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Lower-extremity arteriosclerosis as a reflection of a systemic process: implications for concomitant coronary and
1Department of Vascular Surgery, St George's Hospital Medical School, London, England, United Kingdom.
Insights
Peripheral arterial occlusive disease (PAOD) often co-exists with coronary artery disease (CAD) and cerebrovascular disease (CVD) due to shared atherosclerosis. Awareness of these linked conditions is crucial for comprehensive patient management and prognosis.
Area of Science:
- Cardiovascular Medicine
- Atherosclerosis Research
Background:
- Peripheral arterial occlusive disease (PAOD), coronary artery disease (CAD), and cerebrovascular disease (CVD) are interconnected manifestations of systemic atherosclerosis.
- Co-occurrence of these conditions is common, necessitating a holistic approach to patient care.
- Understanding the extent of co-existing cardiovascular disease is vital for effective treatment and prognosis.
Purpose of the Study:
- To highlight the significant co-morbidity between PAOD, CAD, and CVD.
- To emphasize the importance of recognizing systemic atherothrombotic disease in patients presenting with localized manifestations.
Main Methods:
- Review of existing literature and studies on the prevalence of co-existing PAOD, CAD, and CVD.
- Analysis of the relationship between the severity of PAOD and the presence of CAD and CVD.
- Examination of the prevalence of PAOD in patients with established CAD or CVD.
Main Results:
- Approximately 40% to 60% of patients with PAOD also have asymptomatic or symptomatic CAD.
- The prevalence of PAOD increases with the severity of CAD.
- Up to 60% of patients with PAOD show evidence of CVD, with prevalence increasing as the ankle-brachial pressure index (ABPI) decreases.
- Conversely, a significant proportion of patients with CAD or CVD also have PAOD.
Conclusions:
- Atherosclerosis commonly affects multiple vascular beds, leading to a high degree of co-morbidity between PAOD, CAD, and CVD.
- Physicians must consider the systemic nature of atherothrombosis when managing patients with any of these conditions.
- Integrated management strategies are essential for improving outcomes in patients with multi-vessel atherosclerosis.
Abstract:
Peripheral arterial occlusive disease (PAOD), coronary artery disease (CAD), and cerebrovascular disease (CVD) are all manifestations of atherosclerosis or atherothrombosis, and therefore it is not surprising that the three conditions commonly occur together. Knowledge of the magnitude of co-existing cardiovascular disease and its prognosis is essential for the physician treating IC so that he can treat the local disease in its systemic context. The prevalence of CAD in patients with IC is 40% to 60%, although this may be asymptomatic and increases with the severity of the PAOD. Not surprisingly, the converse is also true; among individuals with CAD, the prevalence of PAOD is higher than in non-CAD individuals. The link between PAOD and CVD seems to be weaker than that with CAD, but again up to 60% of claudicants have some evidence of CVD. The prevalence of patients with CVD increases as the ABPI decreases. The evidence available from all of the relevant studies suggests that approximately 60% of patients with PAOD will have significant disease in the cardiac or cerebral circulation, and approximately 40% of patients with coronary disease or significant cerebral circulatory disease also will have PAOD.