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).