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The generalized nature of atherosclerosis: how peripheral arterial disease may predict adverse events from coronary artery disease

Department of Family and Preventive Medicine, Department of Medicine, University of California School of Medicine, San Diego, CA, USA

Julie O Denenberg

Department of Family and Preventive Medicine, Department of Medicine, University of California School of Medicine, San Diego, CA, USA

Non-invasive measurements, especially segmental pressure ratios and flow measurements, are useful for gauging the severity of peripheral arterial disease (PAD). Although the incidence of PAD is similar for men and women, men are more likely to have severe disease, while women usually have more moderate or asymptomatic disease. Published reports confirm the clinical impression that patients with PAD are more likely to have both coronary artery disease and cerebrovascular disease than those without PAD. However, the degree of overlap is a function of the sensitivity of the diagnostic assessments for the three conditions. A San Diego population study found that the incidence of PAD may be underestimated, with many patients being asymptomatic. Based on blood flow measurements, the study found that 11.9% of the study population had large vessel PAD. Morbidity from both coronary heart disease and stroke was increased in people with PAD, who were 2.5 times more likely to present with morbidity from cardiovascular disease (CVD) than those who did not have PAD. Several studies have now confirmed the strong predictive value of PAD for subsequent CVD mortality and that the risk of CVD mortality increases with the severity of PAD.

Key Words: atherosclerosis • cardiovascular disease • coronary heart disease • non-invasive testing • peripheral arterial disease

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