| Автор | Hirsch, Alan, T |
| Дата выпуска | 1996 |
| dc.description | Patients with peripheral arterial disease are often perceived to suffer from a disorder whose pathogenesis and symptoms are not amenable to drug therapies. This clinical misperception remains prevalent despite an abundance of data suggesting that diverse pharmacotherapies may modulate the natural history of this disease. Patients with chronic limb arterial occlusive disease suffer from a disease that is characterized by: (1) a prolonged asymptomatic state that can be identified by simple physical examination and confirmed by measurement of the ankle brachial index; (2) a multi-year period of symptomatic claudication; and (3) a variable rate of progression to critical limb ischemia or acute arterial occlusion. This stage-dependent disease progression is mediated via the dynamic, but as yet incompletely understood, interaction of factors that elicit endothelial dysfunction, atherogenesis, and thrombosis. Current data suggest that each of these contributory disease processes can be modulated by extant pharmacotherapies. Additionally, many novel pharmacotherapeutic agents that are currently under investigation may further improve the ability of clinicians to modulate these fundamental biologic processes.Pharmacologic therapies should be targeted to decrease the rate of limb arterial disease progression, to improve limiting symptoms, and to prolong life. Symptoms of claudication can be objectively assessed via both exercise testing and disease-specific questionnaires. The presence of lower extremity atherosclerotic disease is predictive of the presence of coronary heart disease and a foreshortened five-year survival. Current data suggest that clinical investigations should be able to effectively stratify this relative risk via use of both clinical variables (e.g., age, diabetes mellitus, tobacco use, etc.) or by measurement of the ankle brachial index (ABI). The role of the physician is to decrease suffering and to prolong life. Judicious administration of medical therapies can play a critical role in helping the vascular practitioner accomplish these goals. |
| Издатель | SAGE Publications |
| Тема | claudication |
| Тема | peripheral arterial disease |
| Тема | pharmacology |
| Тема | thrombosis |
| Название | Claudication as an ‘Orphan Disease’: Rationale and Goals of Drug Therapy for Peripheral Arterial Disease |
| Тип | Journal Article |
| DOI | 10.1177/1358863X9600100107 |
| Electronic ISSN | 1477-0377 |
| Print ISSN | 1358-863X |
| Журнал | Vascular Medicine |
| Том | 1 |
| Первая страница | 37 |
| Последняя страница | 42 |
| Аффилиация | Hirsch, Alan, T, Vascular Medicine Program, Minnesota Vascular Diseases Center, University of Minnesota Medical School, Minneapolis, Minnesota, USA |
| Выпуск | 1 |
| Библиографическая ссылка | 1. Criqui MH, Fronek A, Barrett-Connor E, Klauber MR, Gabriel S, Goodman D The prevalence of peripheral arterial disease in a defined population. Circulation 1985; 71: 510–15. |
| Библиографическая ссылка | 2. Hiatt WR, Hoag S, Hamman RF Effect of diagnostic criteria on the prevalence of peripheral arterial disease. The San Luis Valley diabetes study. Circulation 1995; 91: 1472–79. |
| Библиографическая ссылка | 3. Criqui MH, Fronek A, Klauber MR, Barrett-Connor E, Gabriel S The sensitivity, specificity, and predictive value of traditional clinical evaluation of peripheral arterial disease: results from noninvasive testing in a defined population. Circulation 1985; 71: 516–22. |
| Библиографическая ссылка | 4. Fowkes FGR, Housley E, Cawood EHH, MacIntyre CCA, Ruckley CV, Prescott RJ Edinburgh artery study: prevalence of asymptomatic and symptomatic peripheral arterial disease in the general population. Int J Epidemiol 1991; 20: 384–92. |
| Библиографическая ссылка | 5. Kannel WB, McGee DL Update on some epidemiologic features of intermittent claudication. The Framingham Study. J Am Geriatr Soc 1985; 33: 13–18. |
| Библиографическая ссылка | 6. Kannel WB, Skinner JR, Schwartz MJ, Shurtleff D Intermittent claudication. Incidence in the Framingham study. Circulation 1970; 41: 875–83. |
| Библиографическая ссылка | 7. Kannel WB. The demographics of claudication and the aging of the American population. J Vasc Med Biol (in press). |
