Diagnosing Peripheral Arterial Disease a Priority
Health organizations, professional societies, government agencies unite to raise awareness.
The ankle-brachial index could be an important screening tool for peripheral arterial disease, as asymptomatic patients with abnormal ankle-brachial index measurements have an approximately 30% risk of death or disease over the course of five years.
“We’re missing a golden opportunity to identify at-risk patients who do not go to the doctor,” Michael R. Jaff, DO, a vascular specialist at Massachusetts General Hospital, said in a TCT-TV interview.
The United States Preventive Services Task Force has voted against screening for peripheral arterial disease, but Jaff recently published a paper in Circulation that he hopes will change their minds.
“They thought we wanted to screen the population to do more interventions, but that is clearly not the case,” Jaff said.
Jaff said specialists are getting much better at diagnosing peripheral arterial disease, particularly with the advent of imaging technologies like 3-D computed tomography.
“However, our colleagues in primary care need a little bit more work in understanding how important it is to make a diagnosis,” Jaff said.
Last month, the Peripheral Arterial Disease Coalition was formed in Washington, DC, which will combine the efforts of 44 medical and patient-based societies. This coalition is launching a public information campaign with funding from the NIH.
“This is the first time that the government has put money into a public health venture like this, so we’re going to see a lot of stories about people who get leg pain when they walk for reasons that may go beyond just getting old,” Jaff said.
Academics vs. industry?
Jaff said he does not consider himself an academic, but recognizes that academic institutions do not move as fast as industry to adapt to new technology. However, nothing moves as slow as government.
“The federal government is struggling with how to figure out health care and this unfortunately is getting relegated to a very low priority on the totem poll,” Jaff said. “I’m not saying other issues are not important, but cardiovascular disease is our number one threat.”
Jaff said doctors need to do a better job representing themselves to government officials.
What’s in store?
Asked to predict the future, Jaff said he was very excited about the potential presented by genetics, genomics and proteomics.
“Hopefully in my lifetime we will develop the ability to identify genetic expressers that result in atherosclerosis to upregulate inhibitors or downregulate promoters,” Jaff said. “We’re still going to have environmental predictors that are out of control, but in populations at risk we’ll have early targets.”
TCT: looking forward
Jaff said he was looking forward in particular to analyses of the EVA3S and SPACE trials (recently published in the New England Journal of Medicine and Lancet, respectively), both of which failed to show noninferiority of carotid angioplasty with stenting vs. endarterectomy in patients with symptomatic carotid stenosis.
“The controversy over endarterectomy vs. stenting in these patients has a lot of flaws. We’re looking at different patients every time and a small difference in inclusion criteria can produce a major difference in outcomes,” Jaff said.