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Heart Disease Health Center

Panel Wavers on Screening for Poor Leg Circulation

Evidence not found to support use of 'ankle brachial index' to gauge heart risks
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One expert agrees with the new recommendation.

"There are many logical reasons to think that screening for peripheral artery disease with the ankle brachial index and treating people who are screen-positive will prevent cardiovascular events," said Dr. Mary McGrae McDermott, author of an accompanying journal editorial.

Despite this, there are no rigorous trials that show screening for peripheral artery disease with the ankle brachial index improves outcomes, said McDermott, a professor of medicine at Northwestern University's Feinberg School of Medicine, in Chicago.

"Currently there is not high-quality evidence to demonstrate that screening for peripheral artery disease with the ankle brachial index reduces cardiovascular event rates," she said.

Another expert, however, said the task force's recommendation is at odds with current guidelines from other professional organizations.

"This new systemic evidence review by the U.S. Preventive Services Task Force, which tends to be very conservative in its review and interpretation of evidence, concludes that the ankle brachial index may be of limited value and there is need for further studies," said Dr. Gregg Fonarow, an AHA spokesman and professor of cardiology at the University of California, Los Angeles.

However, Fonarow said, a guideline from the American College of Cardiology Foundation and the American Heart Association recommends that "measurement of ankle brachial index is reasonable for cardiovascular risk assessment in asymptomatic [symptomless] adults at intermediate risk."

Peripheral artery disease is usually treated with blood pressure medications and cholesterol-lowering drugs. Some patients, however, may need minimally invasive treatment or surgery to open their narrow arteries. Left untreated, peripheral artery can lead to gangrene and amputation. The condition affects about 8 million Americans, according to the heart association.

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