Peripheral Arterial Revascularization Research Articles

The role of antiplatelet therapy in patients with peripheral artery disease and lower extremity peripheral artery revascularization.

Although antiplatelet agents are frequently prescribed to patients with lower extremity peripheral artery disease (PAD), there is an overall lack of consensus among published evidence and guidelines with respect to this practice. Antiplatelet agents are prescribed to patients with PAD to reduce both cardiovascular and limb-based events during the follow-up period. A large evidence base supports the use of antiplatelet monotherapy with aspirin or clopidogrel in patients with symptomatic PAD or a history of peripheral artery revascularization. However, antiplatelet monotherapy has not proven beneficial in patients with asymptomatic PAD. Dual antiplatelet therapy has not demonstrated a clear benefit in reducing the risk of cardiovascular events in patients with symptomatic PAD. Its role in reducing the risk of adverse limb events following endovascular or surgical revascularization also remains unclear. Recently, the use of vorapaxar in addition to aspirin and/or clopidogrel has been associated with a significant reduction in the need for repeat revascularization procedures and hospitalization for limb ischemia in patients with established PAD. Eligible patients with symptomatic PAD or with a history of peripheral artery revascularization should be prescribed antiplatelet monotherapy for secondary prevention of both cardiovascular and limb events, using aspirin, clopidogrel, and/or vorapaxar. Given the significant overlap of PAD and coronary artery disease, the evidence presented in this article may have important implications for management of patients with coronary artery disease.

VORAPAXAR AND PERIPHERAL REVASCULARIZATION: INSIGHTS FOM THE TRA2P-TIMI 50 TRIAL

Vorapaxar inhibits PAR-1 on platelets and vascular endothelium reducing ischemic events and peripheral artery revascularization (PR). We investigated whether the reduction in PR with vorapaxar varied by reason or type of revascularization. TRA2°P-TIMI 50 was a multinational, randomized, double-

Recent progress in application of local drug delivery for preventing restenosis after peripheral arterial revascularization

Restenosis following vascular revascularization remains an important clinical problem. Local drug delivery which can provide enough drug concentration in the lesion location without causing adverse systemic effect is an excellent solution for this question. We conducted a systematic literatory search on PubMed and CKNI through May 2014. After reviewing all related papers, we provided a comprehensive overview of the available drugs and techniques for local drug delivery that have been developed to prevent restenosis after peripheral vascular interventions, including innovations that have been tested only in animals as well as those already approved for clinical use. In brief, anti-proliferative drugs such as paclitaxel and sirolimus are the most used and suitable drugs for local delivery system. Additionally, some promising drugs including anti-inflammatory drugs, antioxidant drugs and drugs inhibiting cell proliferation and migration are already being tested in pre-clinical trials or animal models. At the same time, intraluminal and extraluminal delivery devices have also got a rapid development during the past decades. The efficacy of drug-eluting stent, drug-eluting balloon, porous and microporous balloon and the most recent drug-eluting bioresobable scaffold for preventing of restenosis in peripheral vessels have been demonstrated in humans or in animals, some of them even have received the CE mark in Europe. Endovascular microinfusion catheter and drug-loaded perivascular wraps have only been tested in animal models, more researches are needed. With the development of pharmacology and bioengineering, great strides will be made in the prevention of restenosis in the near future.

Peripheral arterial disease and revascularization of the diabetic foot.

