Current medical management of patients with peripheral arterial disease and potential benefits of risk-factor optimization: findings from a prospective national cohort by the Vascular and Endovascular Research Network (VERN) collaboration

Background: Previous research suggests patients with Peripheral Arterial Disease (PAD) are not offered adequate risk-factor modification, despite their high cardiovascular risk. We aimed to assess the cardiovascular profiles of patients with PAD in the UK and quantify the survival benefits of target-based risk-factor modification. Methods: The Vascular and Endovascular Research Network (VERN) prospectively collected cardiovascular profiles of patients with PAD from ten UK vascular centres (April - June 2018) to assess practice against UK and European goal-directed BMT guidelines. Risk and benefits of risk-factor control were estimated using the SMART-REACH model, a validated cardiovascular prediction tool for patients with PAD. Results: Overall, 440 patients (mean age: 70±11 years, 24% female) were included. Mean cholesterol (4.3±1.2 mmol/L) and LDL (2.7±1.1 mmol/L) levels were above recommended levels; 319 (73%) patients were hypertensive and 343 (78%) were smokers. Only 12% of patients were prescribed high-dose statin therapy and 39% an antithrombotic agent. The median risk of a major cardiovascular event over 10-years was 53% [Interquartile Range (IQR): 44-62%]. Controlling all modifiable cardiovascular risk-factors based on UK and European guidance targets (LDL