2) The @cardiomet_ce program is supported by educational grants from AstraZeneca, Bayer, Boehringer Ingelheim Pharmaceuticals Inc and Eli Lilly Company, Bristol Myers Squibb & its Alliance partner Pfizer Inc, Chiesi, & Esperion. This program is intended for healthcare providers.
— cardio-met (@cardiomet_CE) June 28, 2022
4a) So let’s talk #peripheralarterialdisease #PAD.
— cardio-met (@cardiomet_CE) June 28, 2022
👉PAD can affect any artery perfusing the lower extremities 🦵.
👉3rd most common #atherosclerotic disease after coronary artery disease #CAD & #stroke
👉associated with increased morbidity and mortality
5a) #PAD symptomatology
— cardio-met (@cardiomet_CE) June 28, 2022
👉Classic symptoms:
intermittent #claudication (IC), cramping, pain, or fatigue in the lower extremities brought on by exertion & relieved by rest, typically within 10 minutes.
6) Asymptomatic #PAD should be diagnosed, as patients with PAD, regardless of leg symptoms, have poorer prognosis and reduced limb function compared with those without PAD.
— cardio-met (@cardiomet_CE) June 28, 2022
See🔓https://t.co/y1xqEyO7r6 pic.twitter.com/FoonPgQVUx
8a) Most #PAD patients have #polyvascular disease–clinically evident #atherosclerosis in multiple arterial beds, with “cross risk” between different #atherothrombotic manifestations.
— cardio-met (@cardiomet_CE) June 28, 2022
Polyvascular disease is a malignant cardiovascular disease with worse outcomes pic.twitter.com/GC8tFx5FaZ
9a) PAD is common➡️8-12 million Americans. But when intermittent claudication is used in epidemiological studies to define PAD, prevalence is underestimated (overcome with ankle brachial index #ABI). National Health and Nutrition Examination Survey measured ABI only 1999-2004.
— cardio-met (@cardiomet_CE) June 28, 2022
10a) #PAD is inadequately treated w/appropriate evidence-based therapies #GDMT
— cardio-met (@cardiomet_CE) June 28, 2022
🦵patients with established PAD only are less likely to receive antiplatelet drugs, statins, or smoking-cessation intervention.
11a) Traditional #cardiovascular #risk factors, including advanced age, #smoking, #diabetes, #hypertension strongly linked to ⬆️ risk of PAD.
— cardio-met (@cardiomet_CE) June 28, 2022
Cigarette smoking is associated w/2-4x ⬆️risk of #PAD and brings on PAD symptoms ~10 years earlier. https://t.co/8qhUMgAXFe
12) The most severe form of #PAD is called chronic limb-threatening #ischemia #CLI and carries a 20% risk of limb loss within 1 year.
— cardio-met (@cardiomet_CE) June 28, 2022
Among pts with #diabetes, there is a ⬆️% of #CLI, more likely to have #ulcers or #gangrene at presentation, and ⬆️amputations.
13b) Wound care in #PAD #CLI is an iterative process that requires close follow-up & management, partnership with #woundcare centers & #podiatrists, & buy-in from patient.
— cardio-met (@cardiomet_CE) June 28, 2022
🔓https://t.co/TGOvzBOHVN https://t.co/FtKNYk9dWr pic.twitter.com/aHYInHl7jz
15a) After all, #PAD is the leading cause of amputation in 🇺🇸 (~150,000/yr) but @AHAScience estimates 85% of those are preventable Important because ~50% of major amputees die within 1 year
— cardio-met (@cardiomet_CE) June 28, 2022
16) Disparities of care in #PAD are well recognized: Black Americans are 3-4x more likely to have major amputation (🔓https://t.co/mpYlYTeMHx) and Native Americans are 2x as likely (https://t.co/dP19JToVDE)
— cardio-met (@cardiomet_CE) June 28, 2022
18) Correspondingly, with #PAD Black American patients were significantly less likely to undergo revascularization when compared with white patients who had undergone amputation (OR, 0.72).
— cardio-met (@cardiomet_CE) June 28, 2022
🔓https://t.co/P7gyaNQCoV pic.twitter.com/xiA38d6Nw0
19b) In those patients who underwent major LE amputation, 30d mortality rates were double those in pts who did not undergo LE amputation (13.5% vs 6.9%, P < .001); at 1yr: 48.3% vs 24.2%, P < .001) and at 3yr: 70.9% vs 43.2%, P < .001).
