The Prevalence of Peripheral Arterial Disease in High Risk Subjects and Coronary or Cerebrovascular Patients

Abstract

Atherosclerosis is a generalized disease with considerable overlap of its coronary, carotid, and peripheral manifestations. As an indicator of multifocal atherosclerosis, peripheral arterial disease (PAD) is emerging as an important aid in risk stratification of patients with coronary artery (CAD) or cerebrovascular disease (CVD). Therefore, the aim of the study was to assess the prevalence of PAD in high risk subjects and its ability to identify coronary or cerebrovascular patients. A total of 952 (63.3% male; age 63.7 ±10.7 years) patients at high cardiovascular risk (≥2 risk factors), or with evidence of CAD or CVD were screened for PAD by means of ankle-brachial index (ABI) assessment; 226 patients were at high risk (≥2 risk factors), 575 had CAD, and 151 had CVD. A total of 42% of patients with CAD and 36% of patients with CVD had PAD. In patients with CAD one half of cases of PAD were asymptomatic. Asymptomatic PAD (pathological ABI) was strongly associated with CAD and CVD, even after adjustment for age, gender, and other risk factors. No significant differences between CAD, PAD, and CVD patients were observed in terms of risk profiles. In conclusion, our findings confirm a high prevalence of both symptomatic and asymptomatic PAD in patients at high cardiovascular risk and its association with both CAD and CVD.

Get full access to this article

View all access options for this article.

References

Jelnes R. , Gaardsting O. , Hougaard Jensen K : Fate in intermittent claudication: Outcome and risk factors . BMJ 293: 1137-1140 , 1986.

Criqui M. , Langer R. , Fronek A. , et al: Coronary disease and stroke in patients with large-vessel peripheral arterial disease . Drugs 42: 16-21 , 1991.

Criqui M. , Denenberg J. : The generalized nature of atherosclerosis: How peripheral arterial disease may predict adverse events from coronary arterty disease . Vasc Med 3: 241-245 , 1998.

Hirsch AT , Criqui MH , Treat-Jacobson D. , et al: Peripheral arterial disease detection, awareness, and treatment in primary care . JAMA 286: 1317-1324 , 2001 .

Jonason T. , Bergstrom R. : Cessation of smoking in patients with intermittent claudication. Effects on the risk of peripheral vascular complications, myocardial infarction and mortality . Acta Med Scand 221: 253-260 , 1987.

The Heart Outcomes Prevention Evaluation Study Investigators : Effects of angiotensin-converting enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients . N Engl J Med 342: 145-153 , 2000.

Östergen J. , Sleight P. , Dagenais G. , et al: Impact of ramipril in patients with evidence of clinical or subclinical peripheral arterial disease . Eur Heart J 25: 17-24 , 2004.

Blankenhorn D. , Azen S. , Crawford D. , et al: Effects of colestipol-niacin therapy on human femoral atherosclerosis . Circulation 83: 438-447 , 1991.

Allan PL , Mowbray PI , Lee AJ , et al: Relationship between carotid intima-media thickness and symptomatic and asymptomatic peripheral arterial disease: The Edinburgh Artery Study . Stroke 28: 348-353 , 1997.

10.

Hollander M. , Hak A. , Koustaal P. , et al: Comparison between measures of atherosclerosis and risk of stroke: The Rotterdam Study . Stroke 34: 2367-2372 , 2003.

11.

Klop R. , Eikelboom B. , Taks A. : Screening of internal carotid arteries in patients with peripheral vascular disease by colour-flow duplex scanning . Eur J Vasc Surg 5: 41-45 , 1991.

12.

Murabito JM , D'Agostino RB , Silbershatz H. , et al: Intermittent claudication: A risk profile from the Framingham heart study . Circulation 96: 44-49 , 1997.

13.

Chambless LE , Folsom AR , Davis V. , et al: Risk factors for progression of common carotid atherosclerosis: The atherosclerosis risk in communities study, 1987-1998 . Am J Epidemiol 155: 38-47 , 2002.

14.

Smith SC Jr , Milani RV , Arnett DK , et al: Atherosclerotic Vascular Disease Conference: Writing Group II: Risk Factors . Circulation 109: 2613-2616 , 2004.

15.

Newman AB , Naydeck BL , Sutton-Tyrrell K. , et al: Relationship between coronary artery calcification and other measures of subclinical cardiovascular disease in older adults . Arterioscler Thromb Vasc Biol 22: 1674-1679 , 2002 .

16.

Hooi J. , Stoffers H. , Kester A. , et al: Risk factors and cardiovascular diseases associated with asymptomatic peripheral arterial occlusive disease. The Limburg PAOD Study. Peripheral Arterial Occlusive Disease . Scand J Prim Health Care 16: 177-182 , 1998.

17.

Kuller LH , Shemanski L. , Psaty BM , et al: Subclinical disease as an independent risk factor for cardiovascular disease . Circulation 92: 720-726 , 1995.

18.

Psaty BM , Furberg CD , Kuller LH , et al: Traditional risk factors and subclinical disease measures as predictors of first myocardial infarction in older adults: The Cardiovascular Health Study . Arch Intern Med 159: 1339-1347 , 1999.

19.

Leng GC , Fowkes Fgr , Lee AJ , et al: Use of ankle brachial pressure index to predict cardiovascular events and death: A cohort study . BMJ 313: 1440-1443 , 1996.

20.

Papamicael C. , Lekakis J. , Stamatelopoulos K. : Ankle-brachial index as a predictor of the extent of coronary atherosclerosis and cardiovascular events in patients with coronary artery disease . Am J Cardiol 86: 615-618 , 2000.

21.

Karnegis J. , Matts J. , Tuna N. , et al: Correlation of coronary with peripheral arterial stenosis. The POSCH Group . Atherosclerosis 92: 25-30 , 1992.

22.

Atmer B. , Jogestrand T. , Laska J. , et al: Peripheral artery disease in patients with coronary artery disease . Int Angiol 14: 89-93 , 1995.

23.

Dieter R. , Tomasson J. , Gudjonsson T. , et al: Lower extremity peripheral arterial disease in hospitalized patients with coronary artery disease . Vasc Med 8: 233-236 , 2003.

24.

Poredos P. , Golob M. , Jensterle M. : Interrelationship between peripheral arterial occlusive disease, carotid atherosclerosis and flow mediated dilation of the brachial artery . Int Angiol 22: 83-87 , 2003.