Diabetes is a complex disease with many serious potential sequelae, including large vessel arterial disease and microvascular dysfunction. Peripheral arterial disease is a common large vessel complication of diabetes, implicated in the development of tissue loss in up to half of patients with diabetic foot ulceration. In addition to peripheral arterial disease, functional changes in the microcirculation also contribute to the development of a diabetic foot ulcer, along with other factors such as infection, oedema and abnormal biomechanical loading. Peripheral arterial disease typically affects the distal vessels, resulting in multi-level occlusions and diffuse disease, which often necessitates challenging distal revascularisation surgery or angioplasty in order to improve blood flow. However, technically successful revascularisation does not always result in wound healing. The confounding effects of microvascular dysfunction must be recognised--treatment of a patient with a diabetic foot ulcer and peripheral arterial disease should address this complex interplay of pathophysiological changes. In the case of non-revascularisable peripheral arterial disease or poor response to conventional treatment, alternative approaches such as cell-based treatment, hyperbaric oxygen therapy and the use of vasodilators may appear attractive, however more robust evidence is required to justify these novel approaches.

Treatment of Intermittent Claudication due to Peripheral Arterial Disease

Peripheral arterial disease may cause intermittent claudication which is pain or weakness with walking that is relieved with rest [1]. Patients with intermittent claudication should be treated with optimal medical therapy to reduce cardiovascular death, nonfatal myocardial infarction, and stroke and also to improve exercise time until intermittent claudication [1]. Optimal medical therapy to reduce cardiovascular events and mortality in patients with peripheral arterial disease include smoking cessation programs [1], treatment of hypertension [1-3], treatment of hypercholesterolemia [1,4], treatment of diabetes mellitus [1,5], antiplatelet drug therapy [1,6-8], treatment with an angiotensin-converting enzyme inhibitor [1,3], treatment with high-dose statins [1,4,9], and treatment with beta blockers if indicated in patients with mild-to moderate peripheral arterial disease [1,10]. Vorapaxar [11] has recently been approved by the United States Food and Drug Administration to treat patients with peripheral arterial disease receiving aspirin or clopidogrel to reduce the need for peripheral artery revascularization. This drug should not be used in patients with a history of stroke or transient ischemic attack or bleeding in the head.

Abstract 16701: Conventional Cardiovascular Risk Modifies Clinical Outcomes Among Subjects With Elevated Coronary Artery Calcium Score With and Without Statin Therapy: Post Hoc Analysis From the St Francis Heart Study

Objective: Coronary artery calcium score (CAC) predicts cardiovascular (CV) risk independent of conventional risk profile. However, it remains unclear how clinical risk profile modifies CV outcomes among subjects with elevated CAC with and without lipid lowering therapy. Methods: We conducted a post hoc analysis of the treatment trial of the St. Francis Heart Study_double-blind, placebo-controlled randomized clinical trial of atorvastatin 20 mg, vitamin C 1 g, and vitamin E 1,000 U daily, versus matching placebos in 993 asymptomatic individuals with CAC at or above the 80th percentile for age and gender. Primary CV outcomes included non-fatal MI or coronary death, coronary revascularization, stroke, and peripheral arterial revascularization. Among the placebo and treatment groups, we further stratified by eligibility for statin therapy based on current AHA guidelines yielding 4 subgroups: treated not eligible (+Rx/-E), placebo not eligible (-Rx/-E), treated eligible (+Rx/+E) and placebo eligible (-Rx/+E). Results: Mean age was 59±6 years. Those eligible were older (61±5 vs. 56±5 years) and more likely to be males (85% vs. 56%) than those not eligible. Median [IQR] CAC was higher in the eligible than not eligible groups (overall, p<0.0001), 199 [112-396] (+Rx/-E), 207 [114-416] (-Rx/-E), 490 [289-791] (+Rx/+E) and 484 [286-837] (-Rx/+E). After a median follow up of 4.8 years, 4.0%, 4.8%, 9.8% and 15.4% had a CV event in +Rx/-E, -Rx/-E, +Rx/+E and -Rx/+E, respectively. After adjusting for CV risk factors and CAC, hazard ratio (95% CI) was 1.1 (0.4-2.9), 3.3 (1.1-9.4) and 4.9 (1.7-14.0) for -Rx/-E, +Rx/+E and -Rx/+E, respectively compared to +Rx/-E. There was a significant interaction between CAC and eligibility for statin therapy for a CV outcome (p=0.05). Conclusion: Among subjects with elevated CAC, those eligible for statin therapy have higher CAC and overall greater risk for a CV outcome than those not eligible. While statin therapy lowers CV risk among those eligible, it does not significantly alter CV risk among those not eligible. There is a significant interaction between CAC and statin therapy eligibility for a CV outcome. Our findings suggest that clinical risk profile remains an important risk modifier for CV outcomes among those with elevated CAC.

