Physician Update: AHA Special Edition
Read more articles from our most relevant research presented at the 2025 AHA Scientific Sessions.
Comprehensive Heart and Vascular Center
On the Ties Between Blood Pressure and Clinical Events in Peripheral Artery Disease
By Saket Girotra, M.D.
Professor of Internal Medicine
Peripheral artery disease (PAD) affects more than 12 million Americans, is associated with a high risk of death and cardiovascular (CV) events, and is a major cause of disability due to risk of amputation. Despite PAD’s high prevalence, contemporary research in the long-term trajectory of health outcomes in PAD patients and the effect of ongoing treatments remains limited. With funding from the National Institutes of Health and the Department of Veterans Affairs, our team has created the PEripheral ARtery Long-term Survival (PEARLS) registry of more than 100,000 veterans with PAD. The PEARLS registry includes rich clinical and administrative data and is a tremendous resource to conduct real-world studies of the long-term trajectory of health outcomes and the effects of contemporary treatments.
At #AHA25, we presented findings from a study examining the relationship between blood pressure (BP) and clinical events in PAD, showing that while BP was linearly associated with CV risk, the relationship with limb events – major amputation and chronic limb threatening ischemia (CLTI) – was U-shaped, with elevated risk seen at both low and high BP. These patterns were exacerbated in those with involvement of small vessels, diabetes, and severe PAD. These findings have important implications for guidelines that recommend intensive BP control in all patients, including those with PAD.
“Despite PAD’s high prevalence, contemporary research in the long-term trajectory of health outcomes in PAD patients and the effect of ongoing treatments remains limited.”
Saket Girotra, M.D.
In separate presentations, we presented data showing that poor glycemic control was associated with a markedly increased risk of clinical events, especially risk of major amputation and CLTI among diabetic patients with PAD. Because large, randomized controlled trials such as ACCORD included few participants with PAD and did not adjudicate limb events, these data are important for advancing our understanding of the effects of glycemic control in PAD patients.
We hope these and other forthcoming studies from PEARLS will fill much-needed gaps in the management of patients with PAD.
