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(Circulation. 2007;115:e212.)
© 2007 American Heart Association, Inc.

Correspondence

Letter by Calonge and Petitti Regarding Article, "The United States Preventive Services Task Force Recommendation Statement on Screening for Peripheral Arterial Disease: More Harm Than Benefit?"

Ned Calonge, MD, MPH

US Preventive Service Task Force, Colorado Department of Public Health and Environment, Denver, Colo

Diana Petitti, MD, MPH

Department of Preventive Medicine University of Southern California Keck School of Medicine Los Angeles, Calif

To the Editor:

Representing the United States Preventive Services Task Force (USPSTF), we would like to respond to the special report by Beckman and colleagues,¹ "The US Preventive Services Task Force Recommendation Statement on Screening for Peripheral Vascular Disease: More Harm Than Benefit?" published in the August 22, 2006, issue of Circulation. The authors were critical of the USPSTF’s brief evidence update and "D" recommendation for screening for peripheral arterial disease (PAD). Their criticism was based on the potential value of PAD screening for the detection of cardiovascular disease (CVD) in asymptomatic individuals.

The intention of the USPSTF recommendation was clear: It was intended only to address PAD screening to improve the health outcomes for PAD. The brief evidence update indicated, as in 1996 when the recommendation was first released, that there is at least fair evidence that the net benefit of this screening is either zero or negative (indicating no net benefit or net harm). In their article, Beckman et al¹ do not dispute this conclusion, but they suggest that the assumptions of the USPSTF review were flawed because it did not consider other CVD outcomes. This was clearly outside the scope of the recommendation. In fact, the USPSTF is currently reviewing PAD screening for CVD and soon plans to release a recommendation for this and other nontraditional risk factors for CVD.

Beckman et al¹ provide evidence of a significant relationship between PAD and CVD, but they do not address this critical question: What is the additional value of PAD screening to the identification of more established risk factors for CVD, such as hypertension and lipid disorders? Screening for these traditional risk factors is recommended by the USPSTF, and these risk factors are the actual targets of treatment to lower CVD risk. It is the additional value of PAD screening in reducing CVD mortality and morbidity that is of greatest interest to the primary care clinician and his or her patients. Finally, we believe that the upcoming review and recommendation will provide additional information about the utility of PAD screening in evaluating CVD risk.

	Acknowledgments

 
Disclosures

None.

	References

Top References

 
1. Beckman JA, Jaff MR, Creager MA. The United States preventive services task force recommendation statement on screening for peripheral arterial disease: more harm than benefit? Circulation. 2006; 114: 861–866.[Abstract/Free Full Text]

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This Article Extract Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Calonge, N. Articles by Petitti, D. Search for Related Content PubMed PubMed Citation Articles by Calonge, N. Articles by Petitti, D. Pubmed/NCBI databases Medline Plus Health Information Peripheral Arterial Disease Related Collections Primary prevention Related Article