In the 7 years between the publication of the initial Inter-Society Consensus (TASC) and the updated TASC II guidelines for the management of peripheral artery disease (PAD), a corresponding set of PAD treatment guidelines were produced by the American College of Cardiology/American Heart Association (ACC/AHA).¹ Both of these guidelines focus on the management and diagnosis of PAD, with the ACC/AHA guidelines targeted towards United States physicians whilst the TASC II guidelines² are focused on a more multinational audience.

In September 2008, Mohler and Giri authored a review of the similarities and differences between these two sets of treatment guidelines, which was published in Current Medical Research and Opinion.³ A number of the key differences between the two sets of guidelines mentioned within the review are summarized briefly below.

Evidence grading systems Both the ACC/AHA and the TASC II guidelines utilize the ABC system of recommendation grading. The ACC/AHA guidelines provide further information by using an additional classification (Class I, II, IIa,IIb and III) for each of the examined procedures/treatments.

Diabetes therapy Both guidelines suggest aggressive control of glycosylated hemoglobin (HbA_1c) in patients with diabetes to a target of <7.0%. Additionally, the TASC II guidelines indicate that, optimally, HbA_1c should be as close to 6% as possible.

Claudication The guidelines recommend different agents as second-line alternatives to cilostazol in patients with claudication – the ACC/AHA recommends pentoxyfylline and the TASC II guidelines recommend naftidrofuryl.

Hypertension The ACC/AHA guidelines provide no indication as to the initial pharmacotherapeutic strategy to be utilized as antihypertensive medication in patients with PAD. In contrast, the TASC II guidelines advocate the use of either thiazide diuretics or angiotensin-converting enzyme (ACE) inhibitors as first-line blood pressure lowering therapy.

Lipid-lowering therapy The TASC II guidelines recommend that the initial strategy for reducing lipid levels should focus on the use of dietary modifications whilst the ACC/AHA guidelines recommend the use of statins as first-line therapy for lipid level reduction.

In summary, the review of the two PAD treatment guidelines by Mohler and Giri indicates that there is little difference between the guidelines in terms of recommendations for clinical practice. The authors concluded that, despite the limited differences, both guidelines were unequivocal in recommending that aggressive management is required for patients with PAD.

References

1. Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 Practice Guidelines for the management of patients with peripheral arterial disease (lower extremity, renal mesenteric and abdominal aortic): a collaborative report from the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients with Peripheral Arterial Disease): endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus and Vascular Disease Foundation. Circulation 2006; 113: e463-654.

2. Norgren L, Hiatt WR, Dormandy JA, et al. Inter-society consensus for the management of peripheral arterial disease (TASC II). Eur J Vasc Endovasc Surg 2007; 33(Suppl 1): S1-75.

3. Mohler E, Giri J. Management of peripheral arterial disease patients: comparing the ACC/AHA and TASC-II guidelines. Curr Med Res Opin 2008; 24: 2509-2522.