Occurrence of Peripheral Arterial Disease in a Belgian Cohort of Patients with Cardiovascular History of Atherothrombosis

Abstract

Rationale: Peripheral arterial disease (PAD) is an underestimated and under diagnosed disease with as much as 60% of the patients having at least one other vascular bed affected.Purpose: The study aimed to evaluate the prevalence of PAD defined by different means in high risk Belgian ambulatory patients.Methods: Participating physicians were to include a least six consecutive high risk ambulant patients for atherothrombosis. Demographical data and cardiovascular risk factors were recorded. The Edinburgh Questionnaire was administered. A vascular examination, including palpation and blood pressure measurement of the relevant arteries was performed. Results: 275 Belgian physicians included a total of 2831 patients with a mean age of 68.0 years. Sixty three point three percent (63.3%) of the patients had a history of coronary artery disease whereas 28.0% reported a history of cerebrovascular disease. Overall, 1777 patients (62.8%, 95% CI: 61–65%) had a PAD diagnosis with an even distribution among males and females and increasing with age. PAD, defined as an ABI (Ankle Brachial Index) < 0.9, was detected in 28.5% of the population. PAD defined as the presence of intermittent claudication with positive Edinburgh Questionnaire or as a history of peripheral vascular revascularisation, was detected in 12.4% and 8.1% of the population respectively. Sixty six point seven percent (66.7%) of the PAD patients reported walking pain. The presence of pulsation of the tibialis posterior and/or dorsalis pedis arteries was not predictive of an ABI > 0.9. In contrast, the absence of pulse of both arteries was correlated with an odds-ratio of 6.4 to 8.1 to find a pathological ABI. Conclusion: The prevalence of PAD in ambulant patients with a history of coronary artery disease or cerebrovascular disease varied from 62.8% (composite of intermittent claudication with Edinburgh Questionnaire positive, history of peripheral vascular revascularisation, ABI < 0.9) to 28.5% (ABI < 0.9). Sixty six point seven percent (66.7%) of the PAD population reported walking pain. The absence of pulsation of the tibialis posterior and dorsalis pedis arteries was correlated with an ABI < 0.9.