Abstract
Background: Peripheral arterial disease (PAD) is considered as peripheral equivalent of coronary artery disease (CAD). Few studies from India have shown a low and variable prevalence of PAD in high risk population e.g. diabetes but data on patients with clinically manifest CAD is few. This study was done to assess Prevalence of PAD in patients of acute coronary syndrome (ACS), and its co-relation with various established risk factors for atherosclerosis.
Methods: Study was done on 120 patients admitted to our hospital with acute coronary syndrome. A detailed medical history and examination was done. High ankle-brachial index (ABI) was calculated with a hand held doppler. PAD was considered present if ABI was less than 0.9.
Results: Prevalence of PAD in patients of ACS was 8.33% (n=10) and was highest among patients over 50 years of age (mean age 57.98± 9.99). PAD were more in male (80%) as compared to female (20%) (NS=non significant). 50% had diabetics whereas 30.9% of the patients without PAD had diabetes mellitus (NS), 60% were smokers compared to 23.63% of the patients without PAD had smoker (S=significant), 30% were hypertension compared to 26.3 % of the patients without PAD had hypertension (NS). There were no significant differences in the lipid profile of the two groups.
Conclusion: The prevalence of PAD is low even in patients of CAD. Hence PAD screening may not be beneficial to predict cardiovascular events in high risk patients.
Keywords: Peripheral arterial disease, acute coronary syndrome, atherosclerosis, ankle-brachial index, diabetes mellitus, hypertension, smoker
References
- Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA, Halperin JL, et al. ACC/ AHA 2005 guidelines for the management of patients with peripheral arterial disease: Executive summary. J Am Coll Cardiol 2006; 47: 1239-312.
- Criqui MH, Langer RD, Fronek A, Feigelson HS, Klauber MR, McCann TJ, et al. Mortality over a period of 10 years in patients with peripheral arterial disease. N Engl J Med 1992; 326: 381-6.
- Hirsch AT, Criqui MH, Treat-Jacobson D, Regensteiner JG, Creager MA, Olin JW, et al. Peripheral arterial disease detection, awareness and treatment in primary care. JAMA 2001; 286: 1317-24.
- Bartholomew JR, Olin JW. Pathophysi-ology of peripheral arterial disease and risk factors for its development. Cleve Clin J Med 2006; 73 (Suppl 4): S8-14.
- TASC Working Group. Management of peripheral arterial disease.J Vasc Surg 2003; 31(1 suppl): S1–S296.
- Murabito JM, D’ Agostino RB, Silbershatz H, Wilson PWF. Intermittent claudication: a risk pro. le from the Framingham Heart Study. Circulation 1997; 96: 44–49.
- Dieter RS, Chu WW, Pacanowski JP, McBride PE, Tanke TE. The significance of lower extremity peripheral arterial disease. ClinCardiol2002; 25: 3–10.
- Leng GC, Papacosta O, Whincup P et al. Femoral atherosclerosis in an older British population: prevalence and risk factors. Atherosclerosis 2000; 152: 167–74.
- Djousse L, Levy D, Murabito JM, Cupples LA, Ellison RC Alcohol consumption and risk of intermittent claudication in the Framingham Heart Study. Circulation 2000; 102: 3092–97.
- Newman AB, Sisicovick DS, Manolio TA et al. Ankle-arm index as a marker of atherosclerosis in the Cardiovascular Health Study. Circulation 1993; 88: 837–45.
- Worthley SG, Helft G, Zaman AG, Fuster V, Badimon JJ. Atherosclerosis zand the vulnerable plaque–pathogenesis: Part I. Aust NZ J Med 2000; 30: 600–607.
- Dieter RS: Vascular adhesion molecules (letter). Contemp Surg. 1998;52(6):374.
- Wattanakit K, Folsom AR, Selvin E, Weatherley BD, Pankow JS, Brancati FL, et al. Risk factors for peripheral arterial disease incidence in persons with diabetes: The Atherosclerosis Risk in Communities (ARIC) Study. Atherosclerosis 2005; 180: 389-97.
