Risk Factors and Best Medical Therapy

• The risk of PVD increases with age.
  
• Claudicants who smoke have 1.5–3 times the mortality of those who do not. Those who stop smoking will decrease this risk to that of non-smokers over 2–4 years.
  
• Nicotine replacement therapy doubles the success rate of smoking cessation at 1 year compared with placebo.
  
• Diabetes has a 2–4 fold increased risk of PVD with a 10–16 fold increase in the risk of limb amputation compared with non-diabetics.
  
• For every 1% increase in HbA1c levels, there is an almost 30% increased risk of the development of PVD.
  
• For every 10 mmHg decrease in systolic BP treatment, there is a 12% decreased risk in cardiovascular morbidity and 16% decrease in PVD-related morbidity.
  
• Even with a modest decrease in BP (10/5 decrease), there is a decrease in:
  
  
  
  • stroke mortality: 40%.
    
  • ischaemic heart disease (IHD): 16%.
    
  • all cardiovascular (CVS) mortality: 30%.
    
  • peripheral vascular events: 26%.
  
  
• A fasting cholesterol >7 mmol/L is associated with a doubling of the PVD risk.
  
• There is a reduction in CVS death or non-fatal MI by up to 50% in patients treated with statin therapy.
  
• Treatment with statin therapy has been shown to reduce fatal and non-fatal IHD and stroke events by 30–40%.
  
• The use of an antiplatelet agent reduces the risk of serious vascular events by almost 25%.
  
• β-blockade appears to reduce peri-operative MI in high-risk vascular patients undergoing major vascular surgery.

Abdominal Aortic Aneurysm