The U.S. Preventive Services Task Force released recommendations in October discouraging the use of what it deems "nontraditional risk factors" in screening for vascular disease.
The Society for Vascular Medicine (SVM) finds these Task Force recommendations, particularly those discouraging the use of ankle-brachial index (ABI) screening for peripheral arterial disease (PAD), ill-advised and contrary to sound medical research. In a 2006 publication, the Task Force dismissed PAD as an important risk factor in cardiovascular disease. However, PAD is not merely a risk factor for cardiovascular disease, it is cardiovascular disease. PAD is thought to affect 8 - 10 million Americans. Individuals with PAD have a five-times increased risk of suffering an heart attack, stroke, or death within five years.
The threat of premature myocardial infarction, stoke, and death in patients with PAD is so great that all vascular specialty medical societies in the United States have created a unified guideline document endorsing the screening of high-risk patients for PAD. Numerous clinical trials have demonstrated that for patients with cardiovascular disease including PAD, the administration drugs such as aspirin and statins to reduce cholesterol reduce the risk of heart attack, stroke, and death. These medications represent the cornerstone recommendations in the inter-societal guideline.
Several scientific governmental agencies have endorsed the recommendations in this guideline, including the National Heart, Lung, and Blood Institute of the National Institutes of Health. In its National Cholesterol Education Program Adult Treatment Panel Three (ATP III), PAD is recognized as a coronary heart disease risk equivalent.
The Task Force noted, "A recent well-conducted meta-analysis of 16 population-based cohort studies concluded that lower ABI is associated with an increased risk for CVD events and mortality, independent of Framingham risk score, but suggested that this evidence cannot provide an unbiased determination of how many asymptomatic men without known vascular disease would be reclassified from the intermediate classification obtained by using Framingham factors alone to a higher cardiac risk stratum." In other words, despite PAD affecting approximately 15 to 20 percent of the Medicare population, the use of a one-time noninvasive test should be avoided. "Their strict actuarial accounting avoids the harsh truth of PAD: People are dying because they remain undiagnosed," said Joshua Beckman, M.D., M.S., SVM president-elect.
The Society for Vascular Medicine is a professional organization founded in 1989 to improve the integration of vascular biological advances into medical practice, and to maintain high standards of clinical vascular medicine. The Society is distinguished by its emphasis on clinical approaches to vascular disorders.
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