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• W863590767 abstract "Smoking should be stopped and hypertension, diabetes mellitus, dyslipidemia, and hypothyroidism be treated in elderly patients with peripheral arterial disease (PAD). Statins reduce the incidence of intermittent claudication and improve exercise duration until the onset of intermittent claudication in persons with PAD and hypercholesterolemia. Antiplatelet drugs such as aspirin or clopidogrel, especially clopidogrel, angiotensin-converting enzyme inhibitors, and statins should be given to all persons with PAD. Beta blockers should be given if coronary artery disease is present. Exercise rehabilitation programs and cilostazol lengthen exercise time until intermittent claudication develops. Chelation therapy should be avoided. (J Geriatr Cardiol 2007;4:93-100.) Peripheral arterial disease (PAD) is a chronic arterial occlusive disease of the lower extremities caused by atherosclerosis. PAD may cause intermittent claudication, which is pain or weakness with walking that is relieved with rest. The muscle pain or weakness after exercise occurs distal to the arterial obstruction. Since the superficial femo- ral and popliteal arteries are most commonly affected by atherosclerosis, the pain of intermittent claudication is most commonly localized to the calf. Atherosclerotic obstruction of the distal aorta and its bifurcation into the two iliac arter- ies may cause pain in the buttocks, hips, thighs, or the inferior back muscles as well as the legs. Only one-half of elderly persons with documented PAD are symptomatic. Persons with PAD may not walk far or fast enough to induce muscle ischemic symptoms be- cause of comorbidities such as pulmonary disease or arthritis, may have atypical symptoms unrecognized as in- termittent claudication, may fail to mention their symptoms to their physician, or may have sufficient collateral arterial channels to tolerate their arterial obstruction. If the arterial flow to the lower extremities cannot meet the needs of rest- ing tissue metabolism, critical lower extremity ischemia oc- curs with pain at rest or tissue loss. The diagnosis of PAD is discussed elsewhere. 1 The prevalence of PAD increases with age. In one study of 1,160 men, mean age 80 years, and 2,464 women, mean age 81 years, PAD was present in 32% of men and in 26% of women. 2 PAD coexists with other atherosclerotic disorders. 3-5 Persons with PAD are also at increased risk for all-cause mortality, cardiovascular mortality, and cardiovas- cular events. 6-10 This article will discuss the medical treat- ment of PAD in the elderly. Indications for lower extremity angioplasty with stenting and bypass surgery, and indica- tions for amputation are discussed elsewhere. 11 Correct implementation of medical therapy is primarily of importance to significantly reduce cardiovascular events and mortality associated with PAD. In addition, medical therapy may result in significant improvements in walking ability that may obviate the need for lower extremity angioplasty with stenting and bypass surgery. Treatment of PAD is efficacious in older men and in older women. Smoking cessation" @default.
• W863590767 created "2016-06-24" @default.
• W863590767 creator A5091070572 @default.
• W863590767 date "2007-06-28" @default.
• W863590767 modified "2023-09-24" @default.
• W863590767 title "Medical treatment of peripheral arterial disease in the elderly" @default.
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