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Peripheral arterial disease (PAD) assessed by ankle-brachial index in patients with established cardiovascular disease or at least one risk factor for atherosclerosis

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Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Background

Peripheral arterial disease is associated with high cardiovascular morbidity and mortality. The objective of this study was to identify unrecognized patients with peripheral arterial disease using ankle-brachial index in patients with established cardiovascular disease or at least one risk factor for atherosclerosis.

Material and methods

One hundred fifty-four patients with 94 males and 60 females underwent assessment of peripheral arterial disease using ankle-brachial index by pulse Doppler. Correlation between peripheral arterial disease and various variables (history of cardiovascular disease or various risk factors for atherosclerosis) was established using Pearson coefficient correlation test and linear-by-linear association.

Results

Peripheral arterial disease was present in 24.03 % (n = 37) of patients in the study population. A total of 22.08 % (n = 34) patients in study population had ankle-brachial index between 0.41 and 0.90, i.e., mild to moderate peripheral arterial disease, and 1.95 % (n = 3) had ankle-brachial index between 0.00 and 0.40, indicating severe peripheral arterial disease. Advancing age (p < 0.001; linear-by-linear association = 24.448), smoking (p < 0.001), diabetes (p = 0.005), hypertension (p = 0.008), hyperlipidemia (p < 0.001), cardiovascular disease (p = 0.003), and number of risk factors (p < 0.001; linear-by-linear association = 50.099) showed a statistically significant correlation with peripheral arterial disease. No significant difference was found between men and women (59.46 vs. 40.54 %, respectively, p = 0.051) in terms of peripheral arterial disease.

Conclusion

Peripheral arterial disease is highly prevalent in patients with established cardiovascular disease or who have at least one risk factor for atherosclerosis. Screening of patients for peripheral arterial disease by pulse Doppler (which is cheap, rapid, and precise method to detect peripheral arterial disease) would allow identification of high-risk patients who could benefit from an appropriate treatment strategy.

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References

  1. Selvin E, Erlinger TP. Prevalence of and risk factors for peripheral arterial disease in the United States: results from the National Health and Nutrition Examination Survey, 1999–2000. Circulation. 2004;110:738–43.

    Article  PubMed  Google Scholar 

  2. He Y, Jiang Y, Wang J, Fan L, Li X, Hu FB. Prevalence of peripheral arterial disease and its association with smoking in a population-based study in Bei**g, China. J Vasc Surg. 2006;44:333–8.

  3. Ramos R, Quesada M, Solanas P, REGICOR Investigators, et al. Prevalence of symptomatic and asymptomatic peripheral arterial disease and the value of the ankle-brachial index to stratify cardiovascular risk. Eur J Vasc Endovasc Surg. 2009;38(3):305–11.

  4. Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 Practice guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric, and abdominal aortic). Circulation. 2006;113:e463–654.

    Article  PubMed  Google Scholar 

  5. Norgren L, Hiatt WR, Dormandy JA, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). Eur J Vasc Endovasc Surg. 2007;33:S1–S75.

  6. Aquino R, Johnnides C, Makaroun M, et al. Natural history of claudication: long-term serial follow-up study of 1244 claudicants. J Vasc Surg. 2001;34:962–70.

  7. Mostaza JM, Gonzalez-Juanatey JR, Castillo J, et al. Prevalence of carotid stenosis and silent myocardial ischemia in asymptomatic subjects with a low ankle-brachial index. J Vasc Surg. 2009;49(1):104–8.

    Article  PubMed  Google Scholar 

  8. Greenlandams J, Aurigemma GP, Bond MG, et al. Prevention conference V. Beyond secondary prevention: identifying the high-risk patients for primary prevention. Noninvasive tests of atherosclerosis burden. Circulation. 2000;101:1–7.

    Article  Google Scholar 

  9. Belch JJ, Topol EJ, Agnelli J, et al. For the prevention of atherothrombotic disease network: critical issues in peripheral arterial disease in detection and management. Arch Intern Med. 2003;163(8):884–92.

    Article  PubMed  Google Scholar 

  10. Hirsch AT, Haskal ZJ, Hertzer NR, et al. ACC/AHA 2005 guidelines for the management of patients with peripheral arterial disease (lower extremity, renal, mesenteric and abdominal aortic): executive summary. J Am Coll Cardiol. 2006;47:e1–192.

  11. Hirsch AT, Murphy TP, Lovell MB, et al. Gaps in public knowledge of peripheral arterial disease: the first national PAD public awareness survey. Circulation. 2007;116:2086–94.

    Article  PubMed  Google Scholar 

  12. Hirsch AT, Criqui MH, Treat-Jacobson D, et al. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA. 2001;286:1317–24.

    Article  CAS  PubMed  Google Scholar 

  13. Diehm C, Schuster A, Allenberg JR, et al. High prevalence of peripheral arterial disease and comorbidity in 6880 primary care patients: cross-sectional study. Atherosclerosis. 2004;172:95–105.

