IT’S SOMETIMES CALLED “window-shopper’s disease.” As walking brings on leg cramps and pain, people with peripheral artery disease must frequently stop for breaks. When they rest, pain subsides. When they resume walking, PAD pain kicks back in.
PAD is common among older adults. About one in every 20 Americans over age 50 has PAD, with up to 12 million people affected overall, according to the National Heart, Lung, and Blood Institute.
People may mistakenly believe painful walking is part of normal aging. However, PAD is linked to higher risks of cardiovascular complications such as heart attacks or strokes. PAD shouldn’t be suffered stoically or in silence. If you have symptoms, you need a medical evaluation.
Patients with peripheral artery disease (PAD) are at high risk of heart attack, stroke and cardiovascular death. In addition, PAD patients can suffer major adverse limb events, such as acute limb ischemia — the equivalent of a heart attack in the leg — that can lead to limb loss. Managing PAD is challenging for patients and physicians alike — despite best available treatment including high-intensity statins, risk of cardiovascular and limb events remains high. With few clinical trials focused on patients with PAD, physicians must often extrapolate from studies in broader populations with atherosclerosis about the best treatment approach for these patients. Unfortunately, few of these studies have characterized limb risk and fewer have demonstrated benefits of preventive therapies in reducing this risk. A new sub-analysis of the FOURIER clinical trial, however, now offers information on the safety and effectiveness of giving the PCSK9 inhibitor evolocumab on top of statin therapy to this high-risk population. At the 2017 American Heart Association Scientific Sessions, Marc Bonaca, MD, MPH, investigator at the TIMI Study Group and director of the Aortic Disease Center at Brigham and Women’s Hospital, presented results from the sub-analysis, which are published simultaneously in Circulation.
“Whenever trials like FOURIER demonstrate benefit of a therapy in a broad population, we then want to understand the efficacy and safety in subpopulations to help clinicians understand which patients are going to derive the greatest absolute benefit. We’ve found that several sub-groups of patients respond well to evolocumab, but it’s especially encouraging to see these results for patients with PAD since this is a population at heightened cardiovascular risk and there are few therapies that modify limb risk,” said Bonaca. “We see that adding evolocumab can make a big difference for these patients.”
A home-based exercise program helped people with clogged leg arteries walk farther and faster, according to new research in the Journal of the American Heart Association. The program was beneficial even 12 months after participants started the program.
Previously, studies have shown that supervised exercise can improve walking and lessen the symptoms of peripheral artery disease (PAD), but this is the first to document the long-term benefits of a home-based walking program.
“The problem with supervised exercise is that it takes many visits to a cardiac rehabilitation center or other exercise facility, and it is not covered by Medicare,” said Mary McGrae McDermott, M.D., lead author and the Jeremiah Stamler professor of medicine at the Northwestern University Feinberg School of Medicine in Chicago. “Our results should encourage physicians to recommend walking even if their patients do not have access to a supervised-exercise program.”