Interrelationship between peripheral arterial occlusive disease, carotid atherosclerosis and flow mediated dilation of the brachial artery
P Poredos1, M Golob, M Jensterle
1Department of Vascular Disease, University Medical Centre, Ljubljana, Slovenia. pavel.poredos@trnovo.kclj.si
Insights
Patients with peripheral arterial occlusive disease (PAOD) show subclinical atherosclerosis in other arteries. This systemic disease causes structural and functional changes, even without evident coronary or cerebrovascular disease symptoms.
Area of Science:
- Cardiovascular Medicine
- Vascular Biology
- Diagnostic Imaging
Background:
- Atherosclerosis is a systemic vascular disease.
- Peripheral arterial occlusive disease (PAOD) affects lower limb arteries.
- Subclinical changes in other arterial segments are expected in PAOD patients.
Purpose of the Study:
- To investigate subclinical functional and structural arterial wall changes in patients with evident PAOD.
- To assess carotid artery (CA) intima-media thickness (IMT) and plaque presence.
- To measure brachial artery (BA) endothelium-dependent dilation in PAOD patients.
Main Methods:
- Ultrasound assessment of carotid intima-media thickness (IMT) and atherosclerotic plaques.
- Measurement of brachial artery (BA) flow-mediated dilation (FMD) during reactive hyperemia.
- Comparison between 54 PAOD patients (Fontaine stage II) and 50 healthy controls.
Main Results:
- PAOD patients exhibited significantly higher CA IMT and more atherosclerotic plaques than controls.
- Flow-mediated dilation of the BA was significantly reduced in PAOD patients.
- IMT and BA dilation correlated with BMI, ankle-brachial pressure index (ABI), and LDL cholesterol.
Conclusions:
- PAOD patients without clinical cardiovascular or cerebrovascular disease show subclinical atherosclerosis in the carotid arteries.
- Reduced brachial artery dilation indicates endothelial dysfunction in PAOD.
- Findings support atherosclerosis as a generalized disease affecting multiple arterial segments.
Aim:
Atherosclerosis is considered a systemic disease. Therefore, in patients with atherosclerotic disease effects on various sections of the arterial system are expected. The aim of our study was to determine whether patients with evident peripheral arterial occlusive disease (PAOD) of the lower limbs have any subclinical functional or structural arterial wall changes in other sections of the arterial system.
Methods:
The study included 54 patients with PAOD, Fontaine stage II and a claudication distance from 50 to 500 m (average 250+/-170 m). Their mean age was 64. None of them had any symptoms or signs of coronary or cerebrovascular atherosclerosis (CVD). The control group consisted of 50 healthy volunteers with a mean age of 64 years without any risk factors of atherosclerosis. In all subjects the carotid intima-media thickness (IMT), was measured, the presence of atherosclerotic plaques in the carotid artery (CA) was registered and the endothelium-dependent dilation capability of the brachial artery (BA) during reactive hyperemia was measured using the B-mode ultrasound technique.
Results:
The average IMT was significantly greater in PAOD patients than in controls (0.8+/-0.2 mm vs 0.6+/-0.1 mm, p<0.001). In patients atherosclerotic plaques in the CA were also more numerous than in controls (38 vs 4, p<0.001). The IMT of patients was related to body mass index (BMI), ankle-brachial pressure index (ABI), LDL cholesterol and to the number of atherosclerotic plaques. In PAOD patients flow-mediated dilation of the BA was significantly lower than in controls (7.2+/-4.9% vs 12.3+/-2.1%, p<0.001). The dilation capability of the BA was linearly related to the BMI, ABI and IMT.
Conclusion:
The results of our study show that PAOD patients without clinical evidence of CVD have morphological changes of the CA, increased IMT and numerous atherosclerotic plaques. Furthermore, in PAOD patients flow-mediated endothelium-dependent dilation of the peripheral arteries is decreased. These results support the hypothesis that atherosclerosis is a generalized disease, leading to functional and structural changes in several segments of the arterial system.
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