Putting Prevention into Practice
An Evidence-Based Approach
Screening for Peripheral Artery Disease and Cardiovascular Disease Risk Assessment with the Ankle-Brachial Index
Am Fam Physician. 2018 Dec 15;98(12):754-755.
Author disclosure: No relevant financial affiliations.
A 65-year-old man presents to your office for a pre-employment physical examination. He has no concerning symptoms; his medical history reveals type 2 diabetes mellitus, which he controls through diet. He works in an office and rides his bicycle to work. He is single, an occasional smoker, and drinks alcohol socially. His family history is positive for type 2 diabetes and peripheral artery disease (PAD).
Case Study Questions
1. Which of the patient’s characteristics are important risk factors for PAD?
A. Type 2 diabetes.
B. Current smoking.
D. Family history of PAD.
2. The U.S. Preventive Services Task Force (USPSTF) recommendation on screening for PAD and assessing cardiovascular disease (CVD) risk with the ankle-brachial index (ABI) applies to which one of the following populations?
A. All asymptomatic adults and adolescents.
B. Adults at high risk for PAD or CVD.
C. Asymptomatic adults without a diagnosis of PAD, CVD, or severe chronic kidney disease.
D. Asymptomatic men 60 years and older.
E. Asymptomatic women 75 years and older.
3. Which one of the following statements accurately summarizes the USPSTF’s findings on screening for and treatment of PAD and assessing CVD risk with the ABI?
A. The USPSTF found adequate evidence that use of ABI in asymptomatic patients is accurate.
B. The USPSTF found inadequate evidence that early detection of PAD leads to clinically important benefits.
C. The USPSTF found adequate evidence that the direct harms of screening with the ABI are moderate.
D. The USPSTF found adequate evidence that the direct harms of treatment of PAD or CVD are significant.
E. The USPSTF found inadequate evidence that treatment of PAD leads to clinically important benefits.
1. The correct answers are A, B, and C. Important risk factors for PAD include older age, current smoking, high blood pressure, high cholesterol levels, type 2 diabetes, obesity, and physical inactivity. Current smoking and type 2 diabetes have the strongest association.
The views expressed in this work are those of the authors and do not reflect the official policy or position of the Uniformed Services University of the Health Sciences, the Department of Defense, or the U.S. government.
1. Guirguis-Blake JM, Evans CV, Redmond N, Lin JS. Screening for peripheral artery disease using the ankle-brachial index: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2018;320(2):184–196.
2. US Preventive Services Task Force. Screening for peripheral artery disease and cardiovascular disease risk assessment with the ankle-brachial index: US Preventive Services Task Force recommendation statement. JAMA. 2018;320(2):177–183.
This PPIP quiz is based on the recommendations of the USPSTF. More information is available in the USPSTF Recommendation Statement and supporting documents on the USPSTF website (https://www.uspreventiveservicestaskforce.org). The practice recommendations in this activity are available at https://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/peripheral-artery-disease-in-adults-screening-with-the-ankle-brachial-index.
This series is coordinated by Kenny Lin, MD, MPH, Deputy Editor.
A collection of Putting Prevention into Practice published in AFP is available at https://www.aafp.org/afp/ppip.
Copyright © 2018 by the American Academy of Family Physicians.
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