Highlights
- •Polyvascular disease (PolyVD) was found in 3.03% participants, significantly higher in men (4.27%).
- •Patients with polyVD were older with more atherosclerosis risk factors.
- •Asymptomatic polyVD increased risks of cardiovascular events and all-cause death.
Abstract
Background and aims
Atherosclerosis is a diffuse and systemic disease. We aimed to assess prevalence and
outcome of extracoronary polyvascular disease (polyVD) in the asymptomatic Chinese
community population.
Methods
A random sample of 5440 participants aged 40 years or older were enrolled in the Asymptomatic
Polyvascular Abnormalities Community Study from 2010 to 2011. Intracranial artery
stenosis, extracranial artery stenosis, and lower extremity artery disease were detected
by transcranial Doppler and duplex sonography, and by calculating the ankle brachial
index. The study endpoints included the first occurrence of stroke, myocardial infarction
(MI) and all-cause death.
Results
PolyVD (two or three affected vascular territories) was found in 3.0% of the participants,
and was significantly higher in men (4.3%). Over a median follow-up of 4.1 years,
we identified a total of 247 events (4.7%), including 83 strokes (68 ischemic), 45
MIs and 134 all-cause deaths. After adjusting for age, gender and other potential
confounders, we found a significant increase in risk of major cardiovascular events
as well as all-cause death in participants with polyVD. In multivariate Cox regression
analyses, the adjusted hazard ratios (HR) (95% confidence interval, CI) for the composite
of stroke, MI and all-cause death for single and poly-vascular disease (compared with
0 vascular disease) increased from 1.58 (1.19–2.12) to 1.95 (1.26–3.03). Similarly,
the adjusted HR (95% CI) for all-cause death for single and poly-vascular disease
increased from 1.53 (1.03–2.29) to 2.22 (1.27–3.86).
Conclusions
PolyVD significantly increased the risk of major cardiovascular events and all-cause
death in the asymptomatic community population. Performing invasive screening tests
for polyVD is useful in the high-risk asymptomatic population.
Keywords
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References
- Global public health: a scorecard.Lancet. 2008; 372: 1988-1996
- Prevalence, impact, and predictive value of detecting subclinical coronary and carotid atherosclerosis in asymptomatic adults: the BioImage study.J. Am. Coll. Cardiol. 2015; 65: 1065-1074
- Effectiveness and cost effectiveness of cardiovascular disease prevention in whole populations: modelling study.BMJ. 2011; 343: d4044
- Non-coronary atherosclerosis.Eur. Heart J. 2014; 35: 1112-1119
- One-year cardiovascular event rates in outpatients with atherothrombosis.JAMA. 2007; 297: 1197-1206
- Polyvascular disease in patients presenting with acute coronary syndrome: its predictors and outcomes.ScientificWorldJournal. 2012; : 284851
- Prior polyvascular disease: risk factor for adverse ischaemic outcomes in acute coronary syndromes.Eur. Heart J. 2009; 30: 1195-1202
- Prevalence and clinical outcome of polyvascular atherosclerotic disease in patients undergoing coronary intervention.Circ. J. 2013; 77: 89-95
- Prevalence, vascular distribution, and multiterritorial extent of subclinical atherosclerosis in a middle-aged cohort: the PESA (Progression of Early Subclinical Atherosclerosis) study.Circulation. 2015; 131: 2104-2113
- Carotid and femoral ultrasound morphology screening and cardiovascular events in low risk subjects: a 10-year follow-up study (the CAFES-CAVE study (1)).Atherosclerosis. 2001; 156: 379-387
- Cardiovascular events in patients with atherothrombotic disease: a population-based longitudinal study in Taiwan.PLoS One. 2014; 9: e92577
- Impact of polyvascular disease on clinical outcomes in patients undergoing coronary revascularization: an observation from the CREDO-Kyoto Registry Cohort-2.Atherosclerosis. 2013; 228: 426-431
- Three-year follow-up and event rates in the international REduction of atherothrombosis for continued health registry.Eur. Heart J. 2009; 30: 2318-2326
- Cardiovascular disease and risk factors in Asia: a selected review.Circulation. 2008; 118: 2702-2709
- ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC).Eur. Heart J. 2011; 32: 2851-2906
- Management of patients with peripheral artery disease (compilation of 2005 and 2011 ACCF/AHA guideline recommendations): a report of the American College of Cardiology Foundation/American Heart Association task force on practice guidelines.J. Am. Coll. Cardiol. 2013; 61: 1555-1570
- Asymptomatic polyvascular abnormalities in community (APAC) study in China: objectives, design and baseline characteristics.PLoS One. 2013; 8: e84685
- Prevalence of ideal cardiovascular health and its relationship with the 4-year cardiovascular events in a northern Chinese industrial city.Circ. Cardiovasc Qual. Outcomes. 2012; 5: 487-493
- Ideal cardiovascular health metrics and the risks of ischemic and intracerebral hemorrhagic stroke.Stroke. 2013; 44: 2451-2456
- Resting heart rate trajectory pattern predicts arterial stiffness in a community-based Chinese cohort.Arterioscler. Thromb. Vasc. Biol. 2017; 37: 359-364
- Cumulative exposure to ideal cardiovascular health and incident diabetes in a Chinese population: the kailuan study.J. Am. Heart Assoc. 2016; : 5
- A door-to-door survey of intracranial atherosclerosis in Liangbei County, China.Neurology. 2007; 68: 2031-2034
- Carotid artery stenosis: gray-scale and doppler US diagnosis–society of Radiologists in ultrasound Consensus conference.Radiology. 2003; 229: 340-346
- Recommendations on stroke prevention, diagnosis, and therapy. Report of the WHO task force on stroke and other cerebrovascular disorders.Stroke. 1989; 20: 1407-1431
- Universal definition of myocardial infarction.J. Am. Coll. Cardiol. 2007; 50: 2173-2195
- Predictive value of noninvasive measures of atherosclerosis for incident myocardial infarction: the Rotterdam Study.Circulation. 2004; 109: 1089-1094
- International prevalence, recognition, and treatment of cardiovascular risk factors in outpatients with atherothrombosis.JAMA. 2006; 295: 180-189
- The prevalence of carotid plaque with different stability and its association with metabolic syndrome in China: the Asymptomatic Polyvascular Abnormalities Community study.Med. Baltim. 2016; 95: e4619
- Stroke with polyvascular atherothrombotic disease.Atherosclerosis. 2010; 208: 587-592
- Atherothrombotic burden and medium-term prognosis in patients with acute ischemic stroke: findings of the SIRIO study.Cerebrovasc. Dis. 2012; 33: 341-347
- Comparative determinants of 4-year cardiovascular event rates in stable outpatients at risk of or with atherothrombosis.JAMA. 2010; 304: 1350-1357
- Association of ankle-brachial index and plaques in the carotid and femoral arteries with cardiovascular events and total mortality in a population-based study with 13 years of follow-up.Eur. Heart J. 2006; 27: 2580-2587
- Inflammation in peripheral artery disease.Circulation. 2010; 122: 1862-1875
- Validation of transcranial Doppler with magnetic resonance angiography in acute cerebral ischemia.J. Neuroimaging. 2011; 21: e34-40
- Screening for asymptomatic carotid artery stenosis.JAMA. 2015; 313: 192-193
Article info
Publication history
Published online: April 21, 2017
Accepted:
April 20,
2017
Received in revised form:
April 13,
2017
Received:
January 9,
2017
Identification
Copyright
© 2017 Published by Elsevier Ireland Ltd.