Morbidity and mortality associated with arterial surgery site infections by resistant microorganisms

Background:Surgical site infection is a severe complication of peripheral vascular surgery with high morbidity and mortality rates.Objective:To evaluate the morbidity and mortality of infections of peripheral artery surgery sites caused by resistant microorganisms.Methods:This was a prospective study of a cohort of patients who underwent peripheral artery revascularization procedures and developed surgical site infections between March 2007 and March 2011.Results:Mean age was 63.7 years; males accounted for 64.3% of all cases. The overall prevalence of bacterial resistance to antimicrobials was 65.7%. The most common microorganism identified was Staphylococcus aureus (30%). Comparison of the demographic and surgical characteristics of both subsets (resistant versus non-resistant) detected a significant difference in length of preoperative hospital stay (9.3 days vs. 3.7 days). The subset of patients with infections by resistant microorganisms had higher rates of reoperation, lower numbers of limb amputations and lower mortality, but the differences compared to the subset without resistant infections were not significant. Long-term survival was similar.Conclusions:This study detected no statistically significant differences in morbidity or mortality between subsets with surgical wound infections caused by resistant and not-resistant microorganisms.

Clinical and Economic Burden in Patients with Diagnosis of Peripheral Arterial Disease in a Claims Database in Japan

PurposeThe effect of peripheral arterial disease (PAD) among young and middle-aged adults can be significant, but no previous study has examined the prognosis and the associated health care cost of the disease in this population. We evaluated the clinical and economic burden of PAD in patients from a large claims database to clarify the effect of the disease on a relatively young working Japanese population. MethodsPatients aged ≥45 and ≤64 years with first PAD diagnosis between 2005 and 2011 comprised the PAD cohort (n = 362); an age- and sex-matched non-PAD comparison cohort (n = 362) was also identified. Rates of cardiovascular events/interventions, health care utilization, and costs were compared. FindingsThe mean (SD) age of the cohort was 52.8 (5.6) years and 40.8% were women. Baseline Charlson comorbidity index was significantly higher in the PAD cohort than in the non-PAD cohort (1.90 [2.19] vs 1.16 [1.99]; P < 0.001). The PAD cohort had significantly higher first-year event rates than did the non-PAD cohort for myocardial infarction (2.2% vs 0.2%; P = 0.019) and ischemic stroke (4.1% vs 0.5%; P = 0.001). Health care utilization was significantly greater for the PAD cohort for all parameters assessed (number of hospitalization, inpatient days, and outpatient visits) in the first year (all, P < 0.001). Total annual costs for health care were significantly higher in the PAD cohort than in the non-PAD cohort in the first year (P < 0.001). Among patients with diabetes, patients with PAD (n = 98) had significantly greater first-year event rates (myocardial infarction, ischemic stroke, coronary artery bypass surgery, peripheral arterial revascularization, percutaneous coronary intervention, and limb amputation; all, P < 0.001), significantly greater number of clinic visits (P = 0.023), and total cost burden than did patients without PAD (n = 63). ImplicationsEven in a relatively young working Japanese population, PAD is associated with substantial clinical and economic burden.