    Article  CAS  PubMed  Google Scholar 

  14. Fowkes FG, Low LP, Tuta S, AGATHA Investigators, et al. Ankle-brachial index and extent of atherothrombosis in 8891 patients with or at risk of vascular disease: results of the international AGATHA study. Eur Heart J. 2006;27:1861–7.

    Article  PubMed  Google Scholar 

  15. Mourad JJ, Cacoub P, Collet JP, ELLIPSE scientific committee and study investigators, et al. Screening of unrecognized peripheral arterial disease (PAD) using ankle-brachial index in high cardiovascular risk patients free from symptomatic PAD. J Vasc Surg. 2009;50:572–80.

    Article  PubMed  Google Scholar 

  16. Savji N, Rockman CB, Skolnick AH, et al. Association between advanced age and vascular disease in different arterial territories: a population database of over 3.6 million subjects. J Am Coll Cardiol. 2013;61(16):1736–43.

    Article  PubMed  Google Scholar 

  17. Vakili H, Sadeghi R, Doustali K, et al. Evaluation of asymptomatic peripheral arterial disease by ankle-brachial index in patients with concomitant coronary arterial disease. Int Cardiovasc Res J. 2012;6(4):128–30.

    PubMed  PubMed Central  Google Scholar 

  18. Gregg EW, Sorlie P, Paulose-Ram R, et al. Prevalence of lower-extremity disease in the US adult population >=40 years of age with and without diabetes: 1999–2000 national health and nutrition examination survey. Diabetes Care. 2004;27:1591–7.

    Article  PubMed  Google Scholar 

  19. Hooi JD, Kester AD, Stoffers HE, et al. Asymptomatic peripheral arterial occlusive disease predicted cardiovascular morbidity and mortality in a 7-year follow-up study. J Clin Epidemiol. 2004;57:294–300.

    Article  CAS  PubMed  Google Scholar 

  20. Joosten MM, Pai JK, Bertoia ML, et al. Associations between conventional cardiovascular risk factors and risk of peripheral artery disease in men. JAMA. 2012;308:1660–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Lee YH, Shin MH, Kweon SS, et al. Cumulative smoking exposure, duration of smoking cessation, and peripheral arterial disease in middle-aged and older Korean men. BMC Public Health. 2011;11:94.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Creager MA, Luscher TF, Cosentino F, et al. Diabetes and vascular disease: pathophysiology, clinical consequences, and medical therapy: part I. Circulation. 2003;108:1527–32.

    Article  PubMed  Google Scholar 

  23. Kownator S, Cambou JP, Cacoub P, et al. Prevalence of unknown peripheral arterial disease in patients with coronary artery disease: data in primary care from the IPSILON study. Arch Cardiovasc Dis. 2009;102:625–31.

    Article  PubMed  Google Scholar 

  24. Premalatha G, Shanthirani S, Deepa R, Markovitz J, Mohan V. Prevalence and risk factors of peripheral vascular disease in a selected South Indian population: the Chennai Urban Population Study. Diabetes Care. 2000;23:1295–300.

  25. Zhan Y, Yu J, Ding R, Sun Y, Hu D. Triglyceride to high density lipoprotein cholesterol ratio, total cholesterol to high density lipoprotein cholesterol ratio and low ankle brachial index in an elderly population. VASA. 2014;43:189–97.

  26. Criqui MH, Fronek A, Barrett-Connor E, Klauber MR, Gabriel S, Goodman D. The prevalence of peripheral arterial disease in a defined population. Circulation. 1985;71:510–5.

  27. Fowkes FG, Housley E, Cawood EH, Macintyre CC, Ruckley CV, Prescott RJ. Edinburgh artery study: prevalence of asymptomatic and symptomatic peripheral arterial disease in the general population. Int J Epidemiol. 1991;20:384–92.

  28. Bozkurt AK, Tasci I, Tabak O, Gumus M, Kaplan Y. Peripheral artery disease assessed by ankle-brachial index in patients with established cardiovascular disease or at least one risk factor for atherothrombosis—CAREFUL study: a national, multi-center, cross-sectional observational study. BMC Cardiovasc Disord. 2011;11:4.

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Authors and Affiliations

  1. Department of Cardiology, Super Specialty Hospital, Government Medical College, Jammu, 180001, Jammu, India

    Sushil Kumar Sharma

  2. Department of CTVS, Super Specialty Hospital, Government Medical College, Jammu, 180001, Jammu, India

    Arvind Kohli

  3. Department of Internal Medicine, Government Medical College, Jammu, 180001, Jammu, India

    Eshan Chopra

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  1. Sushil Kumar Sharma
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  2. Arvind Kohli
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  3. Eshan Chopra
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Correspondence to Arvind Kohli.

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Sharma, S.K., Kohli, A. & Chopra, E. Peripheral arterial disease (PAD) assessed by ankle-brachial index in patients with established cardiovascular disease or at least one risk factor for atherosclerosis. Indian J Thorac Cardiovasc Surg 32, 120–125 (2016). https://doi.org/10.1007/s12055-015-0415-0

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