The Effect of Lifestyle and Risk Factor Modification on Occlusive Peripheral Arterial Disease Outcomes: Standard Healthcare vs Structured Programme: for a Randomised Controlled Trial Protocol

Abstract

Background: Peripheral arterial disease (PAD) affects more than 200 million of the global population. PAD represents a marker for premature cardiovascular events. Patients with PAD, even in the absence of a history of myocardial infarction or ischemic stroke, have approximately the same relative risk of death from cardiovascular causes as patients with a history of coronary or cerebrovascular disease. Despite the high prevalence of PAD and the strong association with cardiovascular morbidity and mortality, patients with PAD are less likely to receive appropriate treatment for their atherosclerotic risk factors than those who are being treated for coronary artery disease. Atherosclerotic risk factor identification and modification play an important role in reducing the number of adverse outcomes among patients with atherosclerosis. Risk reduction therapy decreases the risk of cardiovascular mortality and morbidity in patients with PAD. In this study we aim to evaluate the effectiveness of a lifestyle and risk factor modification intervention programme in achieving treatment goals for PAD risk factors.Methods: This is a randomised, parallel group, active-control trial to compare the effectiveness of the risk factor modification intervention programme to standard healthcare in a tertiary vascular care centre, in the reduction of modified risk factors in PAD patients. The primary outcome of this study is to evaluate the effectiveness of a lifestyle and risk factor modification intervention programme in achieving treatment goals for PAD risk factors at 3 and 12 months. The secondary outcomes are to compare the impact of the programme on clinical outcomes in PAD patients at 12 months. Secondary outcomes include amputation-free survival, clinical improvement, haemodynamic improvement, need for revascularisation procedures, outcomes of revascularisation procedures, changes in quality of life and the incidence of adverse events.Discussion: This study will provide clear evidence on the effectiveness of a lifestyle and risk factor modification intervention programme in achieving treatment goals for PAD risk factors, through a high quality, well-powered clinical trial.

Diagnosis and treatment of peripheral vascular disease. Literature review

“…Múltiples factores contribuyen a la patogenia de la ateroesclerosis, entre los que se incluyen la disfunción endotelial, la dislipidemia, factores inflamatorios e inmunológicos y el tabaquismo (1,3).…”

“…La enfermedad arterial periférica es una condición caracterizada por una disminución del flujo sanguíneo arterial posterior al arco aórtico secundaria a un mecanismo obstructivo, sea intrínseco o extrínseco, principalmente provocada por ateroesclerosis, y esta a su vez se genera por una acumulación anormal de partículas lipoproteicas (LDL) y de tejido fibroso entre la capa íntima y muscular de la pared arterial. Dentro de sus formas de presentación se encuentran la claudicación intermitente, el dolor en reposo (estos con cambios tróficos debido a isquemia como la ulceración) y la isquemia crítica de miembros inferiores (1,2). Muchos estudios han demostrado su relación directa con un aumento en la morbilidad y en la mortalidad cardiovascular y con el desarrollo de enfermedad arterial periférica.…”