Association of Lower Extremity Peripheral Arterial Disease with Atherosclerotic Vascular Disease, Cardiovascular Events, and Mortality

Abstract

Peripheral arterial disease of the lower extremities (PAD) coexists with other atherosclerotic disorders [1-10]. In a study of 1,886 men and women, mean age 81 years, 270 of 468 patients (58%) with PAD had coexistent coronary artery disease (CAD) and 159 of 468 patients (34%) with PAD had prior ischemic stroke [1]. In a study of 1,802 men and women, mean age 80 years, living in the community and seen in an academic geriatrics practice, 161 of 236 patients (68%) with PAD had coexistent CAD and 100 of 236 patients (42%) with PAD had coexistent prior ischemic stroke [2]. In 924 men, mean age 80 years, the prevalence of PAD was 1.5 times significantly higher in 336 men with mitral annular calcium than in 588 men without mitral annular calcium (43% versus 28%) [3]. In 1,881 women, mean age 81 years, the prevalence of PAD was 1.6 times significantly higher in 985 women with mitral annular calcium than in 896 women without mitral annular calcium (31% versus 19%) [3]. In 989 men, mean age 80 years, the prevalence of PAD was 1.6 times significantly higher in 141 men with valvular aortic stenosis than in 848 men without valvular aortic stenosis (48% versus 30%) [4,5]. In 1,998 women, mean age 81 years, the prevalence of PAD was 1.7 times significantly higher in 321 women with valvular aortic stenosis than in 1,677 women without valvular aortic stenosis (39% versus 23%) [4]. In 279 men and women, mean age 71 years, with documented PAD and in 218 men and women, mean age 70 years, without PAD with a normal ankle-brachial index (ABI) undergoing coronary angiography for suspected CAD, the prevalence of obstructive CAD was significantly higher in patients with PAD (98%) than in patients without PAD (81%) [5]. The prevalence of left main CAD and of 3-vessel or 4-vessel CAD was also significantly higher in patients with PAD (18%) than in patients without PAD [5]. In 1,006 men and women, mean age 72 years, if PAD was present, 63% had coexistent CAD, and 43% had prior ischemic stroke [6]. In 118 patients, mean age 73 years, with a decreased ABI, the prevalence of CAD was 75%, whereas in 118 age-matched and gender-matched patients with a normal ABI, the prevalence of CAD was 29% [7]. The prevalence of aortic valve calcium or mitral annular calcium was also higher in the patients with a reduced ABI (69%) than in the patients with a normal ABI (36%) [7]. In 273 patients, mean age 71 years, with CAD, the lower the ABI, the higher and the prevalence of 3-vessel or 4-vessel CAD [8]. Patients with PAD and CAD have more extensive and calcified coronary atherosclerosis, constrictive arterial remodeling, and greater disease progression [9]. Patients with PAD also have a higher prevalence of left ventricular systolic dysfunction than patients without PAD [10].