US Preventive Services Task Force., Curry SJ, Krist AH, Owens DK, Barry MJ, Caughey AB, Davidson KW, Doubeni CA, Epling JW Jr, Kemper AR, Kubik M, Landefeld CS, Mangione CM, Silverstein M, Simon MA, Tseng CW, Wong JB, et al.
JAMA. Date of publication 2018 Jul 10;volume 320(2):177-183.
1. JAMA. 2018 Jul 10;320(2):177-183. doi: 10.1001/jama.2018.8357.
Screening for Peripheral Artery Disease and Cardiovascular Disease Risk
Assessment With the Ankle-Brachial Index: US Preventive Services Task Force
Recommendation Statement.
US Preventive Services Task Force, Curry SJ(1), Krist AH(2)(3), Owens DK(4)(5),
Barry MJ(6), Caughey AB(7), Davidson KW(8), Doubeni CA(9), Epling JW Jr(10),
Kemper AR(11), Kubik M(12), Landefeld CS(13), Mangione CM(14), Silverstein M(15),
Simon MA(16), Tseng CW(17)(18), Wong JB(19).
Author information:
(1)University of Iowa, Iowa City.
(2)Fairfax Family Practice Residency, Fairfax, Virginia.
(3)Virginia Commonwealth University, Richmond.
(4)Veterans Affairs Palo Alto Health Care System, Palo Alto, California.
(5)Stanford University, Stanford, California.
(6)Harvard Medical School, Boston, Massachusetts.
(7)Oregon Health & Science University, Portland.
(8)Columbia University, New York, New York.
(9)University of Pennsylvania, Philadelphia.
(10)Virginia Tech Carilion School of Medicine, Roanoke.
(11)Nationwide Children's Hospital, Columbus, Ohio.
(12)Temple University, Philadelphia, Pennsylvania.
(13)University of Alabama at Birmingham.
(14)University of California, Los Angeles.
(15)Boston University, Boston, Massachusetts.
(16)Northwestern University, Evanston, Illinois.
(17)University of Hawaii, Honolulu.
(18)Pacific Health Research and Education Institute, Honolulu, Hawaii.
(19)Tufts University, Medford, Massachusetts.
Comment in
JAMA. 2018 Jul 10;320(2):143-145.
Summary for patients in
JAMA. 2018 Jul 10;320(2):212.
Importance: Peripheral artery disease (PAD) is a manifestation of atherosclerosis
in the lower limbs. It can impair walking and, in severe cases, can lead to
tissue loss, infection, and amputation. In addition to morbidity directly caused
by PAD, patients with PAD are at increased risk for cardiovascular disease (CVD)
events, because atherosclerosis is a systemic disease that also causes coronary
and cerebrovascular events.
Objective: To update the 2013 US Preventive Services Task Force (USPSTF)
recommendation on screening for PAD and CVD risk with the ankle-brachial index
(ABI).
Evidence Review: The USPSTF reviewed the evidence on whether screening for PAD
with the ABI in generally asymptomatic adults reduces morbidity or mortality from
PAD or CVD. The current review expanded on the previous review to include
individuals with diabetes and interventions that include supervised exercise and
physical therapy intended to improve outcomes in the lower limbs.
Findings: The USPSTF found few data on the accuracy of the ABI for identifying
asymptomatic persons who can benefit from treatment of PAD or CVD. There are few
studies addressing the benefits of treating screen-detected patients with PAD; 2
good-quality studies showed no benefit of using the ABI to manage daily aspirin
therapy in unselected populations, and 2 studies showed no benefit from exercise
therapy. No studies addressed the harms of screening, although the potential
exists for overdiagnosis, labeling, and opportunity costs. Studies that addressed
the harms of treatment showed nonsignificant results. Therefore, the USPSTF
concludes that the current evidence is insufficient and that the balance of
benefits and harms of screening for PAD with the ABI in asymptomatic adults
cannot be determined.
Conclusions and Recommendation: The USPSTF concludes that the current evidence is
insufficient to assess the balance of benefits and harms of screening for PAD and
CVD risk with the ABI in asymptomatic adults. (I statement).
DOI: 10.1001/jama.2018.8357
PMID: 29998344 [Indexed for MEDLINE]
