Non-invasively detected carotid stenosis and ischaemic heart disease in men with leg arteriosclerosis

Abstract

Since the excess mortality rate associated with an ankle-brachial blood-pressure index (ABPI) less than 0 9 was only partly explained by an excess cardiovascular mortality, we believe that leg artery disease should not only be regarded as a marker of generalised arteriosclerosis but also as a sign associated with an increased risk of premature death. 439 men who were part of a prospective population study in Malmö, Sweden, were, at 68 years of age, invited to a health examination including, ABPI, carotid-artery ultrasonography, and 24 h ambulatory electrocardiographic monitoring. Cause- specific mortality and incidence of myocardial infarction (MI) during 8 years of follow-up was compared in men with and without signs of arteriosclerotic disease. Of 60 men with an ABPI <0·9, 20 (33%) had angina pectoris or previous Ml. Another 11 (18%) had silent ST-segment depression (≽1 mm); 3 (5%) had a history of stroke; and 17 (28%) had symptom-free carotid stenosis (>30% reduction of the cross-sectional diameter). Total mortality rate in men with no signs of arteriosclerotic disease was 19·6 per 1000 person-years and cardiac event rate (fatal and non-fatal Ml and death from chronic ischaemic heart disease was 8·6 per 1000 person-years). Leg artery disease, carotid stenosis, and ischaemic heart disease were in a univariate analysis all associated with an increased cardiac event rate and an increased total mortality rate. In a multivariate analysis an ABPI less than 0·9 was associated with a 2·4 times higher total mortality (95% Cl 1·5-3·9) and a 2·0 times higher cardiac event rate (1·1-3·9). Carotid stenosis and ischaemic heart disease contributed to the risk for Ml (RR 2 1; 95% Cl 1·2-3·8; and 2·1; 1 2-3·9, respectively), whereas no independent association with total mortality was found.