Elevated Small Dense Low-Density Lipoprotein Cholesterol as a Predictor for Future Cardiovascular Events in Patients with Stable Coronary Artery Disease

The aim of the present study was to investigate how small dense low-density lipoprotein cholesterol (sdLDL-C) compared with LDL-C affect the long-term prognosis in patients with stable coronary artery disease (CAD). sdLDL-C measured by heparin magnesium precipitation and LDL particle size measured by non-denatured gradient-gel electrophoresis were compared in 190 consecutive CAD patients who underwent coronary arteriography between 2003 and 2004 who did or did not develop cardiovascular events during a seven-year follow-up period. Cardiovascular events were death caused by cardiovascular diseases(CVDs), onset of acute coronary syndrome, need for coronary and peripheral arterial revascularization, hospitalization for heart failure, surgical procedure for any CVDs, and/or hospitalization for stroke. First-time cardiovascular events were observed in 72 patients. Those who experienced cardiovascular events were older and had higher prevalence rates of hypertension and diabetes; significantly higher Gensini coronary atherosclerotic scores; significantly higher levels of sdLDL-C, sdLDL-C/LDL-C, and LDL-C/high-density lipoprotein cholesterol (HDL-C) ratios; and greater glycated hemoglobin(Hb)A1c and brain natriuretic peptide (BNP) levels. They also had significantly smaller LDL particle sizes, HDL-C, apolipoprotein A-1, and estimated glomerular filtration rate (GFR) compared with patients without cardiovascular events. Conversely, LDL-C, non-HDL-C, apolipoprotein B, remnantlike particle cholesterol, and high-sensitivity C-reactive protein (hs-CRP) levels were similar between the two groups. A Kaplan-Meyer event-free survival curve demonstrated that patients with sdLDL-C≥35 mg/dL (median level) had significantly poorer prognosis compared with those with lower sdLDL-C levels, while patients with LDL-C ≥100 mg/dL had a non-significantly lower survival rate. These results confirm that sdLDL-C is a very promising biomarker to predict future cardiovascular events in the secondary prevention of stable CAD.

Circulation Editors’ Picks

<i>Circulation</i> Editors’ Picks

Long‐term risk of recurrent vascular events after young stroke: The FUTURE study

Long-term data on recurrent vascular events after young stroke are limited. Our objective was to examine the long-term risk of recurrent vascular events after young stroke. We prospectively included 724 consecutive patients with a first-ever transient ischemic attack (TIA), ischemic stroke, or intracerebral hemorrhage (ICH), aged 18 to 50 years, admitted to our hospital between January 1, 1980 and November 1, 2010. Outcomes were (1) stroke; (2) myocardial infarction or cardiac or peripheral arterial revascularization procedures; or (3) composite event of these, whichever occurred first. After a mean follow-up of 9.1 years (standard deviation = 8.2, range = 0-31.0), 142 patients (19.6%) had at least 1 recurrent vascular event. Cumulative 20-year risk of stroke was 17.3% (95% confidence interval [CI] = 9.5-25.1) after TIA, 19.4% (95% [CI] = 14.6-24.3) after ischemic stroke, and 9.8% (95% CI = 1.0-18.7) after ICH. Cumulative 20-year risk of any vascular event was 27.7% (95% CI = 18.5-37.0) after TIA and 32.8% (95% CI = 26.7-38.9) after ischemic stroke. Age and male sex were associated with other arterial events, but not with stroke. Among TOAST (Trial of Org 10172 in Acute Stroke Treatment) subtypes, adjusted for age, sex, and decennium of inclusion, atherothrombotic stroke, cardioembolic stroke, and lacunar stroke were associated with recurrent stroke (hazard ratio [HR] = 2.72, 95% CI = 1.34-5.52; HR = 2.49, 95% CI = 1.23-5.07; and HR = 2.92, 95% CI = 1.45-5.88, respectively). Patients with young stroke remain at substantial risk of recurrent vascular events for decades, suggesting that the underlying disease that caused stroke at a young age continues to put these patients at a high risk for vascular disease throughout their lives.

