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Femoral atherosclerosis in an older British population: prevalence and risk factors
G C Leng1, O Papacosta, P Whincup
1Department of Primary Care and Population Sciences, Royal Free and University College Medical School, Rowland Hill Street, NW3 2PF, London, UK.
Insights
Peripheral atherosclerosis, specifically femoral plaque, affects nearly two-thirds of older adults. This condition is linked to higher risks of heart disease and angina, highlighting the need for better detection methods.
Area of Science:
- Cardiovascular Medicine
- Vascular Biology
- Epidemiology
Background:
- Prevalence estimates for peripheral atherosclerosis often rely on symptoms like intermittent claudication.
- A need exists to understand the prevalence of underlying femoral plaque and its associations.
Purpose of the Study:
- To determine the prevalence of femoral artery plaque in a general population sample.
- To investigate the association of femoral plaque with cardiovascular disease and risk factors.
Main Methods:
- Ultrasound imaging was used to identify femoral plaque in 784 men and women aged 56-77.
- Data on cardiovascular disease, lifestyle (smoking, exercise), blood pressure, cholesterol, and fibrinogen were collected.
Main Results:
- Atherosclerotic plaque was found in 64% of subjects, increasing with age and more common in men.
- Femoral plaque was significantly associated with prior ischemic heart disease and angina.
- Smoking, high total cholesterol, and high fibrinogen were independent risk factors; exercise and high HDL cholesterol were protective.
Conclusions:
- Femoral artery atherosclerosis is highly prevalent in late middle age, affecting nearly two-thirds of the population.
- Femoral plaque presence correlates with increased risk of ischemic heart disease and angina.
- Further trials are needed to assess the clinical utility of ultrasound detection versus risk factor scoring.
Abstract:
Most estimates of the prevalence of peripheral atherosclerosis have been based on intermittent claudication or lower limb blood flow. The aim of this study was therefore to determine the prevalence of underlying femoral plaque, and to determine its association with other cardiovascular disease and risk factors. Presence of plaque was identified using ultrasound in a random sample of men (n=417) and women (n=367) aged 56-77 years. Coexistent cardiovascular disease, exercise and smoking were determined by questionnaire, blood pressure was recorded, and serum cholesterol and plasma fibrinogen were determined. Of the 784 subjects that were scanned, 502 (64%) demonstrated atherosclerotic plaque. Disease prevalence increased significantly with age (P<0.0001), and was more common in men (67.1 vs. 59.4%, P<0.05). Subjects with femoral plaque had a significantly greater odds of previous ischaemic heart disease (OR 2. 2, 95% CI 1.3, 3.7) and angina (OR 1.7, 95% CI 1.03, 2.7), but not of stroke or leg pain on exercise. Current and ex-smoking, raised serum total cholesterol and plasma fibrinogen levels, but not blood pressure, were associated with an increased risk of femoral plaque, independent of age and sex. Frequent exercise and a high HDL cholesterol were significantly associated with lower risk. In conclusion, therefore, atherosclerotic disease of the femoral artery affects almost two-thirds of the population in late middle age. It is associated with an increased prevalence of ischaemic heart disease and angina, but whether detecting at risk individuals using ultrasound offers advantages over simpler and less expensive risk factor scoring requires evaluation in trials.