Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
JCR Impact Factor (IF) – 2.1
5-Year Impact Factor – 2.2
Scopus CiteScore – 3.4 (CiteScore Tracker 3.4)
Index Copernicus  – 161.11; MEiN – 140 pts

ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
Periodicity – monthly

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Advances in Clinical and Experimental Medicine

2018, vol. 27, nr 6, June, p. 819–826

doi: 10.17219/acem/68983

Publication type: original article

Language: English

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Insufficient modification of atherosclerosis risk factors in PAD patients

Katarzyna Skórkowska-Telichowska1,2,3,B,C,D, Katarzyna Kropielnicka1,4,B,C, Katarzyna Bulińska1,4,B,C, Urszula Pilch1,4,B,C, Marek Woźniewski4,A,F, Andrzej Szuba1,2,3,A,D,E,F, Ryszard Jasiński4,B,F

1 WroVasc-Integrated Medical Cardiovascular Center, Regional Specialist Hospital, Research and Development Center, Wrocław, Poland

2 Department of Internal Medicine, 4th Military Hospital, Wrocław, Poland

3 Division of Angiology, Faculty of Health Sciences, Wroclaw Medical University, Poland

4 Department of Rehabilitation, University School of Physical Education, Wrocław, Poland

Abstract

Background. An aggressive reduction of cardiovascular risk factors in patients with intermittent claudication (IC) is extremely important.
Objectives. The aim of this study was to investigate patients’ adherence to current guidelines for the recognition and reduction of atherosclerosis risk factors in peripheral arterial disease (PAD) in Poland.
Material and Methods. The study included 126 patients with PAD stage II, according to the Fontaine Classification, who over a period of 2 years attended an angiological outpatient clinic and were referred for physical rehabilitation.
Results. In the 77% of PAD patients diagnosed with dyslipidemia, 72% had hypertension and 31% had diabetes. Suboptimal treatment was being given to 85.5% of patients with dyslipidemia, to 26% of patients with hypertension and to 95% of diabetics. In this study, a diagnosis of dyslipidemia, hypertension and diabetes was made for the 1st time in 22%, 7% and 4% of patients, respectively. As many as 17.5% of PAD patients with claudication were not receiving any antiplatelet therapy.
Conclusion. The diagnosis of dyslipidemia was insufficient (about 1/3 of the patients were undiagnosed), and diagnoses of hypertension and diabetes prevailed. It was established that the effective control of risk factors using relevant treatment is insufficient in dyslipidemia, hypertension and diabetes. Antiplatelet therapy was not prescribed in approx. 20% of cases.

Key words

diabetes, smoking, arterial hypertension, antiplatelet therapy, dyslipidemia

References (25)

