research
The impact of exercise capacity in the atherosclerotic patient: Keep on walking!
- Publication date
- 9 February 2011
- Publisher
- __Abstract__
Peripheral arterial disease (PAD) is a manifestation of systemic arteriosclerosis. It is a
common disease affecting millions of people. Depending on the age of the investigated
population prevalences between 4% to 29% has been reported. It is alarming that the
prevalence is expected to rise in the following decades due to the aging of the western
population and the increase of risk factors such as diabetes mellitus, obesity and lack of
exercise. Patients with PAD are of an increased risk of cardiovascular events and mortality.
In addition, they may also experience signifi cant limitations in their physical
functioning and impairment in their quality of life. It is important to diagnose patients
with PAD early in the course of the disease to provide them optimal treatment as soon as
possible in attempting to lower the complication rates, improve morbidity, mortality and
subsequent their quality of life. However, symptoms of PAD are diverse. The classical
symptoms are intermittent claudication consisted of calf pain provoked by walking and
declining at rest. Earlier investigations, on the other hand, have demonstrated a large
range of symptoms ranging from no pain at all till pain at rest . A major problem is
that between 20% till 50% of the patients are asymptomatic . Commonly, to
identify patients with PAD the resting ankle brachial index (ABI) is used. This is the ratio
between the ankle’s systolic blood pressure, measured at the dorsalis pedis or posterial
tibial arterie using a Doppler ultrasonic instrument, and the systolic blood pressure at the
arm. An ABI below 0.90 is associated with angiographic stenosis of more than 50% .
According to the guidelines a resting ABI of < 0.90 is defi ned as PAD. Several studies have
found that an ABI of < 0.90 is associated with an increased risk of cardiovascular diseases
and mortality. Moreover it can also be used for prognostic risk stratifi cation.