Targeted Disease Management Plan for Patients with Peripheral Arterial Disease.

INTERVENTION: Lifestyle intervention: low fat diet, exercise, smoking cessation. Frequent review by General practioner (GP) for titration of medications – statins, beta blockers. Participation in a one hour exercise program once a week for twelve weeks. A small group who exercise on a circuit including treadmill, bicycle and floor exercises supervised by physiotherapist and exercise physiologist Program repeated once a year for three years. CONDITION: Peripheral Arterial Disease. PRIMARY OUTCOME: Atherosclerotic burden (carotid intima‐medial thickness, dobutamine echocardiogram) at 36 months. Ultrasound used to measure the carotid intima‐medial thickness. Cardiovascular events; Cardiac death/Myocardial Infarction/ Stroke SECONDARY OUTCOME: Biochemistry markers: Cholesterol, blood glucose, creatinine ‐ blood tests by an accreditated pathology service. Physical parameters: Body Mass Index (BMI), Blood pressure, Pulse. Performed by exercise physiologists. Quality of life measurements; SF12, Hospital Anxiety and Depression Scale (HADS), Vascular Quality of Life Questionnaire (VascuQOL). INCLUSION CRITERIA: All patients included will have a positive Edinburgh Claudication Scale and/or positive ankle Brachial Index. These patients will be assessed into two groups of patients; Low risk group with 1‐2 of these risk factors High Risk group with 3 or more of these risk factors. Age 50 yrs old or more Exercise <30 min. a day (what type of exercise performed) Smoking Current (type/amount) Previous/Passive Obesity Body Mass Index >28 Social behaviour Depression/history of depression. Hypertension Systolic >139mm Hg and Diastolic >89mm Hg Renal impairment Creatinine, = 180 mmol/dL Blood Glucose level Fasting Glucose, =126 mg/dL Hyperlipidemia Low density lipid (LDL) >130mg/dL High Density lipid(HDL) <50mg/dL (women) <49mg/dL (men)