ACC NY Cardiovascular Symposium Peripheral Vascular Disease: Watch the Heart and the Brain Evolving Role of Exercise, ACE-Inhibitors, Interventional and Surgical Options Mark A. Creager, M.D President, American Heart Association Dartmouth-Hitchcock Heart and Vascular Center Geisel School of Medicine at Dartmouth Lebanon, NH
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ACC NY Cardiovascular Symposium
Peripheral Vascular Disease:
Watch the Heart and the Brain
Evolving Role of Exercise, ACE-Inhibitors, Interventional and
Surgical Options
Mark A. Creager, M.D
President, American Heart Association
Dartmouth-Hitchcock Heart and Vascular Center
Geisel School of Medicine at Dartmouth
Lebanon, NH
Conflicts of Interest
• None
Peripheral Artery Disease (PAD)
• The presence of a stenosis or occlusion in the aorta or arteries of the limbs
• Usually caused by atherosclerosis
• Associated with an increased risk of death, myocardial infarction, and stroke
• May impair walking or cause critical limb ischemia
Age,
years
Women, % Men, %
HIC LMIC HIC LMIC
25–29 2.70 3.96 2.76 1.21
30–34 3.20 4.46 3.27 1.50
35–39 3.78 5.01 3.88 1.87
40–44 4.47 5.62 4.58 2.33
45–49 5.28 6.31 5.41 2.89
50–54 6.23 7.08 6.38 3.58
55–59 7.33 7.92 7.51 4.43
60–64 8.60 8.87 8.82 5.47
65–69 10.08 9.91 10.33 6.74
70–74 11.77 11.05 12.07 8.28
75–79 13.71 12.32 14.05 10.13
80–84 15.91 13.70 16.30 12.33
85–89 18.38 15.22 18.83 14.94
90–94 21.14 16.87 21.65 17.99
95–99 24.20 18.65 24.77 21.50
Global Prevalence of PAD
– The global burden of PAD is estimated to be 202 million persons
– The prevalence increases with age
– In HIC, the prevalence of PAD is similar between women and men
– In LMIC, the prevalence of PAD was higher in women than men at most ages
Estimated Age-Specific PAD
Prevalence for Women and Men in HIC
and LMIC
Fowkes FG, et al. Lancet. 2013;382(9901):1329-1340.
Diehm, C. et al. Circulation 2009;120:2053-2061
The German Epidemiological Trial on ABI Study:Event-free Survival by PAD status
REACH Registry One Year Event Rates for the
Composite of CV Death, MI and Stroke
Steg PG et al,. JAMA 2007;297(11): 1197-1206.
4.5
6.5
5.4
2.2
0
1
2
3
4
5
6
7CADPADCVDRisk Factors
Perc
ent
CAD CVD PAD Risk Factors
The REACH Registry recruited >68,000 outpatients aged ≥45 years
with established CV disease or ≥3 risk factors from 44 countries.
Approximately 25% of the
patients with PAD had a
history of MI, 30% had
angina, 16% had a previous
stroke, and 15% had a
previous TIA
Reinecke et al. Eur Heart J 2015;36:932-938
Death Amputation
Contemporary PAD Outcomes in Germany
n = 41,882 PAD patients hospitalized during 2009 – 2011Followed until 2013, (mean 1144 days)
7,825 patients were amputated and 10,880 died.
Physican Use of Secondary Prevention Therapies in PAD
18.7%
0 20% 40% 60% 80%
Statin use
20.8%ACE/ARB use
27.4%Anti-platelettherapy use
34.3%
65.8%
57.5% PAD with CVD
PAD without CVD
p<0.0001*
* Statistical comparison by Chi-square testPande et al., Circulation, 2011
The Efficacy of Statin TherapyThe Heart Protection Study
Heart Protection Study Collaborative Group. Lancet. 2002;360:7-22.