Impact of previous cardiovascular surgery on postoperative morbidity and mortality after major pulmonary resection for non-small cell lung cancer

The aim of this study was to evaluate the impact of previous cardiovascular surgery on the postoperative morbidity and mortality following major pulmonary resection for non-small cell lung cancer (NSCLC). Medical records of 227 patients, who underwent major pulmonary resection for NSCLC from 2003 to 2012 at our department, were reviewed retrospectively. Thirty-one patients with a mean age of 65.8years had previous cardiovascular surgery (group A) including coronary artery revascularization in 11 patients, peripheral arterial revascularization in 6 patients, carotis endarterectomy in 9 patients, and combined coronary artery revascularization and carotis endarterectomy in 5 patients, whereas 167 patients (mean age = 62.0years) had no cardiovascular comorbidity (group B). Twenty-nine patients with nonsurgically treated cardiovascular comorbidity were excluded from this study. There were no significant differences in overall postoperative morbidity (22.6% in group A vs. 19.2% in group B) and mortality (no mortality in group A vs. 2.4% in group B) between both groups. Major pulmonary resections for NSCLC can be performed safely in patients with previous cardiovascular surgical history who are fulfilling the common cardiopulmonary criteria of operability. Operative risk in this subpopulation is comparable to that in patients without cardiovascular comorbidity.

Circulation: Clinical Summaries

<i>Circulation:</i> Clinical Summaries

Vorapaxar in Patients With Peripheral Artery Disease

Background— Vorapaxar is a novel antagonist of protease-activated receptor-1, the primary receptor for thrombin on human platelets that is also present on vascular endothelium and smooth muscle. Patients with peripheral artery disease are at risk of systemic atherothrombotic events, as well as acute and chronic limb ischemia and the need for peripheral revascularization. Methods and Results— The Trial to Assess the Effects of SCH 530348 in Preventing Heart Attack and Stroke in Patients With Atherosclerosis (TRA2°P-TIMI 50) was a randomized, double-blind, placebo-controlled trial of vorapaxar in 26 449 patients with stable atherosclerotic vascular disease (myocardial infarction, stroke, or peripheral artery disease). Patients with qualifying peripheral artery disease (n=3787) had a history of claudication and an ankle-brachial index of &lt;0.85 or prior revascularization for limb ischemia. The primary efficacy end point was cardiovascular death, myocardial infarction, or stroke, and the principal safety end point was Global Utilization of Streptokinase and t-PA for Occluded Coronary Arteries (GUSTO) bleeding. In the peripheral artery disease cohort, the primary end point did not differ significantly with vorapaxar (11.3% versus 11.9%; hazard ratio, 0.94; 95% confidence interval, 0.78–1.14; P =0.53). However, rates of hospitalization for acute limb ischemia (2.3% versus 3.9%; hazard ratio, 0.58; 95% confidence interval, 0.39–0.86; P =0.006) and peripheral artery revascularization (18.4% versus 22.2%; hazard ratio, 0.84; 95% confidence interval, 0.73–0.97; P =0.017) were significantly lower in patients randomized to vorapaxar. Bleeding occurred more frequently with vorapaxar compared with placebo (7.4% versus 4.5%; hazard ratio, 1.62; 95% confidence interval, 1.21–2.18; P =0.001). Conclusions— Vorapaxar did not reduce the risk of cardiovascular death, myocardial infarction, or stroke in patients with peripheral artery disease; however, vorapaxar significantly reduced acute limb ischemia and peripheral revascularization. The beneficial effects of protease-activated receptor-1 antagonism on limb vascular events were accompanied by an increased risk of bleeding. Clinical Trial Registration— URL: http://www.clinicaltrials.gov . Unique identifier: NCT00526474.

