[Risk status of patients with peripheral arterial disease (PAD)]. / Alsó végtagi obliteratív verôérbetegek rizikóstátusa.

The authors have analyzed clinical and laboratory risk factors of 168 patients with PAD and 82 control persons. Among the patients the prevalences of diabetes, coronary heart disease (CHD), and cerebrovascular disease (CVD) were 30.4%, 39.9%, and 6.5%, respectively. 7.1% of the patients had CHD and CVD. Among patients with PAD and control persons, the prevalences of hypertension and current smoking were 76.2% vs 46.3% and 49.4% vs 28%. HDL-cholesterol and ApoA1 levels were significantly lower, while the triglycerides, fibrinogen, hsCRP, homocysteine, creatinine, uric acid levels, and white blood cell count as well as plasma viscosity were significantly higher in the patient group compared with the values of control persons. Among the PAD patients the diabetics and the smokers had further unfavourable significant differencies in the laboratory findings compared with the data of non-diabetics and non-smokers. Correlations were detected between the hsCRP level and the white blood cell count, the plasma viscosity and the fibrinogen level, respectively. Examining 16 selected risk factors the average risk factor count of the patients was 7.79. 118 patients had lipid-lowering, and 142 patients had antithrombotic therapy. Our results emphasize the necessity of the secondary prevention among PAD patients.

[Arterial obliterative disease and physical activity]. / Arteriosclerosis obliterans és fizikai tréning.

Regular physical exercise represents an essential element in treating patients with second-stage peripheral arterial occlusive disease. Peripheral arterial occlusive disease is a characteristic clinical manifestation of atherothrombotic processes. Its prevalence is 2-3%, consequently, it is estimated to be 200,000-300,000 patients in Hungary. Coronary artery disease and atherothrombosis of the carotid artery system may frequently coexist with peripheral arterial obliterative disease. Treatment of peripheral arterial obliterative disease influences their prevalence and prognosis as well. The main aim of regular physical exercise is to improve the quality of life of patients by increasing the functional capacity of the lower limbs. During exercise beneficial vascular changes occur like haemodynamic changes consisting of increasing pressure-gradient of stenotic artery and opening of collateral vessels, as well as improvement of the endothelial dysfunction. It favourably influences lipid profile by decreasing LDL cholesterol and increasing HDL cholesterol. Physical exercise beneficially affects blood rheology as well. It also brings about structural changes in the skeletal muscles, increases the enzyme levels in the oxidative metabolic processes and enhances the density of capillaries in the skeletal muscle fibres. According to the data published so far, patients with peripheral arterial obliterative disease are recommended to take part in supervised treadmill walking at least 3 days per week for 30-60 minutes each session containing 5-5 minute warm-up and cool-down periods. The training should be of intermittent intensity at the pain-free threshold. The physiological benefits are optimised at 3-6 months. The home-based training programme is also remarkably useful.