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Chapter 96: Diagnosis and Management of Diseases of the Peripheral Arteries

A 43-year-old man presents to clinic with a dull lower limb pain that is brought on after 30 minutes of walking and is relieved by rest. He is a smoker with a blood pressure of 145/95 mm Hg, and he stopped taking his prescribed statin medication 3 months ago. Rank the following factors by their relative risk for peripheral artery disease (PAD):

A. Smoking > hypertension > hypercholesterolemia

B. Hypertension > smoking > hypercholesterolemia

C. Hypercholesterolemia > hypertension > smoking

D. Hypertension > hypercholesterolemia > smoking

E. Smoking = hypertension = hypercholesterolemia

The answer is A. (Hurst’s The Heart, 14th Edition, Chap. 96) Many of the risk factors for PAD are the same as those for coronary artery disease (CAD), with tobacco and diabetes having an even greater effect.1,2 Smoking and diabetes constitute the highest risk factors for the development of PAD (option A). Tobacco use, current and past, is associated with a two- to fourfold increase in relative risk for PAD. Diabetes mellitus has a similar increase in relative risk. Other modifiable risk factors include hyperhomocysteinemia, hyperlipidemia, and hypertension. Hypertension and homocysteinemia represent a moderate risk and are associated with a one- to threefold increase in relative risk for PAD, while hypercholesterolemia is considered the lowest risk factor and is associated with a one- to twofold increased risk for PAD. Table 96-1 demonstrates a detailed ranking of risk factors for PAD.

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Table 96-1. Risk Factors for Peripheral Artery Disease
High Risk Moderate Risk Low Risk
Two- to fourfold increase One- to threefold increase One- to twofold increase
Smoking Hypertension Hypercholesterolemia
Diabetes mellitus Homocysteinemia  

A 43-year-old man presents to clinic with a dull lower limb pain that is brought on after 30 minutes of walking and is relieved by rest. He is a smoker with a blood pressure of 145/95 mm Hg, and he stopped taking his prescribed statin medication 3 months ago. The patients undergoes exercise testing while measuring his segmental pressures to assess the potential presence of a stenotic lesion. His ankle-brachial index (ABI) at rest and postexercise was 0.92 and 0.85, respectively. Which of the following statements about ABI values and risk of PAD is correct?

A. The risk of death increases with increasing ABI

B. A decrease in ABI without symptoms is associated with a better prognosis

C. This patient has the same risk of having an MI as someone with ABI ...

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