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Essay on Diagnosis of PAD and CAD in India

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: Peripheral arterial disease (PAD), being a manifestation of systemic atherosclerosis, carries a high risk of adverse cardiovascular events. Secondary medical prevention therapies of same magnitude as that for coronary artery disease (CAD) are recommended for PAD patients also. Available evidence indicates that this condition commonly remains underdiagnosed and undertreated. There is lack of any report about management of these patients in India.
Objective: To characterize the atherosclerotic risk factor profile and pattern of drug prescription for patients of PAD at a tertiary care teaching hospital and to compare this management with standard guidelines.
Material and methods: Data were collected from prescriptions of patients attending CTVS OPD with diagnosis of atherosclerotic PAD from July 2012 to Jun 2013.
Results: One hundred twenty prescriptions were analysed. The mean age (± SD) of patients was 53 ± 7.18 years and 23.3% were females. History of smoking, either past or present, was present in 91.6% patients. History of ischemic heart disease was present in 25% while 26.7% patients were diabetic. Mean number of cardiovascular risk factors was 2.6. The percentage of eligible patients who were receiving a particular drug was 100 % for aspirin and statins, 48.3% for ACE inhibitors, 46.7% for beta blockers and 66.7% for cilostazol.
Conclusion: The vascular surgeons of this centre are using antiplatelet agents and statins adequately for PAD. The prescription of ACE inhibitors, beta blockers and cilostazol is low. Exercise therapy and smoking cessation need more attention.




Introduction
Peripheral arterial disease (PAD) is a common disorder which affects large populations of adults worldwide. It most commonly...


... middle of paper ...


...entoxyphylline) was recorded. Prescription of drugs for other purposes (e.g. antacids, analgesics or antipyretics, multivitamins) was not recorded.
Assessment of eligibility for drugs: Each prescription was analysed for eligibility for drugs for modification of atherosclerotic risk factors (aspirin, ACE inhibitors, beta blockers and lipid lowering drugs) and for drugs for intermittent claudication (cilostazol and pentoxyphylline). Eligibility was decided based on ACC/AHA and TASC-II guidelines for management of patients of PAD.[11, 12] All patients were considered to be eligible for aspirin, ACE inhibitors, lipid lowering drugs and cilostazol. In addition, patients with history of ischemic heart disease (IHD) were considered as eligible for beta blockers. Patients were considered eligible for pentoxiphylline only if cilostazol was contraindicated / not tolerated.



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