Funded Study has Final Goal of Creating PAD Decision Support Tool

June 2015

The American Heart Association has approved activation of its NCRP (National Committee for Responsive Philanthropy) Winter 2015 Mentored Clinical and Population Research Award for Emory vascular surgeon Dr. Shipra Arya's study, "Predicting Lower Extremity Amputation and Cardiovascular Disease Risk with Peripheral Arterial Disease." Of the 48 applications submitted for the award, Dr. Arya's was one of only five to be chosen. The award includes two years of funding.

NCRP Clinical and Population Awards offer incentive to early career investigators to develop appropriate and supportive mentoring relationships while engaging in high quality, introductory and pilot clinical studies. Research funded by the awards should guide future strategies for reducing cardiovascular disease and stroke, foster new research in clinical and translational science, and encourage community- and population-based activities.

Dr. Arya's mentor for the study will be Emory preventive cardiologist Dr. Peter Wilson, director of epidemiology and genomic medicine at the Atlanta VA Medical Center. Dr. Wilson is a distinguished clinician and investigator whose research focuses on metabolic and cardiovascular disease in populations. Prior to coming to Emory in 2006, his experience included 20 years as director of laboratories at the Framingham Heart Study in Massachusetts.

Dr. Arya's study will work towards correcting the fact that peripheral arterial disease (PAD) is not as well recognized as coronary artery disease (CAD), though it is almost equally associated with high risk of heart attack, stroke, and amputation. Due to this disparity, providers often do not treat PAD aggressively enough. In addition, many PAD patients are unaware of their risks, do not seek treatment, or don't comply with recommended measures such as smoking cessation, increased exercise, medical management (blood pressure, diabetes, and cholesterol control), or surgery.

To redress the lack of PAD-related data, Dr. Arya and her team will analyze clinical data maintained by VA Informatics and Computing Infrastructure (VINCI) — a partnership between the VA Office of Information Technology and the Veterans Health Administration Office of Research and Development — and the international registry Reduction of Atherothrombosis for Continued Health (REACH). Managed by a multidisciplinary group of investigators, REACH seeks to illuminate cardiovascular risk factors in stable outpatients with established atherothrombotic disease (EAD), and has been collecting data on approximately 55,000 patients in 44 countries for the past several years. PAD is a common complication of EAD.

After developing predication models based on this data that will estimate risk for such outcomes as amputation, heart attack, stroke, and death according to various patient factors, Dr. Arya plans on creating a web-based app that will serve as a PAD decision support tool (DST). The DST will assist both patients and providers in recognizing, acknowledging, and controlling for risk factors and in determining how aggressive treatment should be.

"This study will form the basis for further translational research work in assessing the impact of the risk prediction models and DST on increasing PAD awareness on treatment approaches, adherence to guidelines, and patient responsiveness and compliance," says Dr. Arya.

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