- Sukhija R, Aronow WS, Yalamanchili K, Peterson SJ, Frishman WH, Babu S. Association of ABI with severity of angiographic CAD in patients with PAD and CAD. Cardiology 2005; 103: 158-60.
- Gornik HL, Creager MA. Contemporary management of peripheral arterial disease: Cardiovascular risk factor modification. Cleve Clin J Med 2006: 73 (Suppl 4): S 30-7.
- Mohan V, Premalatha G, Sastry NG. Peripheral vascular diseasein noninsulin-dependent diabetic mellitus in South India. Diabetes Res Clin Pract. 1995;27:235-40.
- Premalatha G, Shanthirani S, Deepa R, et al. Prevalence and risk factors of peripheral vascular disease in a selected South Indian population: the Chennai urban Population Study (CuPS). Diabetes Care 2000;23:1295-1300.
- Agrawal RP, Ranka M, Beniwal R et al. Prevalence of micro and macro vascular complications in type 2 diabetes and their risk Int J Diabetes Dev Ctries 2004;24:11-16
- Madhu SV, Kant S. Preclinical evaluation of atherosclerosis. Int J Diabetes Dev Ctries 2006;26:105-11.
- Dieter RS, Tomasson J,Gudionson T, Brown RL, Vitcenda M, Einerson J,et al. Lower extremity peripheral artery disease in hospitalized patients with coronary artery disease. Vasc Med 2003;8:233-36.
- Al-Thani HA, El-Menyar A, Zubaid M, Rashed WA, Ridha M, Almahmeed W, et al. Peripheral Arterial Disease in Patients Presenting with Acute Coronary Syndrome in Six Middle Eastern Countries. International Journal of Vascular Medicine. Volume 2011 (2011), Article ID 815902, 8 pages http://dx.doi.org/10.1155/2011/815902
- Kownator S, Cambou JP, Cacoub P, Léger P, Luizy F, Herrmann MA, et al. Prevalence of unknown peripheral arterial disease in patients with coronary artery disease: data in primary care from the IPSILON study. Arch Cardiovasc Dis. 2009;102(8–9):625–631.
- Nikolsky E, Mehran R, Mintz GS, Dangas GD, Lansky AJ, Aymong ED, et al. Impact of symptomatic peripheral arterial disease on 1-year mortality in patients undergoing percutaneous coronary interventions. J Endovasc Ther. 2004;11:60–70.
- Ness J, Aronow WS, Ahn C. Risk factors for peripheral arterial disease in an academic hospital-based geriatrics practice J Am Geriatr Soc..2000;48:312-14.
- Murabito JM, D’Agostino RB, Silbershatz H, Wilson WF. Intermittent claudication. A risk profile from The Framingham Heart Study. Circulation 1997; 96:44–49.
- Selvin E, Erlinger TP. Prevalence of and risk factors for peripheral arterial disease in the United States: results from the National 2004; 110:738–743.
- Lu JT, Creager MA. The relationship of cigarette smoking to Peripheral arterial disease. Rev Cardiovasc Med 2004; 5: 189-93.
- Franklin SS, Khan SA, Wong ND, Larson MG, Levy D. Is pulse pressure useful in predicting risk for coronary heart disease? The Framingham Heart Study. Circulation 1999;100:354-60.
- Murabito JM, Evans JC, Nieto K, Larson MG, Levy D, Wilson PWF. Prevalence and clinical correlates of peripheral arterial disease in the Framingham Offspring Study. Am Heart J 2002; 143: 961-65.
- Newman AB, Shemanski L, Manolio TA, Cushman M, Mittelmark M, Polak JF, et al. Ankle-arm index as a predictor of cardiovascular disease and mortality in the cardiovascular health study group. Arterioscler Thromb Vasc Biol 1999; 19: 538-45.
Corresponding Author
Dr Vivek Kumar Verma
Lecturer, Dept of Medicine, UPUMS, Saifai, Etawah (UP) – 206130 INDIA
Email: This email address is being protected from spambots. You need JavaScript enabled to view it., Mobile: +919450865362
DOI: https://dx.doi.org/10.18535/jmscr/v6i1.153
