***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND In peripheral arterial occlusive disease ( PAOD ) , arterial stenosis or occlusion impairs perfusion in the territory of the distal portion of the aorta and the iliac and leg arteries . In Germany , the prevalence of PAOD rises with age , reaching 20 % among persons over age 70 . METHODS This guideline was prepared by a collaboration of 22 medical specialty societies and two patient self-help organizations on the basis of pertinent publications that were retrieved by a systematic search in PubMed for articles that appeared from 2008 to April 2014 , with a subsequent up date to May 2015 . RESULTS 294 articles were assessed , including 34 systematic review s and 98 r and omized controlled trials ( RCTs ) . The diagnostic assessment of PAOD is based on physical examination , blood pressure at the ankles , and color-coded duplex ultrasonography ( grade A recommendation ) . Other tomographic imaging methods can be used for suitable indications . The main elements of the treatment of PAOD are the control of cardiovascular risk factors and structured vascular exercise ( grade A recommendation ) . Acetylsalicylic acid and statins are the main drugs for symptomatic PAOD ( grade A recommendation ) . Patients with claudication and correlated structural findings can undergo an endo - vascular or open surgical procedure . Critical ischemia is an indication for arterial revascularization as soon as possible ( grade A recommendation ) ; this may be performed either by open surgery or by an endovascular procedure of one of the types that are now undergoing rapid development , or one of the crural treatment options . There is inadequate evidence concerning the optimal drug regimen after revascularization procedures . CONCLUSION The diagnostic assessment of PAOD is based on physical examination , measurement of the ankle-brachial index ( ABI ) , and duplex ultrasonography .  Acetylsalicylic acid and statins are indicated for patients with symptomatic PAOD . Endovascular procedures should be used if indicated . R and omized studies are needed to provide better evidence on many open questions in the treatment of PAOD Background — Our aim was to assess the mortality and vascular morbidity risk of elderly individuals with asymptomatic versus symptomatic peripheral artery disease ( PAD ) in the primary care setting . Methods and Results — This prospect i ve cohort study included 6880 representative unselected patients ≥65 years of age with monitored follow-up over 5 years . According to physician diagnosis , 5392 patients had no PAD , 836 had asymptomatic PAD ( ankle brachial index < 0.9 without symptoms ) , and 593 had symptomatic PAD ( lower-extremity peripheral revascularization , amputation as  a  result  of PAD , or intermittent claudication symptoms regardless of ankle brachial index ) . The risk of symptomatic compared with asymptomatic PAD patients was significantly increased for the composite of all-cause death or severe vascular event ( myocardial infa rct ion , coronary revascularization , stroke , carotid revascularization , or lower-extremity peripheral vascular events ; hazard ratio , 1.48 ; 95 % confidence interval , 1.21 to 1.80 ) but not for all-cause death alone ( hazard ratio , 1.13 ; 95 % confidence interval , 0.89 to 1.43 ) , all-cause death/myocardial infa rct ion/stroke ( excluding lower-extremity peripheral vascular events and any revascularizations ; hazard ratio , 1.18 ; 95 % confidence interval , 0.92 to 1.52 ) , cardiovascular events alone ( hazard ratio , 1.20 ; 95 % confidence interval , 0.89 to 1.60 ) , or cerebrovascular events alone ( hazard ratio , 1.33 ; 95 % confidence interval , 0.80 to 2.20 ) . Lower ankle brachial index categories were associated with increased risk . PAD was a strong factor for the prediction of the composite end point in an adjusted model . Conclusions — Asymptomatic PAD diagnosed through routine screening in the offices of primary care physicians carries a high mortality and /or vascular event risk . Notably , the risk of mortality was similar in symptomatic and asymptomatic patients with PAD and was significantly higher than in those without PAD . In the primary care setting , the diagnosis of PAD has important prognostic value