Abstract 425: Coronary Artery Disease in Patients with Premature Atherosclerotic Peripheral Artery Disease

Abstract

Objective: Premature atherosclerotic peripheral artery disease (PAD) is being diagnosed with increasing frequency. Little is known about concomitant coronary artery disease (CAD) in patients with premature PAD. This study examines prevalence, associated clinical characteristics, and predictors of concomitant CAD in young PAD patients. Methods: We studied patients with severe atherosclerotic PAD <55 years of age (mean 49.36±6.45 yrs) treated at a single academic Vascular center between 1998 and 2010. Data was collected at the time of initial evaluation. CAD was defined by documented acute coronary syndrome; and/or prior coronary revascularizations. Associations with concomitant CAD were evaluated univariately using chi-square tests for categorical characteristics or t-tests for continuous characteristics, and using multivariable logistic regression. Results: Total of 561 patients (46% female, 20% Black) were analyzed. Mean age at diagnosis was 46.64±6.86 years. Risk factors included smoking (97%), hyperlipidemia (67%), hypertension (64%), family history of premature CAD (47%), and diabetes (25%). Aortoiliac disease was present in 77% of patients; 36% were disabled. Overall, 174 (31%) patients had clinical CAD. Patients with premature CAD were less likely to be Blacks (p=0.004), had greater frequency of hypertension, hyperlipidemia, diabetes, family history of premature CAD, polyvascular disease (i.e. cerebral vascular disease [CeVD]) (p<.001 for each), renovascular disease (p=.016) and mesenteric disease (p=.012). Multivariable logistic regression modeling showed higher odds of concomitant CAD for patients with hyperlipidemia (OR 4.71; 95 CI 2.82-7.85; p<.0001), diabetes (OR 2.11; 95% CI 1.28-3.47; p<0.01), family history of premature CAD OR 2.00; 95% CI 1.27-3.14;p<0.01) CeVD (OR 2.15; 95% CI 1.34-3.48;p<0.01), mesenteric vascular disease (OR 2.70;95% CI 1.19-6.14; p=.02). One pack year in smoking increase had 1.01 times odds of concomitant CAD (95% CI 1.001-1.018; p=.02). Conclusions: Clinical CAD was prevalent in 1/3 of patients with premature PAD, and those with premature CAD were less likely to be Black. Among patients with premature PAD, higher odds of concomitant clinical CAD were associated with presence of hyperlipidemia, diabetes, family history of premature CAD, polyvascular disease.