Buflomedil in Peripheral Arterial Disease

Peripheral arterial disease (PAD) is a distinct clinical manifestation of atherosclerosis, with an associated long-term risk of coronary and cerebrovascular events that is equivalent to that of a primary diagnosis of myocardial infarction or ischemic stroke.1,2 The prevalence of PAD, as estimated by an abnormal ankle-to-brachial systolic pressure index (ABI 55 years of age in Western societies.3–5 The majority of patients with PAD are asymptomatic, but recognition of the disease is clinically important because it may be the primary manifestation of systemic atherosclerosis. Indeed, numerous studies have demonstrated a correlation between the global risk of cardiovascular events and ABI, which portends a more dire outcome for those with increasing degrees of hemodynamic compromise in the limb.6,7 The major risk factors for PAD, aside from age, are cigarette smoking, diabetes mellitus, dyslipidemia, hyperhomocysteinemia, and hypertension. Among these, the recent explosion in the worldwide prevalence of diabetes mellitus is of particular concern, particularly because the risk of both mortality and limb loss in diabetic PAD patients is increased several-fold. Thus, a major focus of clinical management in PAD is on secondary prevention, including the aggressive treatment of these risk factors by dietary and behavioral modification, combined with medical therapies. Present evidence suggests that PAD patients should receive lifelong antiplatelet therapy, treatment with a hydroxymethylglutaryl coenzyme A reductase inhibitor (statin), and appropriate antihypertensive therapy, which should probably include an angiotensin-converting enzyme inhibitor.8Article p 816 Symptomatic PAD, which affects approximately one third of all PAD patients, is most commonly manifested as intermittent claudication (IC), a walking impairment that results at least in part from a classic mismatch between blood supply and metabolic demand of the leg muscle groups. Critical limb ischemia, the most severe form …