Skip to main content Accessibility help
Hostname: page-component-546b4f848f-fhndm Total loading time: 0 Render date: 2023-06-03T04:53:42.911Z Has data issue: false Feature Flags: { "useRatesEcommerce": true } hasContentIssue false
This chapter is part of a book that is no longer available to purchase from Cambridge Core

1 - Vascular risk factors and their management

Alasdair Wilson
University of Aberdeen, UK
Julie Brittenden
University Department of Surgery, UK
Vish Bhattacharya
Queen Elizabeth Hospital
Gerard Stansby
Freeman Hospital
Get access


Key points

  • Peripheral arterial disease (PAD) is an under-diagnosed and under-treated condition

  • Patients with PAD have a cardiovascular risk profile equivalent to or worse than those with coronary or cerebrovascular disease

  • PAD patients with concomitant symptomatic cardiac or cerebrovascular disease, diabetes or a low ankle pressure index are at even higher risk of sustaining a vascular event

  • Patients with PAD should receive the same risk factor management as patients with other cardiovascular diseases

  • Patient awareness of the need for cardiovascular secondary prevention therapy in PAD is low

The need for cardiovascular risk factor management in patients with peripheral arterial disease

PAD is a condition that is frequently under diagnosed and often the subject of suboptimal care. The first line treatment for patients with PAD is cardiovascular risk factor management with the aim of improving patient survival. This is because patients with PAD have a two- to threefold increased risk of cardiovascular mortality compared to an age- and sex-matched control population. The risk of a patient with PAD dying from a heart attack is believed to be equivalent to those patients who have already survived their first myocardial infarction.

The global Reduction of Atherothrombosis for Continued Health (REACH) registry has recently been established to determine atherothrombotic risk in more than 68,000 at-risk patients. To date it has shown that, compared to patients with coronary heart disease or cerebrovascular disease, those with PAD had the highest rates of cardiovascular death, myocardial infarction, stroke, or hospitalisation for atherothrombotic events at 1-year follow up (Figure 1.1).

Postgraduate Vascular Surgery
The Candidate's Guide to the FRCS
, pp. 37 - 48
Publisher: Cambridge University Press
Print publication year: 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Steg, PH, Bhatt, D, Wilson, PWF et al. One-year cardiovascular event rates in outpatients with atherothrombosis. JAMA 2007; 297: 1197–206.CrossRefGoogle ScholarPubMed
Criqui, MH, Langer, RD, Fronek, A et al. Mortality over a period of 10 years in patients with peripheral arterial disease. N Engl J Med 1992; 326: 381–6.CrossRefGoogle Scholar
,Ankle Brachial Index Collaboration. Ankle Brachial Index combined with Framingham Risk Score to predict cardiovascular events and mortality. JAMA 2008; 300: 197–208.CrossRefGoogle Scholar
,Scottish Intercollegiate Guidelines Network (SIGN). Diagnosis & Management of Peripheral Arterial Disease 2006; Guideline no. 89.
TASC II guidelines at
Eisenberg, MJ, Filion, KB, Belisle, P et al. Effectiveness of smoking cessation interventions among adults: a systemic review of reviews. Cancer Prevention 2008; 17: 535–44.Google Scholar
LaRosa, JC, Grundy, SM, Walters, DD et al. Intensive lipid lowering with atorvastatin in patients with stable coronary heart disease. N Engl J Med 2005; 352: 1425–35.CrossRefGoogle Scholar
,Antithrombotic Trialists' Collaboration. Collaborative meta-analysis of randomised trials of antiplatelet therapy for the prevention of death, myocardial infarction and stroke in high risk patients. BMJ 2002; 324: 71–86.CrossRefGoogle Scholar
,Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with Simvastatin I 20, 536 high risk individuals: a randomised placebo controlled trial. Lancet 2002; 360: 7–22.CrossRefGoogle Scholar
Stratton, IM, Adler, AI, Neil, HAW et al. Association of macrovascular and microvascular complications of type 2 diabetes (UKPDS:35): prospective observational study. BMJ 2000; 321: 405–12.CrossRefGoogle ScholarPubMed

Save book to Kindle

To save this book to your Kindle, first ensure is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the or variations. ‘’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats