Management of cardiovascular risk factors by primary care physicians in patients with peripheral arterial disease

Background: Patients with significant coronary artery disease (CAD) are now intensively treated by primary care physicians predominantly because of government pressure and remuneration to prescribe anti-platelet and anti-hyperlipidaemic drugs. Peripheral arterial disease (PAD) with the identical risk factors appeared to us to be less intensively investigated and treated by primary care physicians. Objective: To review the treatment of risk factors in all patients referred to two vascular clinics with a diagnosis of suspected PAD. Design: Cross-sectional survey. Setting: Vascular outpatient clinic in two district general hospitals. Participants: 124 consecutive new patients were studied to determine risk factors and appropriate treatment. Results: Of the 124 patients, 85 (68%) were confirmed to have PAD without evidence of symptomatic CAD. In the PAD alone group, less than 25% received anti-smoking advice (p<0.0001) and only 36% were prescribed anti-platelet drugs (p=0.016). Seventy-three per cent of the overall referred patients with hypertension had been treated for this condition and the blood pressure was normal in 71% of the patients with PAD. In patients with hyperlipidaemia, statins had been prescribed in 92% of patients with coexistent symptomatic CAD, but only in 64% of patients with PAD alone (p=0.009). In the patients with diabetes, only 66% of the PAD alone group had adequate control of their blood sugar (p=0.185). Conclusions: It would appear that patients with CAD and PAD are being treated successfully for their risk factors, but patients with PAD alone, sharing the same common risk factors, are being less than optimally treated.