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Atherosclerotic risk factor reduction in peripheral arterial disease

Results of a national physician survey

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Abstract

OBJECTIVE: Individuals with peripheral arterial disease (PAD) have a 3- to 6-fold increased risk of coronary heart disease and stroke compared to those without PAD. We documented physician-reported practice behavior, knowledge, and attitudes regarding atherosclerotic risk factor reduction in patients with PAD.

DESIGN: National physician survey.

PATIENTS/PARTICIPANTS: General internists (N=406), family practitioners (N=435), cardiologists (N=473), and vascular surgeons (N=264) randomly identified using the American Medical Association’s physician database.

MEASUREMENTS AND MAIN RESULTS: Physicians were randomized to 1 of 3 questionnaires describing a) a 55- to 65-year-old patient with PAD; b) a 55- to 65-year-old patient with coronary artery disease (CAD), or c) a 55- to 65-year-old patient without clinically evident atherosclerosis (no disease). A mailed questionnaire was used to compare physician behavior, knowledge, and attitude regarding risk factor reduction for each patient. Rates of prescribed antiplatelet therapy were significantly lower for the patient with PAD than for the patient with CAD. Average low-density lipoprotein levels at which physicians “almost always” initiated lipid-lowering drugs were 121.6±23.5 mg/dL, 136.3±28.9 mg/dL, and 149.7±24.4 mg/dL for the CAD, PAD, and no-disease patients, respectively (P<.001). Physicians stated that antiplatelet therapy (P<.001) and cholesterol-lowering therapy (P<.001) were extremely important significantly more often for the CAD than for the PAD patient. Perceived importance of risk factor interventions was highly correlated with practice behavior. Compared to other specialties, cardiologists had lowest thresholds, whereas vascular surgeons had the highest thresholds for initiating cholesterol-lowering interventions for the patient with PAD. Cardiologists were significantly more likely to report “almost always” prescribing antiplatelet therapy for the patient with PAD than were all other physicians.

CONCLUSIONS: Deficiencies in physician knowledge and attitudes contribute to lower rates of atherosclerotic risk factor reduction for patients with PAD. Reversing these deficiencies may reduce the high rates of cardiovascular morbidity and mortality associated with PAD.

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Authors and Affiliations

  1. the Departments of Medicine and Preventive Medicine, The Feinberg School of Medicine, Northwestern University, USA

    Mary McGrae McDermott MD & Philip Greenland MD

  2. the Division of Vascular Surgery, Department of Surgery, The Feinberg School of Medicine, Northwestern University, USA

    William H. Pearce MD

  3. the Department of Family Medicine, The Feinberg School of Medicine, Northwestern University, USA

    Martin S. Lipsky MD

  4. the Center on Outcomes Research and Education, Evanston Northwestern Healthcare, USA

    Elizabeth A. Hahn MA, David Cella PhD, Kendra Hanley BA, Linda Odom MA, Shaheen Khan MBA, MPH & Stacie Hudgens MA

  5. the Institute for Health Services Research and Policy Studies, Northwestern University, Evanston, Ill

    Elizabeth A. Hahn MA, David Cella PhD & Stacie Hudgens MA

  6. the Division of Preventive and Behavioral Medicine, University of Massachusetts, Worcester, Mass

    Judith K. Ockene PhD

  7. Rollins School of Public Health, Emory University, Atlanta, Ga

    Donna Brogan PhD

  8. Vascular Medicine Program, Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minn

    Alan T. Hirsch MD

  9. the Department of Family and Preventive Medicine, University of California at San Diego, San Diego, Calif

    Michael H. Criqui MD, MPH

Authors
  1. Mary McGrae McDermott MD
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  2. Elizabeth A. Hahn MA
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  3. Philip Greenland MD
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  4. David Cella PhD
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  5. Judith K. Ockene PhD
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  7. William H. Pearce MD
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  8. Alan T. Hirsch MD
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  9. Kendra Hanley BA
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  11. Shaheen Khan MBA, MPH
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  12. Michael H. Criqui MD, MPH
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  13. Martin S. Lipsky MD
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  14. Stacie Hudgens MA
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Corresponding author

Correspondence to Mary McGrae McDermott MD.

Additional information

This work was supported by Grant R01-HL63226 from the National Heart Lung and Blood Institute. Dr. McDermott is supported in part by an Established Investigator Award from the American Heart Association. Dr. McDermott was supported by a Robert Wood Johnson Generalist Physician Faculty Scholar Award during the time this study was performed.

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McDermott, M.M., Hahn, E.A., Greenland, P. et al. Atherosclerotic risk factor reduction in peripheral arterial disease. J GEN INTERN MED 17, 895–904 (2002). https://doi.org/10.1046/j.1525-1497.2002.20307.x

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  • DOI: https://doi.org/10.1046/j.1525-1497.2002.20307.x

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