Prognostic Impact of Coronary Endothelial Dysfunction on Long-Term Adverse Outcome in Patients with Chest Pain and Non-Obstructive Coronary Artery Disease

Coronary endothelial dysfunction is known to be related with adverse cardiovascular outcome. We obtained a long-term follow-up of patients without significant coronary atherosclerosis, complaining of chest pain, in whom intra-coronary acetylene testing was performed in order to assess endothelial function. The study included 41 patient (35 with endothelial dysfunction, 6 with preserved endothelial function). Events considered as adverse outcome were cardiovascular death, acute myocardium-dial infarction, unstable angina pectoris, percutaneous coronary intervention, coronary-aortic by-pass grafting, ischemic stroke and peripheral artery re-vascularization. A high cardiovascular event rate was observed in patients with and without endothelial dysfunction, 34,3% and 50% respectively. Adverse outcome was related not only to endothelial dysfunction but also to traditional cardiovascular risk factors. Thus, evaluation of endothelial function or its determinants seems to be helpful in identifying a subgroup of patients at high risk.

Lipoprotein apheresis in isolated hyperlipoproteinemia(a): a validated treatment or an illusion of validity?

Lipoprotein apheresis in isolated hyperlipoproteinemia(a): a validated treatment or an illusion of validity?

Measurable Urinary Albumin Predicts Cardiovascular Risk among Normoalbuminuric Patients with Type 2 Diabetes

Micro- or macroalbuminuria is associated with increased cardiovascular risk factors among patients with type 2 diabetes, but whether albuminuria within the normal range predicts long-term cardiovascular risk is unknown. We evaluated the relationships between albuminuria and cardiovascular events in 1208 hypertensive, normoalbuminuric patients with type 2 diabetes from the BErgamo NEphrologic Diabetes Complication Trial (BENEDICT), all of whom received angiotensin-converting enzyme inhibitor (ACEI) therapy at the end of the trial and were followed for a median of 9.2 years. The main outcome was time to the first of fatal or nonfatal myocardial infarction; stroke; coronary, carotid, or peripheral artery revascularization; or hospitalization for heart failure. Overall, 189 (15.6%) of the patients experienced a main outcome event (2.14 events/100 patient-years); 24 events were fatal. Albuminuria independently predicted events (hazard ratio [HR], 1.05; 95% confidence interval [CI], 1.02-1.08). Second-degree polynomial multivariable analysis showed a continuous nonlinear relationship between albuminuria and events without thresholds. Considering the entire study population, even albuminuria at 1-2 μg/min was significantly associated with increased risk compared with albuminuria <1 μg/min (HR, 1.04; 95% CI, 1.02-1.07). This relationship was similar in the subgroup originally randomly assigned to non-ACEI therapy. Among those originally receiving ACEI therapy, however, the event rate was uniformly low and was not significantly associated with albuminuria. Taken together, among normoalbuminuric patients with type 2 diabetes, any degree of measurable albuminuria bears significant cardiovascular risk. The association with risk is continuous but is lost with early ACEI therapy.

Severity of Coronary Artery Disease Affects Prognosis of Patients With Peripheral Artery Disease

It remains unclear whether severity of coronary artery disease (CAD) affects the prognosis of patients with peripheral artery disease (PAD). In this retrospective, multicenter study, we analyzed 537 consecutive patients with symptomatic PAD who underwent both peripheral artery revascularization and coronary angiography (CAG) prior to revascularization. We classified patients into 3 groups based on CAG: no-CAD group, intermediate CAD group (1-2 diseased vessels), and triple-vessel disease (TVD) group. We evaluated clinical outcome including all-cause death, major adverse cardiac events (MACEs), and amputation. The no-CAD, intermediate CAD, and TVD groups comprised 204, 268, and 65 patients, respectively. Mean follow-up duration was 952 ± 497 days. Freedom from any adverse outcome was highest in the no-CAD group and lowest in the TVD group (all-cause death: 86% vs 77% vs 65%, P = .043; MACE: 95% vs 87% vs 78%, P = .044; amputation: 96% vs 92% vs 83%, P = .0015). Severity of CAD affected prognosis of patients with PAD.

