Circulation: Cardiovascular Interventions Topic Review

Cardiovascular disease remains a major cause of morbidity and mortality in the United States. Peripheral artery disease (PAD) is a manifestation of systemic atherosclerosis that confers a significantly increased risk of myocardial infarction, stroke, and death. Whether cardiovascular risk can be reduced by implementation of secondary prevention therapies (such as antiplatelet therapy, statins, or angiotensin-converting enzyme inhibitors/angiotensin receptor blockers) in individuals with PAD identified by a screening ankle-brachial index measurement is unknown. Using data from the National Health and Nutrition Examination Survey (NHANES), the authors demonstrate that millions of high risk United States adults with PAD (ankle-brachial index 0.90) were not receiving guideline recommended secondary prevention therapies. All-cause mortality was significantly higher in individuals with PAD, including those without previously recognized cardiovascular disease. Furthermore, treatment with multiple secondary prevention therapies was associated with a significantly reduced risk of all-cause mortality in this population. Given the conflicting literature about the use of secondary prevention therapies, aspirin in particular, in patients with PAD, these observational findings underscore the importance of a large scale clinical trial to determine whether implementation of multiple secondary prevention therapies, specifically in high-risk individuals identified by ankle-brachial index screening as having PAD, can indeed reduce cardiovascular morbidity and mortality.