The Detection of Early Atherosclerosis in Healthy Male Relatives of Men with Peripheral Arterial Disease: a Feasibility Study

Abstract

Aim: A feasibility study to attempt to determine if conventional ultrasound and multi-gate ultrasound could differentiate between men with peripheral arterial disease (PAD), healthy first-degree male relatives (FDRs) of men with PAD, and age/sex matched controls in identifying early atherosclerosis. Methods: three groups were studied using conventional ultrasound: first, four men with premature PAD (≤65 years); second, four healthy first-degree relatives; third, seven male controls with no known family history or evidence of premature cardiovascular disease. Primary outcome measures were plaque and intima-media thickness of the common carotid artery, flow mediated vasodilatation of the brachial artery, and lower extremity arterial plaque. Multigate Doppler ultrasound blood velocity profile measurements were obtained for three controls, but this series of measurements was discontinued due to technical difficulties. Statistics: mean (standard deviation) and analysis of variance (ANOVA) ( p<0·05) Results: Conventional ultrasound demonstrated lower extremity arterial lesions in all four of the patients with PAD. One of their first-degree relatives was found to have a non-significant lesion. No significant carotid artery lesions were found in any of the patients, but males with PAD had significantly greater carotid artery intima-media thickness than a combined group of first-degree relatives and controls (0·75±0·06 mm, versus 0·56±0·07 mm; p≤0·01). The mean (standard deviation) flow mediated vasodilation per cent change of the brachial artery was for males with PAD, 3·49±4·15; relatives, 6·17±2·53; and control subjects, 3·53±6·63. Results from the multigate system were inconclusive. Conclusion: Carotid artery intima-media thickness seemed able to differentiate between patients with PAD and the other two groups. This measurement could be used in future case-control family PAD studies and possibly eventually as a screening tool. Flow mediated dilatation per cent change showed a wide variation in measurements and was not able to differentiate between the three groups. For researchers considering future studies, it is worth noting that recruitment figures for this pilot study were much lower than quoted in previous reports.