Lessons Learnt from A Pilot Screening Program for Lower Extremities Atherosclerotic Disease (Lead) in A Population in Central Greece

Abstract

Introduction: While screening programs for abdominal aortic aneurysms are well-established, in the peripheral arterial disease including carotid and lower extremities atherosclerotic disease (LEAD), their role is controversial without a proven benefit. The aim of the study was to present our finding from a pilot LEAD screening program in central Greece. Methods: Males > 60 years old without known diagnosis of LEAD were invited through public primary health care institutions (state insurance and municipal organizations) to participate to a screening program. Individuals were both from urban and rural areas. Age, height and weight, co-morbidities, hypertension (HT), hyperlipidemia, smoking, coronary artery disease (CAD), diabetes mellitus, chronic obstructive pulmonary disease (COPD), cerebro-vascular disease (CVD) were recorded. Also, the ankle-brachial index (ABPI) was measured from both lower limbs; abnormal values were considered those < 0.9 or >1.4. Results: Among a total of 1152 patients who joined the program (invitation acceptance was 73%) LEAD was detected in 148 (13%); including 81 (7%) with ABPI< 0.9 and 67 (5.8%) with ABPI>1.4. LEAD was associated with age (abnormal ABPI; 72.7±7 years old vs. normal ABPI; 70.9±7 years old, p=0.003), HT (abnormal ABPI; 75% vs. normal ABPI; 67%, p=0.037), COPD (abnormal ABPI; 11.5% vs. normal ABPI; 6.5%, p=0.028) and CVD (abnormal ABPI; 9.5% vs. normal ABPI; 4.5%, p=0.008). An ABPI< 0.9 was associated with age (abnormal ABPI; 74±7 years old vs. normal ABPI; 70.9±7 years old, p=0.001), HT (abnormal ABPI; 80% vs. normal ABPI; 67%, p=0.037), smoking (abnormal ABPI; 42% vs. normal ABPI; 25%, p=0.002), duration of smoking (abnormal ABPI; 38±14 years vs. normal ABPI; 32±13 years, p=0.01), packs/year (abnormal ABPI; 2±3 vs. normal ABPI; 1.5±0.9 years, p=0.002), CAD (abnormal ABPI; 35% vs. normal ABPI; 24%, p=0.02), COPD (abnormal ABPI; 14% vs. normal ABPI; 6.5%, p=0.028) and CVD (abnormal ABPI; 14% vs. normal ABPI; 4.5%, p=0.001). After multivariate analysis, increased age (0.94, CI. 0.026-5.2; p=0.022), history of HT (2.4, CI. 0.44- 3.7; p=0.05) and longer duration of smoking (0.9, CI. 0.01-6.1; 0.013) were associated with ABPI < 0.9. Only 51% of the patients with ABPI< 0.9 were under statin therapy and only 35% under antiplatelets. Abnormally higher ABPI (>1.4) was not associated with any factor. Only 42% of those patients were under statin therapy and only 15% under antiplatelet therapy. Conclusion: Incidence of LEAD was 13% in a male >60 years old population in central Greece. The incidence of an ABPI< 0.9 was 7% and it was associated with older age, HT and duration of smoking. Identification of such a population may allow better implementation of intense optimal medical treatment strategies to prevent cardiovascular mortality and morbidity. Disclosure: Nothing to disclose