Department of Medicine, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: https://twitter.com/APKithcartMDPhD.
Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University, Nashville, Tennessee.
J Am Coll Cardiol. 2018 Dec 4;72(22):2789-2801. doi: 10.1016/j.jacc.2018.09.041.
Peripheral artery disease is a common yet underdiagnosed cause of morbidity worldwide. Significant recent advances in management have resulted in new guideline creation for the diagnosis and management of peripheral artery disease in the United States and Europe. Here, we analyze each set of guidelines with special attention to those areas where the 2 groups disagree. Both groups emphasize the importance of risk factor reduction, including smoking cessation, lipid lowering, blood pressure management, and glucose control. The U.S. guidelines place additional attention on lifestyle factors, including regular physical activity and supervised exercise. The European guidelines offer a number of recommendations for revascularization in patients with limb-threatening ischemia. Both agree that more evidence is needed to understand which patients are at highest risk for tissue loss. A consistent charge to each committee fostering a similar approach to available data and more randomized studies would align recommendations across both organizations.
外周动脉疾病是一种常见但在全球范围内诊断不足的疾病。最近在管理方面取得了重大进展，导致美国和欧洲制定了外周动脉疾病的新诊断和管理指南。在这里，我们分析了每一组指南，特别关注了两组意见不一致的领域。两组都强调了降低风险因素的重要性，包括戒烟、降低血脂、血压管理和血糖控制。美国指南还特别关注生活方式因素，包括有规律的体育活动和监督下的锻炼。欧洲指南为肢体缺血威胁患者的血运重建提供了一些建议。双方都认为，需要更多的证据来了解哪些患者的组织损失风险最高。每个委员会的一致意见都促进了对现有数据和更多随机研究的类似处理，从而使两个组织的建议保持一致。
