2020, Volume 27, Supplement 1: Peripheral artery disease in the UK – unmet needs

This article will contribute to a 'Learning with reflection' CPD activity. Atherosclerosis is the leading cause of death in the UK and is likely to remain so for the foreseeable future.1 Much of the research effort in secondary prevention has focused on patients with myocardial infarction or stroke, particularly on the effects of antithrombotic agents, but populations with peripheral artery disease (PAD) have been studied less intensively....

This article will contribute to a 'Learning with reflection' CPD activity. There is an impending global epidemic in peripheral artery disease (PAD), owing to increasing rates of obesity and diabetes. Despite being a common and potentially preventable condition, the evidence base underpinning the diagnosis, treatment and prevention of PAD is poor when compared with conditions of similar prevalence. This is alarming given that patients with both asymptomatic and symptomatic PAD have worse outcomes in terms of all-cause mortality and, in particular, cardiovascular-related death. A large scale, community effort from specialist practitioners, general practitioners and public health is required to combat this impending health disaster. This can be achieved through higher quality research, increased patient and public awareness, and responsible use of available resources if we are to improve life and limb in this under-recognised group of patients. We aim to give a global view regarding the challenges that lie ahead and the opportunities for improvement in all subgroups in the spectrum of PAD....

This article will contribute to a 'Learning with reflection' CPD activity. Over 200 million individuals are living with peripheral artery disease (PAD), which represents the third leading cause of atherosclerotic morbidity and mortality. Though intermittent claudication is the hallmark symptom of chronic PAD, only a minority of patients with PAD are symptomatic. Yet, even asymptomatic PAD is an important cardiovascular risk factor. Patients at risk for PAD should undergo a thorough assessment of cardiovascular risk factors and a comprehensive vascular evaluation. The primary focus of PAD management is risk factor modification to improve prognosis and amelioration of symptoms. Herein, we review the clinical presentation of atherosclerotic PAD, the appropriate diagnostic investigations, and the available medical and surgical management options....

This article will contribute to a 'Learning with reflection' CPD activity. The COMPASS (Cardiovascular Outcomes for People Using Anticoagulation Strategies) trial was a double-dummy, double-blind, multicentre, randomised clinical trial in patients with stable atherosclerotic vascular disease (sponsored by Bayer). Patients were randomised to one of three treatment groups: low-dose (2.5 mg twice daily) rivaroxaban plus aspirin (100 mg), higher dose (5 mg twice daily) rivaroxaban alone, or aspirin (100 mg) alone. The primary outcome, a composite of cardiovascular death, stroke, or myocardial infarction, occurred in fewer patients randomised to rivaroxaban plus aspirin, compared with aspirin alone. The study was terminated early due to the superiority of the combination therapy after a mean follow-up of 23 months. Major bleeding occurred more frequently in the combination therapy group. Twice-daily rivaroxaban 5 mg monotherapy did not significantly lower the risk of major adverse cardiovascular events versus aspirin alone (HR 0.90, p=0.12) and resulted in a significantly higher risk of major bleeding....