PAD Flashcards
Non-modifiable risk factors:
age
sex
race/ethnicity
FH of CVD
Modifiable risk factors:
smoking DLD DM HTN microalbuminuria obesity/overweight alcohol stress physical inactivity poor diet/nutrition
What age is the main marker for ASCVD risk?
> 40
What diagnostic is used for PAD?
ankle-brachial index (ABI)
> 50% occlusion
intermittent claudication
> 80% occlusion
critical limb ischemia (CLI)
Fontaine PAD classification stage I
reduced pulses
Fontaine PAD classification stage II
intermittent claudication
Fontaine PAD classification stage III
pain even when resting
Fontaine PAD classification stage IV
ulcers
What age is high risk?
> = 65 yrs
should be tested
What age is high risk with risk factors for atherosclerosis (DM, DLD, HTN, smoking)?
50-64
should be tested
What age is high risk with DM + 1 additional ASCVD risk factor?
<= 50
non compressible ABI?
> 1.40
requires further diagnostics
mild to moderate ABI?
0.41-0.90
abnormal
severe PAD?
<= 0.40
abnormal
Used to establish PAD Dx in symptomatic pts when resting ABI is normal-borderline?
exercise ABI testing
Used to establish PAD Dx in pts wit non compressible arteries (ABI > 1.40)?
toe-brachial intex (TBI)
What is most important modifiable risk factor?
smoking cessation
advise them to quit at every visit
Exercise prescription?
30-45mins/session 3 or more times/week for 12 or more weeks
walk at incline/speed to produce IC Sx within 3-5mins
High intensity statin therapy?
lower LDL by >= 5o%
atorvastatin 40-80mg
rosuvastatin 200-40mg
BP goal?
< 130/80
ACEi or ARB
HbA1c goal?
< 7 %
Preferred diabetes meds?
SGLT2i and GLP1 receptor agonists
added after metformin
antiplatelet therapy is reasonable in what pts?
asymptomatic with ABI < 0.90
aspirin 75-325mg PO QD
clopidogrel 75mg PO QD
antiplatelet therapy is recommended in what pts?
symptomatic with ABI < 0.90
aspirin 75-325mg PO QD
clopidogrel 75mg PO QD
When may dual antiplatelet therapy be reasonable?
after lower extremity revascularization
The clinical benefit of what agent added to existing antiplatelet therapy is uncertain?
vorapaxar
used in addition to aspirin and/or clopidogrel
Preferred first line PAD antiplatets?
aspirin or clopidogrel
Should anticoagulants be used in pts with PAD?
no
no benefit and increased bleeding risk with warfarin + antiplatelet therapy
What is an effective therapy to improve Sx and increase walking distance in pts with claudication?
cilostazol
FDA approved in combo with antiplatelet therapy
Cilostazol is contraindicated when?
HF of any severity
Is pentoxifylline recommended for treatment of claudication?
no
How often is ABI monitored?
q 3-6 months
Measurements to assess ASCVD:
- fasting lipid panel
- HbA1c
- BP
How often is treadmill testing done in pts with IC?
q 3-6months
Exercise
Sx improvement?
ASCVD risk reduction?
Sx improvement: yes
ASCVD: no
smoking cessation
Sx improvement?
ASCVD risk reduction?
Sx: yes
ASCVD: yes
statins
Sx improvement?
ASCVD risk reduction?
Sx: yes
ASCVD: yes
BP control
Sx improvement?
ASCVD risk reduction?
Sx: no
ASCVD: yes
ACEi and/or ARB
Sx improvement?
ASCVD risk reduction?
Sx: yes
ASCVD: yes
glycemic control
Sx improvement?
ASCVD risk reduction?
Sx: no
ASCVD: yes
antiplatelets
Sx improvement?
ASCVD risk reduction?
Sx: no
ASCVD: yes
cilostazol
Sx improvement?
ASCVD risk reduction?
Sx: yes
ASCVD: no
