ABC of arterial and vascular disease: Secondary prevention of peripheral vascular disease

Most patients with peripheral vascular disease may be reassured that, with respect to their legs, the condition usually runs a benign course. Less than one third of patients will require any surgical or radiological intervention and only 5% will have amputation. However, peripheral vascular disease is an independent predictor of increased risk of cardiovascular death. Half of patients presenting with peripheral vascular disease have symptoms of coronary artery disease or electrocardiographic abnormality, 90% have abnormalities on coronary angiography, and 40% have duplex evidence of carotid artery disease. Excised atherosclerotic plaque Symptomatic peripheral vascular disease carries at least a 30% risk of death within five years and almost 50% within 10 years, primarily due to myocardial infarction (60%) or stroke (12%). The risks are more than doubled in patients with severe disease (requiring surgery), but even asymptomatic patients (ankle brachial pressure index <0.9) have a twofold to fivefold increased risk of fatal or non-fatal cardiovascular events All patients with peripheral vascular disease should have their risk factors for coronary artery disease assessed and, if appropriate, modified according to current guidelines Although modification of risk factors has not been shown to prevent progression of peripheral vascular disease or loss of limbs, detection of disease mandates an aggressive approach to modifying risk factors in order to reduce the risk of fatal and non-fatal myocardial infarction and stroke. The approach to risk reduction in patients with peripheral vascular disease is based on extrapolation from results of large studies of patients with coronary artery disease. Effective reduction of the risk of cardiovascular disease depends on coordinated and stringent modification of identifiable risk factors to prevent progression or new disease and the use of drugs to correct existing abnormalities. Stopping smoking, correction of hyperlipidaemia and hypertension, and optimisation of diabetic control are the cornerstones of secondary …