— cardio-met (@cardiomet_CE) June 28, 2022
21a) Healthy lifestyle factors⬇️PAD risk by 45% compared with general population +/- #hypertension, #hypercholesterolemia, or #diabetes:
— cardio-met (@cardiomet_CE) June 28, 2022
👍avoidance of heavy alcohol consumption
👍 high adherence to a healthy diet
👍moderate to high level of physical activity
👍never smoking
22) So, dear reader, what’s your go-to treatment for #PAD?
— cardio-met (@cardiomet_CE) June 28, 2022
24) Welcome back! You're learning about #peripheralarterialdisease #PAD from expert #cardiologist @iamritu & as a #physician #physicianassociate #pharmacist #nurse #nursepractitioner you are earning 🆓CE/#CME!
— cardio-met (@cardiomet_CE) June 29, 2022
👍@JoshuaBeckmanMD @EstherSHKimMD @AaronAdayMD @TaraHolderMD pic.twitter.com/yocCsUruRk
25b) This device, developed to treat dissections after balloon angioplasty (one of the major limitations of keeping the vessel open) became the first peripheral vascular implant approved in the United States for below-the-knee #BTK interventions for #PAD. pic.twitter.com/Sa6Pd0p0Ja
— cardio-met (@cardiomet_CE) June 29, 2022
27a) So how do we treat #claudication? Prior to #intervention, think #exercise and #meds. pic.twitter.com/DqbbiPXaVB
— cardio-met (@cardiomet_CE) June 29, 2022
27c) 🩸#Cilostazol is a #PDE3 inhibitor used for intermittent #claudication and is associated w/ ⬆️walking distance. See 🔓https://t.co/RRkRvdMT0Q for a recent data summary. pic.twitter.com/MMdVjKmOdu
— cardio-met (@cardiomet_CE) June 29, 2022
28b) This ⬇️is offset by a relative ⬆️in major bleeding, but not by an excess of fatal or critical organ bleeding. NNT=24, a 19% lower risk of a #MACE or #MALE over 3yr for pts in the rivaroxaban group >placebo group (19.7% versus 23.9%; P=0.026)https://t.co/qzt5MZJZSI
— cardio-met (@cardiomet_CE) June 29, 2022
30) Other #PAD findings:
— cardio-met (@cardiomet_CE) June 29, 2022
Consider a 66♂️ w/bilateral buttock discomfort after walking 1 block. Aching pain worse R > L with hip fatigue. Symptoms subside after 10min of rest. PE ➡️no hair on LE, palpable but diminished peripheral pulses, faint right femoral bruit
32a) The answer is C. #Erectile_dysfunction is a marker of #atherosclerotic CVD risk & is associated with #PAD. PAD doesn’t cause ⬇️ankle reflexes but w/ loss of sensation. Neither post prandial pain nor anal sphincter incontinence are associated with PAD.
— cardio-met (@cardiomet_CE) June 29, 2022
33a) So what's new in #PAD?
— cardio-met (@cardiomet_CE) June 29, 2022
Genome Wide Association Study of PAD found 4 of 19 PAD loci variants are specific for PAD, including F5 p.R506Q ➡️highlighting pathogenic role of thrombosis in peripheral vascular bed . . .
34) More #PAD #new_stuff: Microvascular dysfunction and neurovascular uncoupling are exacerbated in peripheral artery disease, increasing the risk of cognitive decline in older adults #PAD #VascularMedicine
— cardio-met (@cardiomet_CE) June 29, 2022
See https://t.co/vTZyKrQZ8X pic.twitter.com/ccErUH1o2E
35) And that's it! You made it! Go grab your 0.5h CE/#CME credit at https://t.co/0GW4yBDbC7. I am @iamritu & I encourage you to FOLLOW @cardiomet_ce (and @ckd_ce!) for more🆓#accredited education, right here on Twitter, always from expert authors!
— cardio-met (@cardiomet_CE) June 29, 2022
👏@GerhardHerman @wellsbryanj pic.twitter.com/41GptIAP08