Transcatheter arterial revascularization outcomes at vascular and general surgery teaching hospitals and nonteaching hospitals are comparable

Outcomes following transcatheter interventions at vascular and general surgery teaching hospitals (STH) are unknown. We examine whether surgery training programs influence clinically relevant outcomes after commonly performed endovascular procedures. Using an all-payer inpatient care database from 2008, we selected adults who underwent either endovascular carotid stenting, endografting of descending thoracic aortic aneurysm, endovascular abdominal aortic aneurysm repair, or peripheral arterial revascularization. Patients were stratified by procedures completed at Surgery Teaching (Participate in Accreditation Council for Graduate Medical Education [ACGME]-accredited vascular and general surgery programs), STH, or nonteaching hospitals (NTH). Hierarchical regression models assessed adverse outcomes and in-hospital mortality among groups. Of the 175,698 records, 44% of the patients were treated at STH, while 56% underwent procedures at NTH. The adjusted odds ratio of any complication or mortality at STH and NTH were similar. Transfers, weekend admissions, and nonelective cases were higher at STH (P < .001, respectively). Paradoxically, STH treated fewer patients with more than three comorbidities compared with NTH (STH: 47% vs NTH: 53%; P < .001). Surgical teaching status did not lower the adjusted odds of mortality for any procedure. Moreover, the occurrence of any complication (adjusted odds ratios, 0.9; 95% confidence interval, .82-1.14; P = .69) and mortality (adjusted odds ratios, 0.9; 95% confidence interval, .74-1.22; P = .67) were equivalent between vascular and general STH. Following commonly performed transcatheter vascular procedures, and despite more transfers, weekend admissions, and nonelective procedures completed at STH, complications, and mortality were comparable across centers.

Abstract 3561: Associations of Carotid Plaque Composition with Prior Coronary and Peripheral Artery Events

Background: Patients with prior coronary (CAD) or peripheral artery (PAD) events have increased plaque burden in the carotid artery, which is subsequently found to indicate future risks in prospective studies. Carotid MRI is capable of measuring both plaque burden and components (calcification [CA], lipid rich necrotic core [LRNC], intraplaque hemorrhage [IPH]). We sought to determine if certain plaque components detected by MRI are associated with prior CAD and PAD events independently of traditional risk factors and plaque burden. Methods: Subjects with asymptomatic carotid stenosis by ultrasound were referred for a standardized multi-contrast carotid MRI. Plaque area and areas of CA, LRNC and IPH were traced on each cross-sectional slice, which were aggregated to determine plaque volume, presence and percent volumes of components for each subject. Prior CAD events were defined as prior acute coronary syndrome and/or coronary revascularization. Prior PAD events were defined as ABI&lt;0.90 and/or prior peripheral artery revascularization. Logistic regression analysis was used to evaluate the independent associations between plaque compositional variables and prior CAD or PAD events after adjustment for clinical variables and plaque volume. Results: A total of 159 subjects were scanned, of which 36 (22.6%) had prior CAD events, 34 (21.4%) had prior PAD events and 30 (18.9%) had both. The rest 59 (37.1%) subjects, free of both CAD and PAD events, were used as a reference group. All compositional variables were significantly associated with plaque volume. Subjects with prior CAD events (n=66) demonstrated a higher prevalence of IPH (31.8% vs. 13.6%, adjusted OR: 5.16, p=0.006) and larger percent volume of IPH (3.5% vs. 0.8%, adjusted OR: 1.21 per 1% change, p=0.017) compared to the reference group after adjustment for clinical variables and plaque volume. No independent associations were found between prior PAD events and carotid plaque components compared to the reference group. Conclusions: Subjects with prior CAD events appeared to have a higher prevalence of IPH and larger percent volume of IPH given a comparable plaque burden with those without prior events. Prospective studies are needed to evaluate if the composition of asymptomatic carotid plaques provides additional information for CAD risk stratification.