Advertisement

Co-existence of vascular disease in different arterial beds: Peripheral artery disease and carotid artery stenosis – Data from Life Line Screening®

  • Louai Razzouk
    Affiliations
    Department of Medicine, Division of Cardiology, New York University Langone Medical Center, New York, NY, USA
    Search for articles by this author
  • Caron B. Rockman
    Affiliations
    Department of Surgery, Division of Vascular Surgery, New York University Langone Medical Center, New York, NY, USA
    Search for articles by this author
  • Manesh R. Patel
    Affiliations
    Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC, USA
    Search for articles by this author
  • Yu Guo
    Affiliations
    Department of Medicine, Division of Cardiology, Duke University Medical Center, Durham, NC, USA
    Search for articles by this author
  • Mark A. Adelman
    Affiliations
    Department of Surgery, Division of Vascular Surgery, New York University Langone Medical Center, New York, NY, USA
    Search for articles by this author
  • Thomas S. Riles
    Affiliations
    Department of Surgery, Division of Vascular Surgery, New York University Langone Medical Center, New York, NY, USA
    Search for articles by this author
  • Jeffrey S. Berger
    Correspondence
    Corresponding author. The Leon H. Charney Division of Cardiology, Marc and Ruti Bell Program in Vascular Biology, New York University School of Medicine, 530 First Avenue, Skirball 9R, New York, NY 10016, USA.
    Affiliations
    Department of Medicine, Division of Cardiology, New York University Langone Medical Center, New York, NY, USA

    Department of Surgery, Division of Vascular Surgery, New York University Langone Medical Center, New York, NY, USA

    Department of Population Health, Division of Biostatistics, New York University Langone Medical Center, New York, NY, USA
    Search for articles by this author

      Highlights

      • ABI and carotid duplex ultrasound were analyzed from >3.5 million US subjects.
      • Presence of asymptomatic or symptomatic PAD was associated with prevalence of CAS.
      • 1 in 5 individuals with PAD were found to have CAS.
      • PAD severity was associated with increased prevalence of CAS.

      Abstract

      Background

      Atherosclerosis is a systemic vascular disorder, involving multiple arterial territories. This project sought to investigate the relationship between lower extremity peripheral artery disease (PAD) and carotid artery stenosis (CAS) in a large self-referred population.

      Methods

      Data from the ankle brachial index (ABI) and carotid duplex ultrasound were analyzed from 3.67 million US subjects in the Life Line Screening program between 2004 and 2008. PAD was defined by ABI<0.9 and CAS was defined by greater than 50% stenosis. Multivariate logistic regression analysis was used to estimate odds of CAS by PAD status and severity.

      Results

      Mean age of the population was 63.7 ± 10.6 years and 64% were women. The prevalence of PAD and CAS was 4.1% and 3.9%, respectively. Subjects with PAD had a higher prevalence of CAS than those without PAD (18.8% vs. 3.3%, P < 0.0001). In multivariate analysis, PAD was associated with greater odds of CAS (OR 3.28, 95% CI 3.22–3.34). Both symptomatic (OR 3.66, 95% CI 3.58–3.75) and asymptomatic PAD (OR 2.91, 95% CI 2.84–2.98) was associated with CAS. Increasing severity of PAD was associated with greater odds of CAS (OR 2.32, 3.61, 4.19, 5.14, and 7.59 for ABI categories 0.81–0.90, 0.71–0.80, 0.61–0.70, 0.41–0.60, ≤0.40, respectively).

      Conclusion

      Presence and severity of PAD was associated with prevalence of CAS in the large self-referred and self-paying Life Line cohort, regardless of lower extremity symptoms.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Atherosclerosis
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Go A.S.
        • Mozaffarian D.
        • Roger V.L.
        • Benjamin E.J.
        • Berry J.D.
        • Borden W.B.
        • et al.
        Heart disease and stroke statistics–2013 update: a report from the American Heart Association.
        Circulation. 2013; 127: e6-e245
        • Berger J.S.
        • Hochman J.
        • Lobach I.
        • Adelman M.A.
        • Riles T.S.
        • Rockman C.B.
        Modifiable risk factor burden and the prevalence of peripheral artery disease in different vascular territories.
        J. Vasc. Surg. 2013; 58: 673-681
        • Golomb B.A.
        • Dang T.T.
        • Criqui M.H.
        Peripheral arterial disease: morbidity and mortality implications.
        Circulation. 2006; 114: 688-699
        • Aboyans V.
        • Criqui M.H.
        • Abraham P.
        • Allison M.A.
        • Creager M.A.
        • Diehm C.
        • et al.
        Measurement and interpretation of the ankle-brachial index: a scientific statement from the american heart association.
        Circulation. 2012; 126: 2890-2909
        • Zheng Z.J.
        • Sharrett A.R.
        • Chambless L.E.
        • Rosamond W.D.
        • Nieto F.J.
        • Sheps D.S.
        • et al.
        Associations of ankle-brachial index with clinical coronary heart disease, stroke and preclinical carotid and popliteal atherosclerosis: the atherosclerosis risk in communities (aric) study.
        Atherosclerosis. 1997; 131: 115-125
        • Mackey A.E.
        • Abrahamowicz M.
        • Langlois Y.
        • Battista R.
        • Simard D.
        • Bourque F.
        • et al.
        Outcome of asymptomatic patients with carotid disease. Asymptomatic cervical bruit study group.
        Neurology. 1997; 48: 896-903
        • Savji N.
        • Rockman C.B.
        • Skolnick A.H.
        • Guo Y.
        • Adelman M.A.
        • Riles T.
        • et al.
        Association between advanced age and vascular disease in different arterial territories: a population database of over 3.6 million subjects.
        J. Am. Coll. Cardiol. 2013; 61: 1736-1743
        • Grant E.G.
        • Benson C.B.
        • Moneta G.L.
        • Alexandrov A.V.
        • Baker J.D.
        • Bluth E.I.
        • et al.
        Carotid artery stenosis: gray-scale and doppler us diagnosis–society of radiologists in ultrasound consensus conference.
        Radiology. 2003; 229: 340-346
        • Diehm C.
        • Allenberg J.R.
        • Pittrow D.
        • Mahn M.
        • Tepohl G.
        • Haberl R.L.
        • et al.
        Mortality and vascular morbidity in older adults with asymptomatic versus symptomatic peripheral artery disease.
        Circulation. 2009; 120: 2053-2061
        • Fowkes F.G.
        • Murray G.D.
        • Butcher I.
        • Heald C.L.
        • Lee R.J.
        • Chambless L.E.
        • et al.
        Ankle brachial index combined with framingham risk score to predict cardiovascular events and mortality: a meta-analysis.
        J. Am. Med. Assoc. 2008; 300: 197-208
        • Murabito J.M.
        • Evans J.C.
        • Larson M.G.
        • Nieto K.
        • Levy D.
        • Wilson P.W.
        The ankle-brachial index in the elderly and risk of stroke, coronary disease, and death: the framingham study.
        Arch. Intern. Med. 2003; 163: 1939-1942
        • Abbott R.D.
        • Rodriguez B.L.
        • Petrovitch H.
        • Yano K.
        • Schatz I.J.
        • Popper J.S.
        • et al.
        Ankle-brachial blood pressure in elderly men and the risk of stroke: the honolulu heart program.
        J. Clin. Epidemiol. 2001; 54: 973-978
        • Jones W.S.
        • Patel M.R.
        • Rockman C.B.
        • Guo Y.
        • Adelman M.
        • Riles T.
        • et al.
        Association of the ankle-brachial index with history of myocardial infarction and stroke.
        Am. Heart J. 2014; 167: 499-505
        • McDermott M.M.
        • Mehta S.
        • Ahn H.
        • Greenland P.
        Atherosclerotic risk factors are less intensively treated in patients with peripheral arterial disease than in patients with coronary artery disease.
        J. Gen. Intern. Med. 1997; 12: 209-215
        • Subherwal S.
        • Patel M.R.
        • Kober L.
        • Peterson E.D.
        • Jones W.S.
        • Gislason G.H.
        • et al.
        Missed opportunities: despite improvement in use of cardioprotective medications among patients with lower-extremity peripheral artery disease, underuse remains.
        Circulation. 2012; 126: 1345-1354
        • Brott T.G.
        • Halperin J.L.
        • Abbara S.
        • Bacharach J.M.
        • Barr J.D.
        • Bush R.L.
        • et al.
        2011 asa/accf/aha/aann/aans/acr/asnr/cns/saip/scai/sir/snis/svm/svs guideline on the management of patients with extracranial carotid and vertebral artery disease: executive summary a report of the american college of cardiology foundation/american heart association task force on practice guidelines, and the american stroke association, american association of neuroscience nurses, american association of neurological surgeons, american college of radiology, american society of neuroradiology, congress of neurological surgeons, society of atherosclerosis imaging and prevention, society for cardiovascular angiography and interventions, society of interventional radiology, society of neurointerventional surgery, society for vascular medicine, and society for vascular surgery developed in collaboration with the american academy of neurology and society of cardiovascular computed tomography.
        J. Am. Coll. Cardiol. 2011; 57: 1002-1044
        • Stein R.A.
        • Rockman C.B.
        • Guo Y.
        • Adelman M.A.
        • Riles T.
        • Hiatt W.R.
        • et al.
        Association between physical activity and peripheral artery disease and carotid artery stenosis in a self-referred population of 3 million adults.
        ATVB. 2015; 35: 206-212
        • Nead K.T.
        • Cooke J.P.
        • Olin J.W.
        • Leeper N.J.
        Alternative ankle-brachial index method identifies additional at-risk individuals.
        J. Am. Coll. Cardiol. 2013; 62: 553-559