Background Screening for abdominal aortic aneurysm ( AAA ) of men aged 65 - 74 years reduces the AAA-related mortality and is generally considered cost effective . Despite of this only a few national health care services have implemented permanent programs . Around 10 % of men in this group have peripheral arterial disease ( PAD ) defined by an ankle brachial systolic blood pressure index ( ABI ) below 0.9 result ing in an increased mortality-rate of 25 - 30 % . In addition well-documented health benefits may be achieved through primary prophylaxis by initiating systematic cholesterol-lowering , smoking cessation , low-dose acetylsalicylic acid ( aspirins ) , exercise , a healthy diet and blood-pressure control altogether reducing the increased risks for cardiovascular disease by at least 20 - 25%.The benefits of combining screening for AAA and PAD seem evident ; yet they remain to be established . The objective of this study is to assess the efficacy and the cost-effectiveness of a combined screening program for AAA , PAD and hypertension . Methods The Viborg Vascular ( VIVA ) screening trial is a r and omized , clinical ly controlled study design ed to evaluate the benefits of vascular screening and modern vascular prophylaxis in a population of 50,000 men aged 65 - 74 years . Enrolment started October 2008 and is expected to stop in October 2010 . The primary outcome is all-cause mortality . The secondary outcomes are cardiovascular mortality , AAA-related mortality , hospital services related to cardiovascular conditions , prevalence of AAA , PAD and potentially undiagnosed hypertension , health-related quality of life and cost effectiveness . Data analysis by intention to treat . Results Major follow-up will be performed at 3 , 5 and 10 years and final study result after 15 years . Trial registration Clinical Trials.gov Objective To determine whether aspirin and antioxidant therapy , combined or alone , are more effective than placebo in reducing the development of cardiovascular events in patients with diabetes mellitus and asymptomatic peripheral arterial disease . Design Multicentre , r and omised , double blind , 2 × 2 factorial , placebo controlled trial . Setting 16 hospital centres in Scotl and , supported by 188 primary care groups . Participants 1276 adults aged 40 or more with type 1 or type 2 diabetes and an ankle brachial pressure index of 0.99 or less but no symptomatic cardiovascular disease . Interventions Daily , 100 mg aspirin tablet plus antioxidant capsule ( n=320 ) , aspirin tablet plus placebo capsule ( n=318 ) , placebo tablet plus antioxidant capsule ( n=320 ) , or placebo tablet plus placebo capsule ( n=318 ) . Main outcome measures Two hierarchical composite primary end points of death from coronary heart disease or stroke , non-fatal myocardial infa rct ion or stroke , or amputation above the ankle for critical limb ischaemia ; and death from coronary heart disease or stroke . Results No evidence was found of any interaction between aspirin and antioxidant . Overall , 116 of 638 primary events occurred in the aspirin groups compared with 117 of 638 in the no aspirin groups ( 18.2 % v 18.3 % ) : hazard ratio 0.98 ( 95 % confidence interval 0.76 to 1.26 ) . Forty three deaths from coronary heart disease or stroke occurred in the aspirin groups compared with 35 in the no aspirin groups ( 6.7 % v 5.5 % ) : 1.23 ( 0.79 to 1.93 ) . Among the antioxidant groups 117 of 640 ( 18.3 % ) primary events occurred compared with 116 of 636 ( 18.2 % ) in the no antioxidant groups ( 1.03 , 0.79 to 1.33 ) . Forty two ( 6.6 % ) deaths from coronary heart disease or stroke occurred in the antioxidant groups compared with 36 ( 5.7 % ) in the no antioxidant groups ( 1.21 , 0.78 to 1.89 ) . Conclusion This trial does not provide evidence to support the use of aspirin or antioxidants in primary prevention of cardiovascular events and mortality in the population with diabetes studied . Trial registration Current Controlled Trials IS RCT N53295293 Background The significant increase in the average life expectancy has increased the societal challenge of managing serious age-related diseases , especially cancer and cardiovascular diseases . A routine check by a general practitioner is not sufficient to detect incipient