NOTE: This outlines our approach and also as patient education. This is generalized and each patient’s treatment depends on individual patient & doctor
Best Medical Therapy (BMT)possibly life long, is the most important and fundamental need for any patient with vascular disease, irrespective of the method of treatment – conservative, surgical or minimally invasive endo vascular procedures. Most patients with peripheral arterial disease do not require vascular interventions if treated early. Vascular medicine plays an important role in treating them, which includes risk factor modification that is Diabetes mellitus, hypertension, dyslipidemia (abnormal cholesterol etc) management and abstinence from any form oftobacco.
Vascular medicine at JIVAS is a comprehensive program run by specialists is a successful model for improvement of treatment goals of vascular (and caridac) risk factors. It plays an important role in prevention of disease and recurrence, progression and treatment of peripheral arterial disease (PAD) - Atherosclerotic cardiovascular diseases.
Atherosclerotic cardiovascular diseases (CVDs) is the leading cause of death and disability. It is potentially preventable multifactorial disease. Some of the complications include peripheral arterial disease, stroke, coronary heart disease (CHD). Treating atherosclerotic cardiovascular risk factors (CVRFs) (eg, high blood sugars, elevated levels of low-density lipoprotein cholesterol [LDL-C], high blood pressure [BP], and smoking) reduces cardiovascular morbidity and mortality significantly.
Diabetes mellitus:is an independent risk factor for several forms of vascular diseases and related complications develop gradually. Long standing diabetics, especially those with poor control have higher risk of complications (PAD, myocardial infarction, acute coronary syndrome, stroke, nephropathy, retinopathy and neuropathy). Patients with diabetes when they develop clinical CVD, they sustain a worse prognosis for survival than do CVD patients without diabetes
CVDs are listed as the cause of death in 65% of persons with diabetes. 15 to 30% of diabetics have PAD and this is a major indicator systemic diseases – ie PAD (or leg attcak) indicates that patient is likelt have other systems like heart, brain etc. involved. Mortality from stroke is increased almost 3-fold when patients with diabetes are matched to those without diabetes. Approximately 13% of patients with diabetes >65 years old have had a stroke. Up to 35% of new patients beginning dialysis therapy have type 2 diabetes. Blood sugar monitoring at regular intervals and maintaining required blood sugars with regular intake of required medication along with proper diet and regular exercise in diabetics reduces the CVDs significantly.
Hypertension:is a well-established major risk factor for CVDs. High blood pressure does not cause symptoms, it is known as the "Silent Killer." Longstanding suboptimal blood pressure control may result in kidney failure, stroke, heart attack, heart failure, and death. Treating blood pressure with appropriate medications will prevent these long-term effects on the blood vessels and organs in the body to promote longevity and health. While most patients will require medications, reducing salt intake and exercising regularly has been shown to lower blood pressure as well.
Dyslipidemia (abnormal cholesterol etc):Plaque build-up in the arteries leading to blockage is due to both diet and genetics. For some, diet modification alone may not be enough to reduce cholesterol or cardiovascular disease risk. A class of medications known as "statins" is very effective in treating high cholesterol, as well as improving health outcomes for patients with atherosclerosis. Each patient is different, and you should discuss with your physician which medication, at which dose, is right for you to reduce your overall cardiovascular disease risk.
Patients with diabetes have an increase prevalence of lipid abnormalities, contributing to their risk of atherosclerosis cardiovascular disease.
Avoid Tobacco:Tobacco wreaks havoc to the blood vessels throughout the body, allowing for the formation of sticky plaque and accelerating heart and vascular disease. One of the most important things you can do for your overall cardiovascular health is to stop all forms of tobacco use, including cigarettes, cigars, pipe, and chewing tobacco products. The addictive properties of tobacco are well-recognized, and there are a number of agents (medicine and otherwise) now available to help stop tobacco.
Antiplatelet Therapy:Platelets are small particles in the blood and assist in clot formation to stop bleeding. In some cases, this property is not helpful – for example, in the setting of unhealthy arteries or cholesterol plaque which leads to platelet pooling, clot formation, and blocked arteries. For patients with coronary or peripheral atherosclerosis, diabetes, stroke, or mini-stroke (TIA), antiplatelet therapy with aspirin or other agents can reduce cardiovascular disease risk. Each patient is different, and you should discuss with your physician which medication, at which dose, is right for you to promote longevity and cardiovascular health.
Specific meidicnes used in PAD
- Cilastazole – medicine to improve walking distance in those with blocked arteries in the legs and have difficulty in walking. It has perhaps the best available drug today for this purpose. Not effective in advanced cases called dritical limb ischemia, where there is already a non healing wound or gangrene
- Pentoxyphyline: Similar to use of cilasazole, but less effective
- Blood thinners like heaprin and similar newer drugs used in thrombosis (clotting)
- Prostaglandins/prostacyclines: Used very few specific patients