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Screening for Peripheral Artery Disease and Cardiovascular Disease Risk Assessment With the Ankle–Brachial Index: U.S. Preventive Services Task Force Recommendation Statement FREE

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The full report is titled “Screening for Peripheral Artery Disease and Cardiovascular Disease Risk Assessment With the Ankle–Brachial Index in Adults: U.S. Preventive Services Task Force Recommendation Statement.” It is in the 3 September 2013 issue of Annals of Internal Medicine (volume 159, pages 342-348). The author is V.A. Moyer, on behalf of the U.S. Preventive Services Task Force.


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Ann Intern Med. 2013;159(5):I-28. doi:10.7326/0003-4819-159-5-201309030-00002
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Who developed these guidelines?

The U.S. Preventive Services Task Force (USPSTF) developed these recommendations. The USPSTF is a group of health experts that reviews published research and makes recommendations about preventive health care.

What is the problem and what is known about it so far?

Peripheral artery disease (PAD) is atherosclerosis of blood vessels in the legs. Atherosclerosis causes narrowing or blockage of the vessels, resulting in low blood flow to the legs. Peripheral artery disease is diagnosed by using a test called the ankle–brachial index (ABI) to show that blood pressure in the lower leg is lower than blood pressure in the arm. Risk factors for PAD include smoking, high blood pressure, high cholesterol levels, and diabetes. Peripheral artery disease may cause leg pain or heaviness that develops with walking and goes away with rest. The pain often limits the distance that people can walk. However, some people with PAD have no symptoms. For this reason, some medical experts believe that older adults should routinely have their ABI measured to screen for PAD. Screening is looking for a condition in people who have no symptoms. In addition, because people with PAD are at high risk for other conditions related to atherosclerosis, such as heart attack and stroke, some experts believe that measuring the ABI will help to determine whether people are at risk for these other conditions. The USPSTF recommended against screening for PAD in 2005 and is now updating those recommendations on the basis of new information published since then.

How did the USPSTF develop these recommendations?

The USPSTF reviewed published research to evaluate the use of the ABI as a screening test for PAD or as a risk predictor for cardiovascular disease.

What did the authors find?

The USPSTF found no studies that directly addressed the effect of screening for PAD with the ABI on future health outcomes. It found only 1 fair-quality study that evaluated the accuracy of the ABI in people with no PAD symptoms. In addition, the USPSTF concluded that it remains unclear whether measuring the ABI improves risk assessment beyond other risk factors that consider blood pressure and cholesterol levels or that early treatment of screen-detected PAD improves patient outcomes. The potential harms of screening include harms resulting from false-positive test results, such as anxiety and additional invasive testing to confirm the diagnosis.

What does the USPSTF recommend that patients and doctors do?

The USPSTF concluded that there is inadequate evidence to weigh the benefits and harms of screening for PAD and cardiovascular disease risk assessment with the ABI.

What are the cautions related to these recommendations?

These recommendations do not apply to people with symptoms of PAD, who should be tested for the condition, or people with cardiovascular disease, severe chronic kidney disease, or diabetes.

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