scholarly journals Observational study of the medical management of patients with peripheral artery disease

2019 ◽  
Vol 106 (9) ◽  
pp. 1168-1177 ◽  
Author(s):  
A. Saratzis ◽  
N. E. M. Jaspers ◽  
B. Gwilym ◽  
O. Thomas ◽  
A. Tsui ◽  
...  
Keyword(s):  
Observational Study ◽  
Peripheral Artery Disease ◽  
Medical Management ◽  
Peripheral Artery ◽  
Artery Disease

Abstract 24: Health Status Differences Between Early Invasive and Non Invasive Treatment Strategies in Patients With Peripheral Artery Disease: Insights From Portrait Registry

2020 ◽  
Vol 13 (Suppl_1) ◽  
Author(s):  
Suveen Angraal ◽  
Vittal Hejjaji ◽  
Laith Derbas ◽  
Manesh R Patel ◽  
Jan Heyligers ◽  
...  
Keyword(s):  
Health Status ◽  
Peripheral Artery Disease ◽  
Real World ◽  
Medical Management ◽  
World Health ◽  
Peripheral Artery ◽  
Supervised Exercise ◽  
Early Revascularization ◽  
Artery Disease

Background: In patients with symptomatic peripheral artery disease (PAD), a key treatment goal is to improve their health status; their symptoms, function, and quality of life (QoL). While medical therapy with lifestyle changes is recommended in all, revascularization can be a consideration to alleviate PAD symptoms. We sought to compare the real-world impact of either treatment strategy on patients’ health status improvement. Methods: Patients with new or worsening PAD symptoms (Rutherford category 1-3), from 10 U.S. specialty vascular clinics between 2011-2015, who either underwent early revascularization (using stent, angioplasty or surgery within 3 months of enrolment) or medical management alone (statin, aspirin, cilostazol, supervised exercise therapy, risk factor (diabetes, hypertension) management) were identified from the Patient-Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories (PORTRAIT) registry. The Peripheral Artery Questionnaire (PAQ) was used to assess patients’ disease-specific health status at enrollment and at 3, 6 and 12 months of follow up. The differences in PAQ overall summary scores, and each subdomain, were compared using an adjusted generalized linear model for repeated measures (Figure 1). Results: Among 797 patients (mean age of 68.6 years, 58.1% male), 226 underwent early revascularization and 571 were managed medically. At baseline, patients in the revascularization vs. medical management cohort had lower PAQ summary scores (mean ± SD; 42.6 ± 20.7 vs. 48.5 ± 22.3, P<0.001) and QoL scores (43.4 ± 23.9 vs. 50.4 ± 26.4, P<0.001). Over 1 year of follow-up, patients who underwent revascularization reported significantly higher health status over time than patients managed medically without revascularization (P <0.001 for all PAQ sub-domains; Figure 1). Conclusion: Patients with PAD who received early revascularization had worse health status at baseline, but they reported a greater degree of improvement over 1 year of follow-up when compared to patients managed medically without revascularization. Summarizing real-world health status benefits following a PAD diagnosis is critical to help guide preference-sensitive decisions on PAD management.

scholarly journals Optimizing medical management in peripheral artery disease

2018 ◽  
Vol 105 (9) ◽  
pp. 1079-1081 ◽  
Author(s):  
P. A. Coughlin ◽  
J. H. F. Rudd
Keyword(s):  
Peripheral Artery Disease ◽  
Medical Management ◽  
Peripheral Artery ◽  
Artery Disease

Medical Management of Peripheral Artery Disease

2021 ◽  
Vol 39 (4) ◽  
pp. 471-482
Author(s):  
Tara A. Holder ◽  
J. Antonio Gutierrez ◽  
Aaron W. Aday
Keyword(s):  
Peripheral Artery Disease ◽  
Medical Management ◽  
Peripheral Artery ◽  
Artery Disease

Medical management of stable peripheral artery disease: the COMPASS trial. Perspectives from a vascular standpoint

2018 ◽  
Vol 37 (4) ◽  
Author(s):  
Eduardo Ramacciotti ◽  
Valter Castelli Jr. ◽  
Jeanine Walenga ◽  
Jawed Fareed
Keyword(s):  
Peripheral Artery Disease ◽  
Medical Management ◽  
Peripheral Artery ◽  
Artery Disease

scholarly journals Evidence-Based Medical Management of Peripheral Artery Disease

2020 ◽  
Vol 40 (3) ◽  
pp. 541-553 ◽  
Author(s):  
Graham H. Bevan ◽  
Khendi T. White Solaru
Keyword(s):  
Peripheral Artery Disease ◽  
Medical Management ◽  
Limb Ischemia ◽  
Evidence Based ◽  
Cholesterol Reduction ◽  
Pressure Management ◽  
Peripheral Artery ◽  
Lifestyle Modifications ◽  
Systemic Complications ◽  
Artery Disease

