Peripheral arterial disease versus other localizations of vascular disease: The ATTEST study

Objective: Despite the increased cardiovascular morbidity and mortality risk of patients with peripheral arterial disease, previous worldwide studies have documented undertreatment of cardiovascular risk factors in such patients. Method. The ATTEST study was an observational cross-sectional epidemiologic study. Patients (n = 8475) were selected by 3020 general practitioners in France who were asked to include the first three patients with at least one site of proven atherothrombotic disease (peripheral arterial disease of the lower limbs for two patients and coronary artery disease or ischemic stroke for the third patient). We designed the ATTEST study to compare medical management of patients with peripheral arterial disease, including pharmacologic treatment, cardiovascular tests, and physician's assessment of future cardiovascular and amputation risks, with patients with coronary artery disease or ischemic stroke. Results. Only 13% of the patients with peripheral arterial disease (n = 3811) received angiotensin converting enzyme inhibitors, statins, and antiplatelet agents vs 30% of the patients with coronary artery disease or ischemic stroke (n = 4664). This undertreatment of the population with peripheral arterial disease was associated with a too-optimistic physician's assessment of future cardiovascular risk: only 27% of the general practitioners predicted a 5-year cardiovascular risk > 20%. Conversely, amputation risk prediction was greatly overestimated: only 44% of the practitioners predicted a 5-year amputation risk < 5%. Conclusions. Patients with atherothrombotic disease recruited from primary care practices were not adequately tested and treated, especially the patients with peripheral arterial disease. To improve the medical management of patients with peripheral arterial disease, there is a need for epidemiologic and clinical education of physicians.