cardiovascular disease . Design Population -based r and omized clinical ly controlled screening trial . Methods Participants : 45,000 Danish men aged 65–74 years living on the Isl and of Funen , or in the surrounding communities of Vejle and Silkeborg . No exclusion criteria are used . Interventions : One-third will be invited to cardiovascular seven-faceted screening examinations at one of four locations . The screening will include : ( 1 ) low-dose non-contrast CT scan to detect coronary artery calcification and aortic/iliac aneurysms , ( 2 ) brachial and ankle blood pressure index to detect peripheral arterial disease and hypertension , ( 3 ) a telemetric assessment of the heart rhythm , and ( 4 ) a measurement of the  cholesterol and plasma glucose levels  . Up-to- date cardiovascular preventive treatment is recommended in case of positive findings . Objective : To investigate whether advanced cardiovascular screening will prevent death and cardiovascular events , and whether the possible health benefits are cost effective . Outcome : Registry-based follow-up on all cause death ( primary outcome ) , and costs after 3 , 5 and 10 years ( secondary outcome ) .R and omization : Each of the 45,000 individuals is , by EPI DATA , given a r and om number from 1–100 . Those numbered 67 + will be offered screening ; the others will act as a control group . Blinding : Only those r and omized to the screening will be invited to the examination;the remaining participants will not . Numbers r and omized : A total of 45,000 men will be r and omized 1:2.Recruitment : Enrollment started October 2014 . Outcome : A 5 % reduction in overall mortality ( HR = 0.95 ) , with the risk for a type 1 error = 5 % and the risk for a type II error = 80 % , is expected . We expect a 2-year enrollment , a 10-year follow-up , and a median survival of 15 years among the controls . The attendance to screening is assumed to be 70 % . Discussion The primary aim of this so far st and -alone population -based , r and omized trial will be to evaluate the health benefits and costeffectiveness of using non-contrast full truncus computer tomography ( CT ) scans ( to measure coronary artery calcification ( CAC ) and identify aortic/iliac aneurysms ) and measurements of the ankle brachial blood pressure index ( ABI ) as part of a multifocal screening and intervention program for CVD in men aged 65–74.Attendance rate and compliance to initiated preventive actions must be expected to become of major importance .Trial registration Current Controlled Trials : IS RCT N12157806 ( 21 March 2015 ) OBJECTIVE To assess the prophylactic efficacy of aspirin and a high-dose antioxidant vitamin combination in patients with peripheral arterial disease ( PAD ) in terms of reduction of the risk of a first vascular event ( myocardial infa rct ion , stroke , vascular death ) and critical limb ischaemia . DESIGN R and omized , placebo-controlled , double-blind clinical trial with 2 x 2 factorial design . SETTING Thirty-seven European angiology/vascular medicine units . SUBJECTS A total of 366 out patients with stage I-II PAD documented by angiography or ultrasound , with ankle/brachial index < 0.85 or toe index < 0.6 ; 210 patients completed the follow-up . INTERVENTIONS Four treatment groups : ( i ) oral aspirin ( 100 mg daily ) , ( ii ) oral antioxidant vitamins ( 600 mg vitamin E , 250 mg vitamin C and 20 mg beta-carotene daily ) , ( iii ) both or ( iv ) neither , given for 2 years . MAIN OUTCOME MEASURE Major vascular events ( cardiovascular death , myocardial infa rct ion or stroke ) and critical leg ischaemia . RESULTS Seven of 185 patients allocated aspirin and 20 of 181 allocated placebo suffered a major vascular event ( risk reduction 64 % , P = 0.022 ) ; five and eight patients , respectively , suffered critical leg ischaemia ( total 12 vs. 28 , P = 0.014 
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Conflicting recommendations on treatment were found in the target value of the lipid lowering and antiplatelet therapy .
Conclusions Current guidelines on asymptomatic PAD varied in the method ological quality and fell short of the st and ard in the rigor of development and editorial independence .
Conflicting recommendations were found both on the screening and treatment .