Peripheral artery disease is an atherosclerotic disease of the lower extremities associated with high cardiovascular mortality. Management of this condition may include lifestyle modifications, medical management, endovascular repair, or surgery. The medical approach to peripheral artery disease is multifaceted and includes cholesterol reduction, antiplatelet therapy, anticoagulation, peripheral vasodilators, blood pressure management, exercise therapy, and smoking cessation. Adherence to this regimen can reduce limb-related complications like critical limb ischemia and amputation, as well as systemic complications of atherosclerosis like stroke and myocardial infarction. Relative to coronary artery disease, peripheral artery disease is an undertreated condition. In this article, we explore the evidence behind medical therapies for the management of peripheral artery disease.

scholarly journals Cardiorenal and other diabetes related outcomes with SGLT-2 inhibitors compared to GLP-1 receptor agonists in type 2 diabetes: nationwide observational study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Moa Lugner ◽  
Naveed Sattar ◽  
Mervete Miftaraj ◽  
Jan Ekelund ◽  
Stefan Franzén ◽  
...  
Keyword(s):  
Heart Failure ◽  
Type 2 Diabetes ◽  
Observational Study ◽  
Peripheral Artery Disease ◽  
Peripheral Artery ◽  
Short Term Treatment ◽  
Receptor Agonists ◽  
Artery Disease ◽  
Nationwide Observational Study

Abstract Background Major prospective randomized clinical safety trials have demonstrated beneficial effects of treatment with glucagon-like peptide-1 receptor agonists (GLP-1RA) and sodium–glucose co-transporter-2 inhibitors (SGLT-2i) in people with type 2 diabetes and elevated cardiovascular risk, and recent clinical treatment guidelines therefore promote early use of these classes of pharmacological agents. In this Swedish nationwide observational study, we compared cardiorenal outcomes and safety of new treatment with GLP-1RA and SGLT-2i in people with type 2 diabetes. Methods We linked data from national Swedish databases to capture patient characteristics and outcomes and used propensity-score based matching to account for differences between the two groups. The treatments were compared using Cox regression models. Results We identified 9648 participants starting GLP-1RA and 12,097 starting SGLT-2i with median follow-up times 1.7 and 1.1 years, respectively. The proportion of patients with a history of MACE were 15.8%, and 17.0% in patients treated with GLP-1RA and SGLT-2i, respectively. The mean age was 61 years with 7.6 years duration of diabetes. Mean HbA1c were 8.3% (67.6 mmol/mol) and 8.3% (67.2 mmol/mol), and mean BMI 33.3 and 32.5 kg/m2 in patients treated with GLP-1RA or SGLT-2i, respectively. The cumulative mortality risk was non-significantly lower in the group treated with SGLT-2i, HR 0.78 (95% CI 0.61–1.01), as were incident heart failure outcomes, but the risks of cardiovascular or renal outcomes did not differ. The risks of stroke and peripheral artery disease were higher in the SGLT-2i group relative to GLP-1RA, with HR 1.44 (95% CI 0.99–2.08) and 1.68 (95% CI 1.04–2.72), respectively. Conclusions This observational study suggests that treatment with GLP-1RA and SGLT-2i result in very similar cardiorenal outcomes. In the short term, treatment with GLP-1RA seem to be associated with lower risks of stroke and peripheral artery disease, whereas SGLT-2i seem to be nominally associated with lower risk of heart failure and total mortality.

Medical Management of Lower Extremity Manifestations of Peripheral Artery Disease

2015 ◽  
Author(s):  
Mary M. McDermott
Keyword(s):  
United States ◽  
Lower Extremity ◽  
Peripheral Artery Disease ◽  
Medical Management ◽  
Cardiovascular Events ◽  
The United States ◽  
Peripheral Artery ◽  
Exercise Interventions ◽  
Medical Therapies ◽  
Artery Disease

Lower extremity peripheral artery disease (PAD) affects eight million people in the United States and over 200 million men and women worldwide. Furthermore, recent evidence from the Global Disease Burden suggests that the prevalence of PAD increased worldwide by 20% between 2000 and 2010. Patients with PAD are at increased risk for cardiovascular events, functional impairment, and mobility loss. With advancements in medical science and improved treatments for cardiovascular disease, rates of cardiovascular events have declined in the United States and in other high socioeconomic countries. Consequently, people are living longer with chronic debilitating diseases, such as PAD. Optimal medical management of patients with PAD is essential to help these patients survive longer with optimal quality of life and without disability. This review covers medical therapies to improve lower extremity functioning in people with PAD, additional medications to improve walking performance in PAD, and both walking and nonwalking exercise interventions for lower extremity PAD,  Tables outline outcome measures typically used to assess improvement in response to medical therapies for PAD; FDA-approved medications and medications that may be beneficial but are not FDA-approved for intermittent claudication symptoms; exercise therapies that benefit patients with PAD; and additional considerations regarding exercise therapy in PAD. Graphs showcase ramipril versus placebo and changes in walking time according to home-based versus supervised walking exercise. This review contains 2 figures, 5 tables, and 68 references.

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