Management of Mild Arteriosclerotic Disease with Normal ABI

Diagnostic Assessment

• The American College of Cardiology and Circulation guidelines confirm that patients with mild arteriosclerotic disease and normal ABI values (between 1.00-1.40) have atherosclerotic plaques with less than 50% stenosis in multiple lower extremity arteries, indicating systemic atherosclerosis and increased cardiovascular risk 1, 3, 4
• Normal ABI values range from 1.00-1.40, and this patient's values fall within normal limits, with triphasic and biphasic waveforms in the arteries further supporting adequate arterial flow despite the presence of atherosclerotic plaques 3, 4

Management Recommendations

Cardiovascular Risk Reduction

• The American College of Cardiology recommends smoking cessation for all patients with arteriosclerotic disease to reduce disease progression and cardiovascular events, with a strength of evidence classified as high 2, 5
• Lipid management with statin therapy to achieve LDL <100 mg/dL (or <70 mg/dL for very high-risk patients) is recommended by the American Heart Association to reduce cardiovascular risk, with a moderate strength of evidence 6
• The American Diabetes Association recommends diabetes management according to current guidelines (target HbA1c <7%) to reduce microvascular complications, with a high strength of evidence 6
• Hypertension control with target BP <140/90 mmHg (or <130/80 mmHg for patients with diabetes or chronic kidney disease) is recommended by the American Heart Association to reduce cardiovascular risk, with a high strength of evidence 6

Antiplatelet Therapy

• The American College of Cardiology recommends antiplatelet therapy to reduce the risk of myocardial infarction, stroke, and vascular death in patients with arteriosclerotic disease, with a high strength of evidence 7, 8
• Options for antiplatelet therapy include aspirin 75-325 mg daily, with a moderate strength of evidence, and clopidogrel 75 mg daily as an alternative for those who cannot tolerate aspirin, with a low strength of evidence 7, 8

ACE Inhibitor Therapy

• The American College of Cardiology recommends ACE inhibitor therapy for cardiovascular risk reduction in patients with peripheral arterial disease, with a moderate strength of evidence 2, 5

Screening for Other Atherosclerotic Disease

• The American College of Cardiology recommends screening for abdominal aortic aneurysm with duplex ultrasound in patients with PAD, as PAD is a risk factor for AAA, with a moderate strength of evidence 1, 4
• Patients with evidence of atherosclerotic disease in one vascular bed have a higher prevalence of disease in other arterial beds (coronary, carotid, renal), with a low strength of evidence 4

Follow-up Recommendations

• Regular follow-up visits to monitor for progression of disease and development of symptoms are recommended by the American College of Cardiology, with a moderate strength of evidence 9, 10
• Periodic vascular examination including pulse assessment and inspection of the legs and feet is recommended by the American College of Cardiology, with a low strength of evidence 11, 10