Peripheral arterial disease: Evidence for screening using ankle brachial index is insufficient

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The US Preventive Services Task Force released its final recommendation statement and final evidence report on screening for peripheral arterial disease and cardiovascular risk assessment with the ankle brachial index in adults on 3 September 2013.

The Task Force found that for adults with no symptoms of peripheral arterial disease, the evidence was insufficient to determine if using the ankle brachial index test to screen for peripheral arterial disease and predict risk of cardiovascular disease is beneficial. Therefore, the Task Force issued an I statement, which means there is not enough evidence to make a definitive recommendation.

“Cardiovascular disease is the nation’s number one killer, and, as clinicians, we know that addressing the underlying risk factors can help to prevent heart attacks and strokes,” says Task Force member Kirsten Bibbins-Domingo, University of California San Francisco School of Medicine. “Although the evidence is not yet clear on using the ankle brachial index test to evaluate cardiovascular disease risk in people with no symptoms, there are many other steps we know work to help to prevent cardiovascular disease—including eating a healthy diet and maintaining a healthy weight, exercising regularly, and not smoking.”

“Even though it is not clear if the ankle brachial index helps healthcare professionals make treatment decisions, there are many things clinicians can do to help their patients reduce their chance of heart attacks and strokes,” says US Preventive Services Task Force co-vice chair Albert Siu. “The US Preventive Services Task Force recommends screening for and managing high blood pressure, high blood cholesterol, and diabetes and screening for tobacco use and providing cessation support.”

This statement does not apply to people who are having symptoms of peripheral arterial disease, such as leg pain when walking that is relieved with rest. People with symptoms should see a health professional and should receive appropriate diagnostic testing and therapy.

The Task Force’s final recommendation statement and final evidence report are published online in the Annals of Internal Medicine, as well as on the Task Force Web site at www.uspreventiveservicestaskforce.org. A fact sheet that explains the recommendation statement in plain language is also available. Before finalising this recommendation, the US Preventive Services Task Force posted a draft version for public comment in the spring of 2013.

The Task Force is an independent, volunteer panel of national experts in prevention and evidence-based medicine.

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