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Coronary artery disease and intermittent claudication: how to manage the patient

P. Perrone-Filardi* and M. Chiariello

Division of Cardiology, Federico II University of Naples, Naples, Italy

* Correspondence: Dr Pasquale Perrone-Filardi, Division of Cardiology, Federico Il University, Via Pansini, 5, 80131 Napoli, Italy.

Abstract

Coexistence of peripheral arterial disease (PAD) and coronary artery disease (CAD) is common. PAD worsens the prognosis of patients with and without CAD. Thus, patients with PAD should be treated for secondary prevention, regardless of the diagnosis of CAD. PAD should be sought in smokers or diabetics aged between 59 and 69 years, in those older than 70 years, in those with known atherosclerotic disease, and in those with suspicion of PAD. As a screening tool, Doppler measurement of the ratio between ankle and arm pressures offers the best approach. Conversely, pharmacological stress imaging should be employed to rule out CAD in PAD patients. Treatment of PAD implies risk factor modification, especially smoking cessation and lipid profile. Pharmacological treatments include preventive drugs and drugs that affect claudication. Unfortunately, few drugs have been proven effective for the latter. These include cilostazol and propionylL-camitine, which ameliorates symptoms and quality of life. It remains unresolved whether different treatment strategies for coexistent CAD impact favourably on prognosis in these problematic patients.

Key Words: Cardiovascular risk • coronary artery disease • peripheral artery disease

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