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?”
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.