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STATE-OF-THE-ART PAPER

Peripheral Arterial Disease in Patients With Diabetes

Steven P. Marso, MD, FACC^_*,_* and William R. Hiatt, MD

^_* Mid America Heart Institute, University of Missouri-Kansas City, Saint Luke’s Hospital, Kansas City, Missouri
Divisions of Geriatrics and Cardiology, Section of Vascular Medicine, University of Colorado Health Sciences Center and the Colorado Prevention Center, Denver, Colorado

Manuscript received April 15, 2005; revised manuscript received August 18, 2005, accepted September 8, 2005.

^_* Reprint requests and correspondence: Dr. Steven P. Marso, Mid America Heart Institute, University of Missouri-Kansas City, Saint Luke’s Hospital, 4401 Wornall Road, Kansas City, Missouri 64111. (Email: smarso{at}saint-lukes.org).

Peripheral arterial disease (PAD) is a chronic, lifestyle-limiting disease and is an independent predictor of cardiovascular and cerebrovascular ischemic events. Despite the recognition that PAD is associated with a marked increase in the risk of ischemic events, this particular manifestation of systemic atherosclerosis is largely underdiagnosed and undertreated. The risk of PAD is markedly increased among individuals with diabetes, and ischemic event rates are higher in diabetic individuals with PAD than in comparable non-diabetic populations. Consequently, early diagnosis and treatment of PAD in patients with diabetes is critically important in order to reduce the risk of cardiovascular events, minimize the risk of long-term disability, and improve quality of life. A diagnosis of PAD in patients with diabetes mandates a multi-faceted treatment approach, involving aggressive risk-factor modification, antiplatelet therapy, and revascularization procedures. The American Diabetes Association recently issued a consensus statement on the epidemiology, pathophysiology, diagnosis, and management of PAD in patients with diabetes. This article will review the clinical implications of the consensus statement and highlight the treatment options available in order to help prevent future ischemic events in diabetic individuals with PAD.

Abbreviations and Acronyms   ABCD = Appropriate Blood Pressure Control in Diabetes trial   ABI = ankle-brachial index   ADA = American Diabetes Association   CAD = coronary artery disease   CARDS = Collaborative AtoRvastatin Diabetes Study   CLI = critical limb ischemia   CRP = C-reactive protein   CTA = computed tomographic angiography   FDA = Food and Drug Administration   LDL = low-density lipoprotein   MI = myocardial infarction   MRA = magnetic resonance angiography   NO = nitric oxide   PAD = peripheral arterial disease   UKPDS = United Kingdom Prospective Diabetes Study

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