Panel Wavers on Routine Screening for Poor Leg Circulation09/03/13
TUESDAY, Sept. 3 (HealthDay News) -- A simple test of blood
pressure in the ankle may help gauge heart disease risk for adults
without any symptoms, but a U.S. government-appointed panel says
there's not enough evidence to recommend it for routine checks.
In its final recommendation, released Tuesday, the U.S.
Preventive Services Task Force said it's unclear whether using the
"ankle brachial index" to screen for peripheral artery disease
(PAD) and assess the risk of heart disease is beneficial in people
with no symptoms.
"We recognize this is a common problem and PAD afflicts many Americans," said task force co-vice chair Dr. Albert Siu. "And we recognize it's a common cardiovascular risk factor, but we don't know, in the absence of symptoms, whether this test is useful or not."
The statement by the task force, an independent panel that
advises the federal government on the effectiveness of various
medical interventions, doesn't apply to people with symptoms of
peripheral artery disease. People with symptoms should see a doctor
and be diagnosed, Siu said.
Peripheral artery disease is a narrowing of the arteries in the
pelvis and legs, and like heart disease, restricts the blood supply
to the heart. The condition, which becomes more common with age,
often goes undiagnosed and people who have it face four to five
times more risk of heart attack or stroke, according to the
American Heart Association (AHA) website.
The most common symptoms are cramping, pain or tiredness in the
leg or hip muscles while walking or climbing stairs. Typically,
this pain goes away with rest and returns when walking again.
Peripheral artery disease is most often diagnosed with the ankle
brachial index, which compares the blood pressure in the feet with
the blood pressure in the arms. In healthy people, the ankle
pressure is at least 90 percent of arm pressure, but in PAD it may
be less than 50 percent, according to the heart association.
The task force's recommendation appears in the Sept. 3 online
issue of the
Annals of Internal Medicine.
One expert agrees with the new recommendation.
"There are many logical reasons to think that screening for peripheral artery disease with the ankle brachial index and treating people who are screen-positive will prevent cardiovascular events," said Dr. Mary McGrae McDermott, author of an accompanying journal editorial.
Despite this, there are no rigorous trials that show screening
for peripheral artery disease with the ankle brachial index
improves outcomes, said McDermott, a professor of medicine at
Northwestern University's Feinberg School of Medicine, in
"Currently there is not high-quality evidence to demonstrate that screening for peripheral artery disease with the ankle brachial index reduces cardiovascular event rates," she said.
Another expert, however, said the task force's recommendation is
at odds with current guidelines from other professional
"This new systemic evidence review by the U.S. Preventive Services Task Force, which tends to be very conservative in its review and interpretation of evidence, concludes that the ankle brachial index may be of limited value and there is need for further studies," said Dr. Gregg Fonarow, an AHA spokesman and professor of cardiology at the University of California, Los Angeles.
However, Fonarow said, a guideline from the American College of
Cardiology Foundation and the American Heart Association recommends
that "measurement of ankle brachial index is reasonable for
cardiovascular risk assessment in asymptomatic [symptomless] adults
at intermediate risk."
Peripheral artery disease is usually treated with blood pressure
medications and cholesterol-lowering drugs. Some patients, however,
may need minimally invasive treatment or surgery to open their
narrow arteries. Left untreated, peripheral artery can lead to
gangrene and amputation. The condition affects about 8 million
Americans, according to the heart association.
For more on peripheral arterial disease, visit the
American Heart Association.
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