Table 2

Data captured in the Patient Record Form (PRF)

Date of birth, sex, race, civil status

Physical examination, i.e. height, weight, waist circumference, heart pulse, sitting blood pressure

Presence of CVD risk factors

• Cigarette/tobacco smoking habits

• Physical activity (a physically active patient is defined as an individual performing at least 30 minutes of continuous or intermittent moderate-intensity exercise 5 days/week)

• Alcohol intake

• Family history of premature CHD, as defined in Table 1

• Arterial blood hypertension, as defined in Table 1

• Dyslipidaemia (type of dyslipidaemia; whether untreated or on current lipid-lowering drug treatment)

Lipid data from fasting blood sample taken in the past 12 months (last measure) (date of the blood sample; total cholesterol, HDL cholesterol, and triglycerides as minimum requirements; LDL cholesterol, glucose, Apo-A1, and Apo-B, if available)

Current pharmacological treatments (drug Anatomical Therapeutic Chemical (ATC) class, duration of treatment, reason for therapy)

Right and left ABI measurement at rest, performed according to American College of Cardiology (ACC)/American Heart Association (AHA) guidelines for the management of patients with PAD

Cimminiello et al. BMC Cardiovascular Disorders 2010 10:35   doi:10.1186/1471-2261-10-35