Kabiul Haque, MD, on Effective Management of Peripheral Arterial Disease in Primary Care

A patient mentions leg pain when walking. It's a common complaint that could be anything from musculoskeletal strain to something far more serious. How do you know when to suspect peripheral arterial disease—and more importantly, what can you do in primary care to prevent progression before referral becomes urgent?

PAD affects millions of individuals, yet it often goes undiagnosed until complications develop. Primary care physicians are uniquely positioned to catch this condition early through careful history-taking and risk factor assessment, then implement evidence-based interventions that can significantly slow disease progression, according to Kabiul Haque, MD, a clinical assistant professor of family medicine at Ochsner LSU Health System in Shreveport, LA.

Patient Care® spoke with Dr Haque, during the 2025 FMX conference in Anaheim. In this segment, Dr Haque walks through a practical, systematic approach to identifying PAD in your practice and outlines the four essential management strategies every primary care physician should implement immediately upon diagnosis.

In this segment, Dr Haque covers:

• Key history questions that raise suspicion for PAD
• Major risk factors to assess in every patient with leg pain
• The diagnostic pathway: ABI testing and ultrasound interpretation
• When to refer to vascular surgery based on ABI results
• The four-pillar management approach to prevent progression

The following transcript has been lightly edited for style and clarity.

Patient Care: What are some of the most effective ways primary care physicians can identify and manage peripheral arterial disease early to prevent disease progression?

Kabiul Haque, MD: Primary care has an important role in preventing or diagnosing PAD, or peripheral arterial disease. The first thing that we have to make sure as primary care doctors is that we take a good history. So if a patient comes in with leg pain, or what we call claudication—that's when a patient feels leg pain after walking 10 or 15 minutes—taking the history is the first thing to identify this. So if a patient is telling you that I'm having leg pain, having claudication, then we have to ask the patient, are you smoking or not? So there are some risk factors. One is smoking is a big risk factor. Gender, male, is a risk factor. Also, other cardiometabolic diseases, for example, diabetes or essential hypertension. So those are the risk factors. So taking the history is very important if the patient has leg pain and risk factors. And then we diagnose the patient with PAD, sort of like initially, and then we have to run the diagnostic test. We have to get what we call an ABI, Ankle-Brachial Index test, and then after that, we get an ultrasound for the lower extremity. So if the ultrasound confirms that the patient has PAD, peripheral arterial disease, then we have to make sure that we send the appropriate referral, depending on the diagnostic finding on the ABI. Now, if the ABI is 0.7 to 0.9, which is mild, or between 0.4 to 0.7, the ABI is moderate. So in that case, you refer the patient to a vascular surgeon if it's moderate. But definitely we have to start the patient on aspirin if there is no contraindication. So aspirin is a blood thinner, so it thins the blood so the patient will feel a little bit better. Besides starting the aspirin, the other thing you have to do is smoking counseling. So you have to make sure that you counsel every patient who smokes cigarettes and has PAD. So if you can stop smoking, that will further prevent the progression of PAD. So smoking cessation, starting aspirin, and also starting cholesterol medicine, statin. Statin is very important. So according to the recommendation, USPSTF, you have to bring down the cholesterol level almost like less than 50% after the initial diagnosis. So if the patient has, let's say, cholesterol of 100, you need to aim to bring it down less than 70. Seventy is the cutoff. So you can start a statin. And if the statin doesn't work, you can also have other choices, like, for example, Zetia, or like Repatha. You can also try that to bring down the cholesterol. So to prevent the progression, definitely stop smoking, aspirin, and also statin. So three things you can do to prevent further progression, and also you can recommend the patient to do exercises. Exercise will increase the blood flow in the arterial system in the leg so the patient will feel better. So these four things, if I tell you—aspirin, smoking cessation, statin, and exercise—will be the four things you can, as a primary care doctor, tell the patients to prevent further progression of PAD.