Atherosclerotic Risk Factors Are Less Intensively Treated in Patients with Peripheral Arterial Disease Than in Patients with Coronary Artery Disease

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Abstract
OBJECTIVE: To compare rates of therapy for atherosclerotic risk factors between patients with lower extremity peripheral arterial disease (PAD) and patients with coronary artery disease (CAD). DESIGN: Cross-sectional. SETTING: Academic medical center. PATIENTS/PARTICIPANTS: Three hundred forty-nine consecutive patients diagnosed with PAD or CAD identified from the blood flow and cardiac catheterization laboratories, respectively. MEASUREMENTS AND MAIN RESULTS: Participants were interviewed by telephone for medical history as well as therapies prescribed and recommended by their physicians. Among patients with hypercholesterolemia, more CAD patients were taking cholesterol-lowering drugs (58% vs 46%, p = .08) and more CAD patients recalled a physician's instruction to follow a low-fat, low-cholesterol diet (94% vs 83%, p = .01). CAD patients were more likely to exercise regularly (71% vs 50%, p < .01). Among patients not exercising, more CAD patients recalled a physician's advice to exercise (74% vs 47%, p < .01). In logistic regression analysis, hypercholesterolemic patients with exclusive CAD were more likely to be treated with drug therapy (odds ratio [OR] 2.3, p = .05). CAD patients were more likely to recall advice to exercise (OR 4.0, p < .001), and more likely to be taking aspirin or warfarin (OR 4.8, p = .01). CONCLUSIONS: Atherosclerotic risk factors are less intensively treated among PAD patients than CAD patients. A number of possible explanations could account for these disparities in therapeutic intensity.