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Mary McGrae McDermott, MD; Aimee Luna Mandapat, BA; Amanda Moates, BA; Monique Albay, BA; Eric Chiou, BS; Lillian Celic, BS; Philip Greenland, MD

Arch Intern Med. 2003;163:2157-2162.

Background  We compared perceptions regarding risk of cardiovascular events and benefits of cardiovascular disease (CVD) risk factor reduction between patients with peripheral arterial disease (PAD), patients with coronary artery disease (CAD), and patients without atherosclerosis (no disease).

Methods  Participants with no disease (n = 142) had a normal ankle-brachial index and no clinically evident atherosclerosis (group 1). The PAD participants (n = 136) had an ankle-brachial index less than 0.90 and no other clinically evident atherosclerosis (group 2). Participants with CAD (n = 70) had a normal ankle-brachial index and a history of heart disease (group 3). Participants were interviewed regarding risk of mortality, CVD, and the importance of CVD risk factor reduction for hypothetical patients with PAD and CAD.

Results  All groups reported that risks of myocardial infarction, stroke, and death were higher for a patient with CAD than for a patient with PAD. Group 2 was less likely than group 3 to believe that PAD is associated with an extremely high risk of stroke (13.3% vs 28.7%; P = .005) or mortality (10.9% vs 26.6%; P = .003). Group 2 was less likely than group 1 to believe that a patient with PAD has a very high risk of myocardial infarction (13.1% vs 23.8%; P = .02), stroke (13.3% vs 27.5%; P = .003), or mortality (10.9% vs 24.3%; P = .004). Compared with group 3, a smaller percentage of patients in group 2 reported that cholesterol lowering was very important in PAD (57.5% vs 75.8%; P = .005).

Conclusions  Compared with other patients, those with PAD underestimated the high risk of cardiovascular events associated with PAD and the benefits of cholesterol-lowering therapy. These findings may help explain the low rates of CVD risk factor control previously reported in patients with PAD.

From the Departments of Medicine (Drs McDermott and Greenland, Mss Mandapat, Moates, Albay, and Celic, and Mr Chiou) and Preventive Medicine (Drs McDermott and Greenland), Feinberg School of Medicine, Northwestern University, Chicago, Ill. The authors have no relevant financial interest in this article.

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