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Occult aorto-iliac disease in patients with symptomatic coronary artery disease
A Kafetzakis1, A D Giannoukas, G Kochiadakis
1Division of Vascular Surgery, University Hospital of Heraklion, University of Crete School of Medicine, Heraklion, Crete, Greece.
Insights
Occult aorto-iliac disease (OAID) in patients undergoing coronary angiography is linked to more severe coronary artery disease (CAD). This subset of patients also shows a higher prevalence of hypercholesterolemia and family history of atherosclerosis.
Area of Science:
- Cardiovascular Medicine
- Vascular Biology
- Diagnostic Imaging
Background:
- Atherosclerosis can affect the entire cardiovascular system, even without symptoms.
- Early carotid artery changes correlate with increased coronary artery disease (CAD) morbidity and mortality.
- Investigating occult aorto-iliac disease (OAID) can reveal hidden risks for CAD severity.
Purpose of the Study:
- To determine the relationship between occult aorto-iliac disease (OAID) and CAD severity.
- To identify risk factors associated with the presence of OAID.
- To understand the implications of OAID in patients with coronary atherosclerosis.
Main Methods:
- 284 patients undergoing coronary angiography (CA) were assessed.
- Aorto-iliac arterial segments were imaged in addition to coronary arteries.
- Risk factors and CAD severity were analyzed in relation to OAID presence in eligible patients.
Main Results:
- 203 patients with positive CA and no lower limb arterial disease were analyzed.
- Patients with OAID (110) exhibited more severe CAD compared to those without OAID (93).
- Hypercholesterolemia and positive family history were significantly more prevalent in patients with OAID.
Conclusions:
- Occult aorto-iliac disease (OAID) is associated with more severe coronary artery disease (CAD).
- Patients with OAID have a higher prevalence of hypercholesterolemia and family history of atherosclerosis.
- This patient group may represent a subset with more aggressive atherosclerotic disease.
Background:
Atherosclerosis may affect the entire cardiovascular system despite absence of symptoms. Early changes in the wall of the carotid artery have been related to a higher morbidity and mortality from coronary artery disease (CAD). This study was conducted to investigate the relationship between the presence of occult aorto-iliac disease (OAID) and certain risk factors with the severity of CAD.
Methods:
Two hundred and eighty-four consecutive patients subjected to coronary angiography (CA) were studied. Additional images of the aorto-iliac arterial segment were taken. Patients with negative CA or symptomatic lower limb arterial disease (LLAD) were excluded from further analysis. In the remaining patients, the risk factors (age, smoking, diabetes mellitus, hypertension, hyperlipidemia and positive family history for atherosclerosis) and the severity of coronary artery disease (CAD) were analyzed in relation to the presence or absence of OAID.
Results:
Twelve patients with impaired renal function were excluded from the study. Negative CA was found in 12% (32/272) and symptomatic LLAD was present in 14% (37/272). Eligible for further analysis were 203 patients with positive CA and no LLAD. A hundred and ten of them had a positive CA and the presence of OAID whereas the remaining 93 patients had only a positive CA. The patients with OAID had more severe CAD on CA (p=0.003). There was no difference between the two groups concerning age and gender. The most common risk factors in both groups were hypercholesterolemia and a positive family history but with a significantly higher prevalence in the patients with OAID (p=0.008 and p<0.001, respectively).
Conclusions:
The presence of OAID in coronary patients was associated with more severe CAD and with a significantly higher prevalence of hypercholesterolemia and positive family history for atherosclerosis. This subset of patients may represent those with more aggressive atherosclerosis.