age.

PAD disproportionately affects African-Americans, consistent with findings that African-Americans face a higher burden of stroke and heart disease than other ethnic groups.

Socioeconomic factors also are important. The prevalence of PAD is highest among people in the lowest income and education brackets, risk factors that are largely independent of traditional cerebrovascular and cardiovascular risk factors.

Simply having PAD doubles the risk of death. Having PAD elevates the risk of stroke or myocardial infarction to the same degree as having a prior stroke or MI.

“PAD is a health crisis that is largely unnoticed,” Creager said. “Physicians often do not look for PAD, chalking up leg pains to age, arthritis or general ailments. Physicians sometimes diagnose it yet fail to treat it properly. Risk factor-modifying therapies and antiplatelet drugs are prescribed for fewer than 20 percent of PAD patients who did not have previously established cerebrovascular or coronary disease.”

Those oversights can be deadly, he said. “Antiplatelet drugs and statins each reduce the risk of stroke, heart attack and death by 25 percent. Among symptomatic patients, supervised exercise training can double walking distance, yet it cannot be prescribed if the diagnosis is not made.”

The good news, Creager said, is that the ability to diagnose and treat vascular disease has never been greater. The growing understanding of the pathophysiology underlying atherosclerosis and thrombosis is being translated into novel therapies for prevention and treatment. Novel oral antithrombotic drugs to treat venous thrombosis and prevent pulmonary embolism have entered the marketplace. New antiplatelet drugs have the potential to reduce limb complications of PAD.

“It is exciting to witness the tremendous advances in technology, drug discovery and the promise of new biopharmaceuticals to treat vascular disease, but we need much more clinical research in vascular diseases,” he said. “I also urge you to remember vascular diseases and their terrible toll. We can help save many lives and limbs by helping patients and healthcare professionals understand the threat that vascular diseases pose, as well as the importance of preventing, diagnosing and treating them.”