Patients with atherosclerosis in the leg arteries face a substantially increased all-cause and cardiovascular mortality risk.
Researchers used the ankle brachial-index ( ABI ), which is simple to understand and to apply by physicians and nurses. In an individual in the supine position, the blood pressure in the leg arteries is equal to or a little higher than in the arm arteries. If atherosclerotic stenoses in the legs manifests, blood flow after the obstruction decreases, and the pressure in the leg artery is lower than in the arm.
The study included a total of 6,880 unselected patients in primary care, which underwent ABI testing by their primary care physician. Mean age of the patients was 72.5 years, 58% were females, 46% were past or current smokers, 74% had hypertension, 24% diabetes mellitus and 52% lipid disorders. Of all patients, 18.0% in the total cohort had a pathological ABI test, but the majority of these patients had no clinical signs or complaints.
After a 5-year observation period, all-cause mortality was 24% in patients with symptomatic peripheral arterial disease, 19% with asymptomatic peripheral arterial disease, and 9% in patients without peripheral arterial disease.
Even when all other known risk factors for cardiovascular death were accounted for by statistical means, peripheral arterial disease had the best ability to predict future death, stroke or myocardial infarction.
The study also showed that the extent of the blood pressure difference between legs and arms matters: the higher the spread between both pressures is, the higher is the mortality of patients.
According to researchers, every effort should be made to implement the ABI screening in standard programs for elderly patients and patients with cardiac risk factors such as diabetes or hypertension.
Source: European Society of Cardiology ( ESC ) – Congress, 2007
XagenaMedicine2007
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