Prevalence of carotid stenosis and silent myocardial ischemia in asymptomatic subjects with a low ankle-brachial index

Objective Subjects with symptomatic peripheral artery disease (PAD) have an elevated prevalence of carotid stenosis and of silent myocardial ischaemia. As such, clinical guidelines advocate the detection of sub-clinical vascular disease in this population. However, the prevalence of occult vascular...

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Bibliographic Details
Published in:Journal of vascular surgery 2009, Vol.49 (1), p.104-108
Main Authors: Mostaza, Jose M., MD, PhD, González-Juanatey, Jose R., MD, PhD, Castillo, Jose, MD, PhD, Lahoz, Carlos, MD, PhD, Fernández-Villaverde, Jose M., MD, PhD, Maestro-Saavedra, Francisco J., MD
Format: Article
Language:English
Subjects:
Aged
Ankle - blood supply
Biological and medical sciences
Blood Pressure
Brachial Artery - physiopathology
Carotid Stenosis - diagnostic imaging
Carotid Stenosis - epidemiology
Carotid Stenosis - etiology
Carotid Stenosis - physiopathology
Case-Control Studies
Cross-Sectional Studies
Exercise Test
Female
Humans
Male
Medical sciences
Middle Aged
Myocardial Ischemia - epidemiology
Myocardial Ischemia - etiology
Myocardial Ischemia - physiopathology
Neurology
Odds Ratio
Peripheral Vascular Diseases - complications
Peripheral Vascular Diseases - diagnostic imaging
Peripheral Vascular Diseases - epidemiology
Peripheral Vascular Diseases - physiopathology
Prevalence
Risk Assessment
Risk Factors
Spain - epidemiology
Surgery
Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases
Ultrasonography
Vascular diseases and vascular malformations of the nervous system
Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
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Summary:Objective Subjects with symptomatic peripheral artery disease (PAD) have an elevated prevalence of carotid stenosis and of silent myocardial ischaemia. As such, clinical guidelines advocate the detection of sub-clinical vascular disease in this population. However, the prevalence of occult vascular disease in asymptomatic patients with a low ankle-brachial index (ABI) has not been previously evaluated. Methods Cross-sectional study in five primary care centres for patients' selection and two University Hospitals for further assessment. Subjects were 1070 asymptomatic individuals between 60 and 80 years of age with at least two cardiovascular risk factors, selected for ankle-brachial index measurement. Eighty five subjects with an ABI 50% and an abnormal EST. Results The prevalence of a low ABI in the overall population was 9.1%. A carotid stenosis >50% was detected in 14.3% of the subjects with a low ABI and in 4.7% of the control subjects (Odds Ratio [OR]: 3.37; 95% Confidence Interval [CI]: 1.04-10.93, P = .033). The prevalence of a positive EST test was 16.2% in those with a low ABI and 10.5% in control subjects (OR: 1.65; 95% CI: 0.63-4.29, P = .309). These prevalences were higher in older subjects, in those with hypertension or diabetes, or in those with dyslipidemia. Conclusion Our results indicate that in high-risk asymptomatic subjects >60 years of age, the presence of an ABI
ISSN:0741-5214
1097-6809
DOI:10.1016/j.jvs.2008.07.074