Top Research Advances Highlight New Approaches To Cardiovascular Risk Prediction

Main Category: Cardiovascular / Cardiology
Also Included In: Vascular
Article Date: 18 Sep 2009 - 2:00 PDT

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The Peripheral Arterial Disease (P.A.D.) Coalition announced the Coalition's third annual Best PAD Research Awards for papers published in 2008 at the organization's sixth annual meeting in Washington, DC. The Best PAD Research Awards honor the work of investigators and acknowledge the creation of new clinical research relevant to the understanding and/or treatment of peripheral arterial disease.

The Best PAD Research Award in Epidemiology/Preventive Medicine was presented to Gerry Fowkes, professor of Epidemiology, Public Health Sciences Section, Division of Community Health Sciences at the University of Edinburgh, United Kingdom. Fowkes and his fellow researchers that comprise the international Ankle Brachial Index Collaboration were recognized for their work on the research study, "Ankle Brachial Index Combined With Framingham Risk Score to Predict Cardiovascular Events and Mortality: A Meta-analysis," published in the Journal of the American Medical Association (JAMA. 300:197-208, 2008).

Prior research has established that a low ankle-brachial index (ABI), a test used to diagnosis PAD, is associated with an increased incidence of myocardial infarction, stroke and death. However, it has been unclear whether the ABI improves the identification of individuals at risk for cardiovascular events independent of the Framingham risk score, a standard tool used widely in clinical practice. The authors conducted a meta-analysis of 16 studies that together included more than 48,000 men and women.

Results showed that use of the ABI may improve cardiovascular risk prediction beyond the Framingham risk score and reclassify the risk category and, thus, modify treatment recommendations in approximately 19 percent of men and 36 percent of women.

"Despite great advances in understanding the cause of heart attacks and stroke, we still find it difficult to accurately predict who will develop these conditions. Our research has shown that the ABI has the potential to improve risk prediction, and we continue to refine this work to show how the ABI might be used in clinical practice," stated professor Fowkes.

The Best PAD Research Award in Vascular Medicine went to Mary M. McDermott, MD, professor, Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL. Dr. McDermott and her colleagues were recognized for their work on the research study, "Asymptomatic Peripheral Arterial Disease Is Associated With More Adverse Lower Extremity Characteristics Than Intermittent Claudication," published in Circulation: Journal of the American Heart Association (Circulation. 117:2484-2491, 2008).

While up to half of PAD patients do not report exertional leg symptoms, the impact of asymptomatic PAD on quality of life is poorly understood. This study examined 465 patients with PAD and 292 sedentary, age-matched, non-PAD patients. The study found that patients who do not develop leg symptoms have greater functional impairment, poorer lower-extremity nerve function and adverse calf muscle characteristics than patients with intermittent claudication. Quality of life was poorer among always asymptomatic PAD patients than among persons with IC or non-PAD participants.

"These results suggest that PAD patients who slow their walking speed to avoid exertional leg symptoms may experience more adverse consequences in their lower extremity muscles and nerves, compared to PAD patients who walk to the point of leg pain," added Dr. McDermott. "Available data suggest that clinicians should encourage their PAD patient to walk sufficiently to experience leg symptoms."

About The Peripheral Arterial Disease (P.A.D.) Coalition

The Peripheral Arterial Disease (P.A.D.) Coalition is an alliance of leading health organizations, vascular health professional societies, and government agencies united to raise public and health professional awareness about lower extremity PAD. Established in 2004, the P.A.D. Coalition is coordinated by the Vascular Disease Foundation, a national, not-for-profit section 501(c)(3) organization and is supported by the following national sponsors: the Bristol-Myers Squibb/Sanofi Pharmaceuticals Partnership; Cordis Endovascular, a division of Cordis Corporation; Abbott Vascular; AnGes, Inc.; AstraZeneca; Bard Peripheral Vascular; Baxter Healthcare; BioMedix; Cook, Inc; ev3 Endovascular, Inc.; W.L. Gore and Associates; Hokanson; Ingenix; Medtronic; Novo Nordisk; and Summit Doppler.

Source: P.A.D. Coalition