Key Insights On Assessing The Risk Factors For PAD
A review of the literature reveals that smoking and diabetes are the strongest risk factors for PAD. There have been no positive prospective studies linking risk factor controls to changes in PAD. The consensus is that the cardio-protective effects of lipid and blood pressure control, and reduction of microvascular risk with glycemic are beneficial in the context of PAD (TASCII study).16 Smoking has the greatest impact on PAD and cessation is the cornerstone of PAD treatment.8
Currently, there is an ongoing North American study that is worth watching. For this study, the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, researchers have enrolled over 10,000 patients and are studying the effects of three treatment arms and cardiovascular risk. The three treatment arms are as follows:
• intensive lowering of blood sugar levels (compared to a more standard blood sugar treatment);
• intensive lowering of blood pressure in comparison to standard blood pressure treatment; and
• treatment of blood lipids by a fibrate plus a statin in comparison to a statin alone.
Recently, researchers halted the glucose control arm due to an increased mortality associated with the intensive glucose regimen in comparison to the standard glucose control. This is significant because it goes against conventional thought that the tighter the glucose control, the better the outcome. It is important to note that the increased risk was slight and was only specific to a subset of patients who had two or more risk factors for heart disease outside of diabetes, or who had preexisting heart disease upon entering the study. The study is expected to be complete in 2009 and the results are eagerly anticipated.17
Dr. Yung practices at Kitsap Podiatry and at Harrison Memorial Hospital, both in Silverdale, Wash. Dr. Khan is the Chief Resident in the Department of Orthopaedics/Podiatry at the University of Texas Health Science Center.
Dr. Steinberg is an Assistant Professor in the Department of Plastic Surgery at the Georgetown University School of Medicine in Washington, D.C. Dr. Steinberg is a Fellow of the American College of Foot and Ankle Surgeons.