Original article
High prevalence of subclinical peripheral artery disease in Greek hospitalized patients

https://doi.org/10.1016/j.ejim.2005.02.002Get rights and content

Abstract

Background

Peripheral artery disease (PAD) represents a common manifestation of systemic atherosclerosis that is associated with an increased risk of cardiovascular death and ischemic events but one that may be underdiagnosed in clinical practice. The purpose of this study was to identify PAD using the ankle–brachial index (ABI) in hospitalized patients from a Department of Internal Medicine and to further investigate the association of this index with traditional cardiovascular risk factors.

Methods

We measured ABI in 990 consecutive patients (400 men and 590 women) aged 50 years or older (71.2 ± 9.1) without a history or symptoms suggestive of PAD. ABI values below 0.90 were considered abnormal.

Results

PAD was detected in 356 patients (36%), and men had a higher prevalence than women (p < 0.001). Hypertension (p < 0.001), smoking (p < 0.001), diabetes (p < 0.05), male sex (p < 0.001), and dyslipidemia (p < 0.05) were statistically more frequent in patients with PAD, whereas obesity had no significant relation to PAD in our series. In a stepwise, logistic regression analysis, hypertension, male sex, diabetes mellitus, smoking, and dyslipidemia were found to be independent risk factors with odds ratios (95% confidence intervals) of 2.46 (1.85–3.27), 2.25 (1.66–3.05), 1.80 (1.32–2.47), 1.78 (1.31–2.42), and 1.64 (1.22–2.19), respectively.

Conclusions

A simple ABI measurement revealed a large number of patients with unrecognized PAD. It is, therefore, recommended that ABI measurement should be included in the evaluation of cardiovascular risk in hospitalized patients aged 50 years or older.

Introduction

There is convincing evidence that atherosclerosis is the first cause of death worldwide since it is responsible for 28% of all deaths all over the world [1]. Peripheral artery disease (PAD) represents a slowly progressive disease that is due to atherosclerosis and that is found in 18% of elderly people [2]. The patients affected present the following symptoms in order of severity: intermittent claudication (defined as suppressing pain at the calf, hip, or thigh, which develops during walking or exercise; it is relieved at rest, and is due to ischemia of the lower extremity muscles), rest pain, and gangrene necrosis. It has been demonstrated that PAD determined non-invasively by ankle–brachial index (ABI) is associated with increased cardiovascular morbidity and mortality. Of note, the Framingham Heart Study showed that individuals with intermittent claudication had a fourfold annual rate of morbidity compared to normal ones [3]. Although several studies in western, industrialized countries have shown that PAD is widely prevalent in the general older population, not much data are available regarding Mediterranean countries.

The purpose of the present study was to investigate the prevalence of PAD in Greek hospitalized patients from a Department of Internal Medicine using the ABI, as well as to record its correlation with different traditional cardiovascular risk factors.

Section snippets

Materials and methods

We determined the ABI in consecutive patients from a Department of Internal Medicine who were hospitalized for various reasons. Our department includes diabetic and metabolic medicine units, but no cardiology wards. All patients aged 50 years or older without a history or symptoms suggestive of PAD were eligible for the study. The final study population consisted of 990 patients who had been hospitalized over a 2-year period (January 2002 to December 2003). All patients gave informed consent

Results

We studied 990 patients (400 males and 590 females, mean age 71.2 ± 9.1 years). Clinical and demographic characteristics of the study population are shown in Table 1. Thirty-six percent of the patients were found to have an ABI below 0.90, indicating the presence of PAD. Of the patients who were found to have PAD, 57% were males while only 31% of those without PAD were males (p < 0.001). Arterial hypertension, smoking, dyslipidemia, and diabetes mellitus had a statistically significant relationship

Discussion

We demonstrated that the prevalence of PAD in our population was 36%. This value is higher than the reported prevalence of large international studies like the SHEP [4], where the prevalence was 25.5%, and the USA PARTNERS study, where the prevalence was 29% [5]. Both of these multicenter studies, with samples of 1537 and 6979 patients, respectively, used ABI in order to reveal PAD in individuals who were unaware that they were suffering from PAD. It is prudent to assume that direct comparisons

Conclusion

In conclusion, we found a high prevalence of PAD among Greek hospitalized patients. It must be stressed that although PAD prevalence is high, the physicians' level of clinical suspicion is relatively low. Something very important is that most patients are not aware of their underlying disease since PAD is usually asymptomatic in the early stages. On the other hand, a simple ABI determination may lead to the early detection of such patients who, as suggested by the current evidence, are at an

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Cited by (17)

  • Prognostic value of low and high ankle-brachial index in hospitalized medical patients

    2012, European Journal of Internal Medicine
    Citation Excerpt :

    In primary care, the prevalence of low ABI has varied from 11% to 29% [1,5,6], and screening for PAD is highly recommended in this setting [2]. A previous study performed in patients admitted to a department of internal medicine reports a prevalence of low ABI of 36% [15]. In that study, however, ABI was measured by pulse palpation, and therefore the prevalence of PAD may have been overestimated.

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