Symptomatic and Asymptomatic Peripheral Artery Disease and the Risk of Abdominal Aortic Aneurysm: The Atherosclerosis Risk in Communities (ARIC) Study

Abstract

A prospective cohort study was performed at visit 1 (1987-1989) and a cross-sectional cohort study was performed at visit 5 (2011-2013) from four U.S. communities (Washington County, Md; suburban Minneapolis, Minn; Jackson, Miss; Forsyth County, NC) in the Atherosclerosis Risk in Communities (ARIC) study. Of 14,148 participants (55% female, 26% black, 1% with symptomatic peripheral arterial disease), after a median follow-up of 23 years, 3.7% had developed incident abdominal aortic aneurysms (AAAs). The presence of symptomatic peripheral artery disease (PAD) resulted in a higher hazard ratio (HR) of incident AAA (HR, 4.9), as did asymptomatic PAD with an ankle brachial index (ABI) of ≤0.9 (HR, 2.33) compared with the reference ABI of >1.1. The crude 15-year cumulative incidence of AAAs was 12% in the symptomatic PAD group, 4% in the asymptomatic PAD group with an ABI of <0.9, and 2% in the asymptomatic PAD group with an ABI of >1.1. The cross-sectional analysis demonstrated similar patterns for ultrasound-based AAAs, with odds ratio for AAAs of 2.5 for symptomatic PAD and 4.0 for asymptomatic PAD in a demographically adjusted model. These prospective and cross-sectional data showed an elevated risk of AAAs in patients with symptomatic and asymptomatic PAD. These data support the current recommendation of AAA screening for symptomatic PAD patients and suggest the potential extension to asymptomatic PAD patients as well.