  1. European Stroke Organisation, Tendera M, Aboyans V, Bartelink ML, et al.; ESC Committee for Practice Guidelines. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases. Eur Heart J. 2011;32(22):2851–2906.
  2. Gardner A, Montgomery P, Flinn W, Katzel LI. The effect of exercise intensity on the response to exercise rehabilitation in patients with intermittent claudication. J Vasc Surg. 2005;42(4):702–709.
  3. Goff DC, Bertoni AG, Kramer H, et al. Dyslipidemia prevalence, treatment, and control in the multi-ethnic study of atherosclerosis (MESA): Gender, ethnicity, and coronary artery calcium. Circulation. 2006;113(5):647–656.
  4. James PA, Oparil S, Carter BL, et al. Evidence-based guideline for the management of high blood pressure in adults: Report from the panel members appointed to the Eighth Joint National Committee (JNC 8). JAMA. 2014;311(5):507–520.
  5. World Health Organization. Definition and diagnosis of diabetes mellitus and intermediate hyperglycaemia: Report of a WHO/IDF consultation. Geneva, Switzerland: World Health Organization; 2006.
  6. Graham I, Atar D, Borch-Johnsen K, et al.; European Society of Cardiology (ESC); European Association for Cardiovascular Prevention and Rehabilitation (EACPR); Council on Cardiovascular Nursing; European Association for Study of Diabetes (EASD); International Diabetes Federation Europe (IDF-Europe); European Stroke Initiative (EUSI); International Society of Behavioral Medicine (ISBM); European Society of Hypertension (ESH); European Society of General Practice/Family Medicine (ESGP/FM/WONCA); European Heart Network (EHN). European guidelines on cardiovascular disease prevention in clinical practice: Executive summary. Fourth Joint Task Force of the European Society of Cardiology and other s
  7. European Association for Cardiovascular Prevention & Rehabilitation, Reiner Z, Catapano AL, De Backer G, et al.; ESC Committee for Practice Guidelines (CPG) 2008–2010 and 2010–2012 Committees. ESC/EAS guidelines for the management of dyslipidaemias: The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Eur Heart J. 2011;32(14):1769–1818.
  8. Collins R, Armitage J, Parish S, Sleigh P, Peto R; Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study in cholesterol-lowering with simvastatin in 5963 people with diabetes: A randomized placebo-controlled trial. Lancet. 2003;361(9374):2005–2016.
  9. The Heart Outcomes Prevention Evaluation Study Investigators, Yusuf S, Sleight P, Pogue J, Bosch J, Davies R, Dagenais G. Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high risk patients. N Engl J Med. 2000;342(3):145–153.
  10. ONTARGET Investigators, Yusuf S, Teo KK, Pogue J, et al. Telmisartan, ramipril or both in patients at high risk for vascular events. N Engl J Med. 2008;358(15):1547–1559.
  11. Radack K, Deck C. Beta-adrenergic blocker therapy does not worsen intermittent claudication in subjects in peripheral arterial disease. A meta-analysis of randomized, controlled trials. Arch Intern Med. 1991;151(9):1769–1776.
  12. Murabito JM, Evans JC, Nieto K, Larson MG, Levy D, Wilson PW. Prevalence and clinical correlates of peripheral arterial disease in the Framingham Offspring Study. Am Heart J. 2002;143(6):961–965.
  13. Hirsh AT, Criqui MH, Treat-Jacobson D, et al. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA. 2001;286(11):1317–1324.
  14. American Diabetes Association. Standards of Medical Care in Diabetes – 2014. Diabetes Care. 2014;37(Suppl 1):S14–80.
  15. Resnic H, Shorr R, Kuller L. Prevalence and clinical implications of American Diabetes Association-defined diabetes and other categories of glucose dysregulation in older adults: The health, aging and body composition study. J Clin Epidemiol. 2001;54(9):869.
  16. Hiatt WR. Preventing atherotrombotic events in peripheral arterial disease: The use of antiplatelet therapy. J Intern Med. 2002;251(1):93–206.
  17. Dawson DL, Hiatt WR, Creager MA, Hirsch AT. Peripheral arterial disease: Medical care and prevention of complications. Prev Cardiol. 2002;5:119–130.
  18. Antithrombotic Trialists’ (ATT) Collaboration, Baigent C, Blackwell L, Collins R, et al. Aspirin in the primary and secondary prevention of vascular disease: Collaborative meta-analysis of individual participant data from randomized trials. Lancet. 2009;373(9678):1849–1860.
  19. CAPRIE Steering Committee. A randomized, blinded, trial of clopidogrel versus aspirin in patients at risk of ischemic events (CAPRIE). Lancet. 1996;348(9038):1329–1339.
  20. Bhatt DL, Fox KA, Hacke W, et al. CHARISMA Investigators. Clopidogrel and aspirin versus aspirin alone for the prevention of atherotrombotic events. N Engl J Med. 2006;354(16):1706–1717.
  21. Cacoub PP, Bhatt DL, Steg PG, Topol EJ, Creager MA; CHARISMA Investigators. Patients with peripheral arterial disease in the CHARISMA trial. Eur Heart J. 2009;30(2):192–201.
  22. Momsen AH, Jensen MB, Norager CB, Madsen MR, Vestergaard-Andersen T, Lindholt JS. Drug therapy for improving walking distance in intermittent claudication: A systematic review and meta-analysis of robust randomized controlled studies. Eur J Vasc Endovasc Surg. 2009;38(4):463–474.
  23. Fowkes FG, Housley E, Riemersma RA, et al. Smoking, lipids, glucose intolerance, and blood pressure as risk factors of peripheral atherosclerosis compared with ischaemic heart disease in the Edinburgh Artery Study. Am J Epidemiol. 1992;135(4):331–340.
  24. Criqui MH. Peripheral artery disease – epidemiological aspects. Vasc Med. 2001;6:3–7.
  25. Powell JT, Edwards RJ, Worrell PC, Franks PJ, Greenhalgh RM, Poulter NR. Risk factors associated with the development of peripheral arterial disease in smokers: A case-control study. Atherosclerosis. 1997;129(1):41–1248.
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