Screening for peripheral artery disease and cardiovascular disease risk assessment with the Ankle-Brachial Index

US Preventive Services Task Force Recommendation Statement

US Preventive Services Task Force

Research output: Contribution to journalReview article

17 Citations (Scopus)

Abstract

IMPORTANCE Peripheral artery disease (PAD) is a manifestation of atherosclerosis in the lower limbs. It can impair walking and, in severe cases, can lead to tissue loss, infection, and amputation. In addition to morbidity directly caused by PAD, patients with PAD are at increased risk for cardiovascular disease (CVD) events, because atherosclerosis is a systemic disease that also causes coronary and cerebrovascular events. OBJECTIVE To update the 2013 US Preventive Services Task Force (USPSTF) recommendation on screening for PAD and CVD risk with the ankle-brachial index (ABI). EVIDENCE REVIEW The USPSTF reviewed the evidence on whether screening for PAD with the ABI in generally asymptomatic adults reduces morbidity or mortality from PAD or CVD. The current review expanded on the previous review to include individuals with diabetes and interventions that include supervised exercise and physical therapy intended to improve outcomes in the lower limbs. FINDINGS The USPSTF found few data on the accuracy of the ABI for identifying asymptomatic persons who can benefit from treatment of PAD or CVD. There are few studies addressing the benefits of treating screen-detected patients with PAD; 2 good-quality studies showed no benefit of using the ABI to manage daily aspirin therapy in unselected populations, and 2 studies showed no benefit from exercise therapy. No studies addressed the harms of screening, although the potential exists for overdiagnosis, labeling, and opportunity costs. Studies that addressed the harms of treatment showed nonsignificant results. Therefore, the USPSTF concludes that the current evidence is insufficient and that the balance of benefits and harms of screening for PAD with the ABI in asymptomatic adults cannot be determined. CONCLUSIONS AND RECOMMENDATION The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for PAD and CVD risk with the ABI in asymptomatic adults. (I statement)

Original languageEnglish (US)
Pages (from-to)177-183
Number of pages7
JournalJAMA - Journal of the American Medical Association
Volume320
Issue number2
DOIs
StatePublished - Jul 10 2018

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Ankle Brachial Index
Peripheral Arterial Disease
Advisory Committees
Cardiovascular Diseases
Exercise Therapy
Lower Extremity
Atherosclerosis
Morbidity
Amputation
Aspirin
Walking
Therapeutics
Costs and Cost Analysis

ASJC Scopus subject areas

  • Medicine(all)

Cite this

@article{875443998cf747379109e7cc17d6676e,
title = "Screening for peripheral artery disease and cardiovascular disease risk assessment with the Ankle-Brachial Index: US Preventive Services Task Force Recommendation Statement",
abstract = "IMPORTANCE Peripheral artery disease (PAD) is a manifestation of atherosclerosis in the lower limbs. It can impair walking and, in severe cases, can lead to tissue loss, infection, and amputation. In addition to morbidity directly caused by PAD, patients with PAD are at increased risk for cardiovascular disease (CVD) events, because atherosclerosis is a systemic disease that also causes coronary and cerebrovascular events. OBJECTIVE To update the 2013 US Preventive Services Task Force (USPSTF) recommendation on screening for PAD and CVD risk with the ankle-brachial index (ABI). EVIDENCE REVIEW The USPSTF reviewed the evidence on whether screening for PAD with the ABI in generally asymptomatic adults reduces morbidity or mortality from PAD or CVD. The current review expanded on the previous review to include individuals with diabetes and interventions that include supervised exercise and physical therapy intended to improve outcomes in the lower limbs. FINDINGS The USPSTF found few data on the accuracy of the ABI for identifying asymptomatic persons who can benefit from treatment of PAD or CVD. There are few studies addressing the benefits of treating screen-detected patients with PAD; 2 good-quality studies showed no benefit of using the ABI to manage daily aspirin therapy in unselected populations, and 2 studies showed no benefit from exercise therapy. No studies addressed the harms of screening, although the potential exists for overdiagnosis, labeling, and opportunity costs. Studies that addressed the harms of treatment showed nonsignificant results. Therefore, the USPSTF concludes that the current evidence is insufficient and that the balance of benefits and harms of screening for PAD with the ABI in asymptomatic adults cannot be determined. CONCLUSIONS AND RECOMMENDATION The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for PAD and CVD risk with the ABI in asymptomatic adults. (I statement)",
author = "{US Preventive Services Task Force} and Curry, {Susan J.} and Krist, {Alex H.} and Owens, {Douglas K.} and Barry, {Michael J.} and Caughey, {Aaron B.} and Aaron Caughey and Doubeni, {Chyke A.} and Epling, {John W.} and Kemper, {Alex R.} and Martha Kubik and Landefeld, {C. Seth} and Mangione, {Carol M.} and Michael Silverstein and Simon, {Melissa A.} and Tseng, {Chien Wen} and Wong, {John B.}",
year = "2018",
month = "7",
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doi = "10.1001/jama.2018.8357",
language = "English (US)",
volume = "320",
pages = "177--183",
journal = "JAMA - Journal of the American Medical Association",
issn = "0002-9955",
publisher = "American Medical Association",
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T1 - Screening for peripheral artery disease and cardiovascular disease risk assessment with the Ankle-Brachial Index