| Библиографическая ссылка | 8. Brevetti G, Perna S, Sabba C et al. Superiority of L-propionyl carnitine vs L-carnitine in improving walking capacity in patients with peripheral vascular disease: an acute, intravenous, double-blind, cross-over study. Eur Heart J 1992; 13: 251–55. |
| Библиографическая ссылка | 9. Scheffler P, de la Hamette D, Gross J, Mueller H, Schieffer H Intensive vascular training in stage IIb of peripheral arterial occlusive disease. The additive effects of intravenous prostaglandin E1 or intravenous pentoxifylline during training. Circulation 1994; 90: 818–22. |
| Библиографическая ссылка | 10. Brevetti G, Perna S, Sabba C, Martone VD, Condorelli M Propionyl-L-carnitine in intermittent claudication: double-blind, placebo-controlled, dose-titration, multicenter study. J Am Coll Cardiol 1995; 26: 1411–16. |
| Библиографическая ссылка | 11. Isner JM, Walsh K, Smyes J et al. Arterial gene therapy for therapeutic angiogenesis in patients with peripheral arterial disease. Circulation 1995; 91: 2687–92. |
| Библиографическая ссылка | 12. Dzau VJ, Gibbons GH, Cooke JP, Omoigui N Vascular biology and medicine in the 1990s: scope, concepts, potentials, and perspectives. Circulation 1993; 87: 705–19. |
| Библиографическая ссылка | 13. Hiatt WR, Hirsch AT, Regensteiner JG, Brass EP, the Vascular Clinical Trialists Clinical trials for claudication. Assessment of exercise performance, functional status, and clinical end points. Circulation 1995; 92: 614–21. |
| Библиографическая ссылка | 14. Regensteiner JG, Steiner JF, Panzer RJ, Hiatt WR Evaluation of walking impairment by questionnaire in patients with peripheral arterial disease. J Vasc Med Biol 1990; 2: 142–52. |
| Библиографическая ссылка | 15. Hiatt WR, Regensteiner JG Exercise rehabilitation in the treatment of patients with peripheral arterial disease. J Vasc Med Biol 1990; 2: 163–70. |
| Библиографическая ссылка | 16. Regensteiner JG, Steiner JR, Hiatt WR. Exercise training improves functional status in patients with peripheral arterial disease. J Vasc Surg (in press). |
| Библиографическая ссылка | 17. Criqui MH, Langer RD, Fronek A et al. Mortality over a period of 10 years in patients with peripheral arterial diseases. N Engl J Med 1992; 326: 381–86. |
| Библиографическая ссылка | 18. Newman AB, Siscovick DS, Manolio TA et al for the Cardiovascular Health Study (CHS) Collaborative Research Group. Ankle-arm index as a marker of atherosclerosis in the Cardiovascular Health Study. Circulation 1993; 88: 837–45. |
| Библиографическая ссылка | 19. Vogt MT, Cauley JA, Newman AB, Kuller LH, Hulley SB Decreased ankle/arm blood pressure index and mortality in elderly women. JAMA 1993; 270: 465–69. |
| Библиографическая ссылка | 20. Newman AB, Sutton-Tyrrell K, Vogt MT, Kuller LH Morbidity and mortality in hypertensive adults with a low ankle/arm blood pressure index. JAMA 1993; 270: 487–89. |
| Библиографическая ссылка | 21. McKenna M, Wolfson S, Kuller L The ratio of ankle and arm blood pressure as an independent risk factor of mortality. Atherosclerosis 1991; 87: 119–28. |
| Библиографическая ссылка | 22. Hess H, Miewtaschik A, Deischsel G Drug-induced inhibition of platelet function delays progression of peripheral occlusive arterial disease: a prospective, double-blind arteriographically controlled trial. Lancet 1985; i: 415–19. |
| Библиографическая ссылка | 23. Clagett GP, Genton E, Salzman EW Antithrombotic therapy in peripheral vascular disease. Chest 1989; 95 (suppl): 128S–139S. |
| Библиографическая ссылка | 24. Antiplatelet Trialists Collaboration Secondary prevention of vascular disease by prolonged antiplatelet treatment. Br Med J 1988; 296: 320–31. |
| Библиографическая ссылка | 25. Janzon L, Bergquist D, Boberg J et al. Prevention of myocardial infarction and stroke in patients with intermittent claudication: effects of ticlopidine. Results from STIMS, the Swedish Ticlopidine Multicentre Study. J Intern Med 1991; 27: 301–308. |
| Библиографическая ссылка | 26. Balsano F, Cocherri S, Libretti A et al. Ticlopidine in the treatment of intermittent claudication: a 21-month double-blind trial. J Lab Clin Med 1989; 114: 84–91. |
