Abstract 9570: Advanced Endothelial Dysfunction in Patients with Coexistence of Coronary Artery Disease and Peripheral Artery Disease -Effect of Cilostazol on the Advanced Endothelial Dysfunction-

Abstract

Backgrounds In patients with coronary artery disease (CAD), coexistence of peripheral arterial disease (PAD) indicates poor cardiovascular prognosis. Endothelial dysfunction plays a crucial role in cardiovascular diseases and reactive hyperemia peripheral arterial tonometry (RH-PAT) can noninvasively examine endothelial function. We hypothesized that advanced endothelial dysfunction might associate with the coexistence of CAD and PAD and we investigated effects of cilostazol on the endothelial dysfunction in diabetic patients with PAD. Methods and Results We measured RH-PAT index (RHI) and ankle-brachial index (ABI) in consecutive stable patients with coronary risk factors (n=511). CAD was defined by coronary angiography (stenosis≥50%, n=358) and PAD was diagnosed by ABI<0.9, ABI>1.4 with vascular imaging evidence of PAD, previous history of peripheral revascularization, or Fontaine classification≥II (n=73). CAD group (n=358) demonstrated significant lower RHI than non-CAD group (n=153) (RHI: 0.52±0.20 vs. 0.60±0.20, p<0.001). RHI were significantly attenuated in patients with coexistence of CAD and PAD (n=63) compared to CAD patients without PAD (n=295) (RHI: 0.40±0.17 vs. 0.54±0.19, p<0.001). In patients with CAD, univariate logistic regression analysis revealed that age (odd ratio (OR)=1.09, p=0.006), smoking (OR=9.94, p<0.001), body mass index (OR=0.76, p=0.001), high density lipoprotein-cholesterol (OR=0.96, p=0.038), estimated glomerular filtration ratio (OR=0.96, p=0.001), and RHI (per 0.1) (OR=0.57, p<0.001) correlated with the presence of PAD. Multivariate logistic regression analysis demonstrated independent correlation of RHI with the coexistence of PAD in CAD-patients (OR: 0.60, 95% confidence interval 0.451 to 0.798, p<0.001). 12 weeks cilostazol treatment (200mg/day) significantly improved the endothelial dysfunction in diabetic patients with PAD (n=21, age 67±7) (RHI; 0.48±0.11 to 0.68±0.25, p<0.001). Conclusions: Advanced endothelial dysfunction is associated with coexistence of PAD in CAD patients and cilostazol ameliorated the endothelial dysfunction in diabetic patients with PAD. Severe impairment of endothelial function might be a key component in the concomitant CAD and PAD.