T2 - US Preventive Services Task Force Recommendation Statement

AU - US Preventive Services Task Force

AU - Curry, Susan J.

AU - Krist, Alex H.

AU - Owens, Douglas K.

AU - Barry, Michael J.

AU - Caughey, Aaron B.

AU - Caughey, Aaron

AU - Doubeni, Chyke A.

AU - Epling, John W.

AU - Kemper, Alex R.

AU - Kubik, Martha

AU - Landefeld, C. Seth

AU - Mangione, Carol M.

AU - Silverstein, Michael

AU - Simon, Melissa A.

AU - Tseng, Chien Wen

AU - Wong, John B.

PY - 2018/7/10

Y1 - 2018/7/10

N2 - IMPORTANCE Peripheral artery disease (PAD) is a manifestation of atherosclerosis in the lower limbs. It can impair walking and, in severe cases, can lead to tissue loss, infection, and amputation. In addition to morbidity directly caused by PAD, patients with PAD are at increased risk for cardiovascular disease (CVD) events, because atherosclerosis is a systemic disease that also causes coronary and cerebrovascular events. OBJECTIVE To update the 2013 US Preventive Services Task Force (USPSTF) recommendation on screening for PAD and CVD risk with the ankle-brachial index (ABI). EVIDENCE REVIEW The USPSTF reviewed the evidence on whether screening for PAD with the ABI in generally asymptomatic adults reduces morbidity or mortality from PAD or CVD. The current review expanded on the previous review to include individuals with diabetes and interventions that include supervised exercise and physical therapy intended to improve outcomes in the lower limbs. FINDINGS The USPSTF found few data on the accuracy of the ABI for identifying asymptomatic persons who can benefit from treatment of PAD or CVD. There are few studies addressing the benefits of treating screen-detected patients with PAD; 2 good-quality studies showed no benefit of using the ABI to manage daily aspirin therapy in unselected populations, and 2 studies showed no benefit from exercise therapy. No studies addressed the harms of screening, although the potential exists for overdiagnosis, labeling, and opportunity costs. Studies that addressed the harms of treatment showed nonsignificant results. Therefore, the USPSTF concludes that the current evidence is insufficient and that the balance of benefits and harms of screening for PAD with the ABI in asymptomatic adults cannot be determined. CONCLUSIONS AND RECOMMENDATION The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for PAD and CVD risk with the ABI in asymptomatic adults. (I statement)

AB - IMPORTANCE Peripheral artery disease (PAD) is a manifestation of atherosclerosis in the lower limbs. It can impair walking and, in severe cases, can lead to tissue loss, infection, and amputation. In addition to morbidity directly caused by PAD, patients with PAD are at increased risk for cardiovascular disease (CVD) events, because atherosclerosis is a systemic disease that also causes coronary and cerebrovascular events. OBJECTIVE To update the 2013 US Preventive Services Task Force (USPSTF) recommendation on screening for PAD and CVD risk with the ankle-brachial index (ABI). EVIDENCE REVIEW The USPSTF reviewed the evidence on whether screening for PAD with the ABI in generally asymptomatic adults reduces morbidity or mortality from PAD or CVD. The current review expanded on the previous review to include individuals with diabetes and interventions that include supervised exercise and physical therapy intended to improve outcomes in the lower limbs. FINDINGS The USPSTF found few data on the accuracy of the ABI for identifying asymptomatic persons who can benefit from treatment of PAD or CVD. There are few studies addressing the benefits of treating screen-detected patients with PAD; 2 good-quality studies showed no benefit of using the ABI to manage daily aspirin therapy in unselected populations, and 2 studies showed no benefit from exercise therapy. No studies addressed the harms of screening, although the potential exists for overdiagnosis, labeling, and opportunity costs. Studies that addressed the harms of treatment showed nonsignificant results. Therefore, the USPSTF concludes that the current evidence is insufficient and that the balance of benefits and harms of screening for PAD with the ABI in asymptomatic adults cannot be determined. CONCLUSIONS AND RECOMMENDATION The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for PAD and CVD risk with the ABI in asymptomatic adults. (I statement)

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DO - 10.1001/jama.2018.8357

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