Peripheral Arterial Disease: Medical Care and Prevention of Complications

David L. Dawson, MD; William R. Hiatt, MD; Mark A. Creager, MD; Alan T. Hirsch, MD


Prev Cardiol. 2002;5(3) 

In This Article

PAD as a Marker for Atherosclerosis and Cardiovascular Ischemic Risk

The population with PAD is at increased risk for cardiovascular morbidity and mortality. This increased risk is observed in both patients with claudication symptoms and those who are asymptomatic. In patients with PAD documented by noninvasive studies, Criqui et al.[9] demonstrated that both men and women had an approximately three-fold increase in all-cause mortality, compared with age-matched control subjects with normal peripheral arteries. Even when clinically evident cardiovascular disease was absent at baseline, the diagnosis of PAD was associated with a higher mortality risk; the diagnosis of PAD was a more important predictor of survival outcome than was a clinical history of coronary disease. Additional analyses correlated PAD severity and relative risk for cardiovascular mortality. The diagnosis of PAD was associated with a six-fold increase in relative risk, but when subjects had severe symptomatic PAD affecting large vessels, relative risk was increased 15-fold.[9] Similar findings in women were described by Vogt et al.,[10] who found that women with PAD (whether or not they had claudication or a prior history of cardiovascular disease) have about the same risk of mortality as men with PAD. Their study showed that the relative risk for all-cause mortality in the study population was increased 3.1-fold at 4 years (after adjustment for age, smoking, and other risk factors). The relative risks for heart disease and cardiovascular disease events were estimated at 3.7 and 4.0, respectively.

Leng et al.[11] also showed that asymptomatic individuals with PAD have a significantly increased risk of ischemic events. They prospectively followed 1592 patients with PAD (both patients with claudication and asymptomatic PAD), aged 55-74 years, over a period of 5 years, to determine rates of subsequent cardiovascular events and death. The incidence of new intermittent claudication symptoms was 1.6% per year in these patients. Asymptomatic patients appeared to have the same increased risk of cardiovascular events and death as those with symptoms of claudication.

There is a similar correlation of cerebrovascular disease with PAD. The incidence of ischemic stroke has been reported to be as high as 42% in patients with PAD.[12] Further, PAD patients appear to have a poorer prognosis following a stroke than do those without PAD.[13]

Thus, it is clear that establishing a diagnosis of PAD in populations at risk for cardiovascular disease can yield an important measure that independently predicts both all-cause and cardiovascular mortality.