Skip Navigation

This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Disclaimer
Right arrow Request Permissions
Google Scholar
Right arrow Articles by Coccheri, S
Right arrow Articles by Palareti, G
Right arrow Search for Related Content
PubMed
Right arrow Articles by Coccheri, S
Right arrow Articles by Palareti, G
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?


The cardiovascular risk burden of intermittent claudication

S Coccheri* and G Palareti

Cardiovascular Department, Division of Vascular Medicine, University Hospital St. Orsola, Bologna, Italy

* Correspondence: S. Coccheri, MD, Divisione di Angiologia, Ospedale Policlinico S.Orsola, Via Massarenti 9, 40138 Bologna, Italy.

Abstract

Intermittent claudication is the main clinical feature of chronic symptomatic atherothrombotic disease of the lower limbs (peripheral arterial disease [PAD]). The natural history of these patients includes a relatively limited risk for deterioration toward acute or chronic critical limb ischaemia and amputation. Patients with PAD have a high cardiovascular mortality rate, however, which is related to acute myocardial infarction and stroke (fourfold to sixfold increase in l0-year risk for these conditions). In fact, PAD is often associated with multifocal atherothrombotic arterial involvement. The presence of diffuse atherothrombotic lesions in PAD patients significantly increases their cardiovascular risk burden. Conversely, in the general population as well as in coronary patients the presence of PAD is an independent risk factor for increased mortality. Evidence of plaque instability may occur simultaneously at different locations. Finally, increased intima-media thickness at the common carotid and femoral arteries can be associated with overt disease at other arterial regions.

Key Words: Cardiovascular mortality • intima-media thickness • multidistrict atherothrombosis • peripheral arterial disease • plaque instability

References

  1. Dormandy J, Mahir M, Ascady G, et al. Fate of the patient with chronic leg ischaemia. A review article. J Cardiovasc Surg. 1989;30:50–57[Medline]
  2. Criqui MH, Coughlin SS, Fronek A. Noninvasively diagnosed peripheral arterial disease as a predictor of mortality: results from a prospective study. Circulation. 1985;72:768–773[Abstract/Free Full Text]
  3. Criqui MH, Denenberg JO, Langer RD, Fronek A. The epidemiology of peripheral arterial disease: importance of identifying the population at risk. Vasc Med. 1997;2:221–226[Medline]
  4. Bertelè V, Roncaglioni MC, Pangrazzi J, Terzian E, Tognoni Gon behalf of the ICAI Group. Clinical outcome and its predictors in 1560 patients with critical leg ischaemia. Eur J Vase Endovasc Surg. 1999;18:401–410
  5. Fowkes FGR, Housley E, Cawood EHH, et al. Edinburgh Artery Study: prevalence of asymptomatic and symptomatic peripheral arterial disease in the general population. Int J Epidemiol. 1991;20:384–392[Abstract/Free Full Text]
  6. Leng GC, Fowkes FGR, Lee AJ, et al. Use of ankle-brachial pressure index to predict cardiovascular events and death: a cohort study. BMJ. 1996;313:1440–1444[Abstract/Free Full Text]
  7. Zheng ZJ, Sharrett AR, Chambless LE, et al. Associations of ankle-brachial index with clinical coronary heart disease, stroke and preclinical carotid and popliteal atherosclerosis: the Athero sclerosis Risk in Communities (ARIC) Study. Atherosclerosis. 1997;131:115–125[CrossRef][Web of Science][Medline]
  8. Aronow WS, Ahn C. Prevalence of coexistence of coronary artery disease, peripheral arterial disease, and atherothrombotic brain infarction in men and women >=62 years of age. Am J Cardiol. 1994;74:64–65[CrossRef][Web of Science][Medline]
  9. Ogren M, Hedblad B, Isacsson SO, Janzon L, Jungquist G, Lindell SE. Non invasively detected carotid stenosis and ischaemic heart disease in men with leg arteriosclerosis. Lancet. 1993;342:1138–1341[CrossRef][Web of Science][Medline]
  10. Eagle KA, Charanjit SR, Foster ED, Mickel MC, Gersh BJ. Longterm survival in patients with coronary artery disease: importance of peripheral vascular disease. J Am Coll Cardiol. 1994;23:1091–1095[Abstract]
  11. Sutton-Tyrrell K, Rihal C, Sellers MA, et al. Long-term prognostic value of clinically evident non coronary vascular disease in patients undergoing coronary revascularization in the Bypass Angioplasty Revascularization Investigation (BARI). Am J Cardiol. 1998;8:495–500[CrossRef]
  12. Sandcrcock PAG, Warlow CP, Jones LN, Starkey IR. Predisposing factors for cerebral infarction: the Oxfordshire Community Stroke Project. BMJ. 1989;298:75–80
  13. Caicoya Gomez-Moran M, Corrales Cartel C, Lasheras Mayo C, Cuello Rocas R, Rodriguez Alvarez T. The association between a cerebrovascular accident and peripheral arterial disease: a case-control study in Asturias, Spain. [in SpanishlRev Clin Esp. 1995;195:830–835[Web of Science][Medline]
  14. CAPRIE Steering Committee. A randomized, blinded trial of clopidogrel versus aspirin in patients at risk of ischaemic events (CAPRIE). Lancet. 1996;93:1201–1205
  15. Coccheri S, on behalf of the CAPRIE investigators. Distribution of symptomatic atherothrombosis and influence of atherosclerotic disease burden on risk of secondary ischaemic events: results from CAPRIE. [abstract]Eur Heart J. 1998;19:1268 (suppl)
  16. Klop RB, Eikelboom BC, Taks AC. Screening of the internal carotid arteries in patients with peripheral vascular disease by colour-flow duplex scanning. Eur J Vase Surg. 1991;5:41–45
  17. Valentine RJ, Grayburn PA, Eichhorn EJ, Myers SI, Claggett GP. Coronary artery disease is highly prevalent among patients with premature peripheral vascular disease. J Vase Surg. 1994;19:668–674
  18. Long TH, Criqui MH, Vasilevskis EE, et al. The correlation between the severity of peripheral arterial disease and carotid occlusive disease. Vase Med. 1999;4:135–142[CrossRef]
  19. Allan PL, Mowbray PhI, Lee AJ, Fowkes GR. Relationship between carotid intima-media thickness and symptomatic and asymptomatic peripheral arterial disease. Stroke. 1997;28:348–353[Abstract/Free Full Text]
  20. Rietzschel ER, De Buyzere ML, Duprez DA, Clement DL. Interchangeability of carotid and femoral intima-media thickness in risk stratification. Int Angiol. 2001;20:38–46[Web of Science][Medline]
  21. Held C, Hjemdahl P, Eriksson SV, et al. Prognostic implications of intima-media thickness and plaques in the carotid and femoral arteries in patients with stable angina pectoris. Eur Heart J. 2001;22:62–72[Abstract/Free Full Text]
  22. Rothwell PM. The interrelation between carotid, femoral and coronary artery disease. Eur Heart J. 2001;22:11–14[Free Full Text]
  23. Rothwell PM. Evidence of chronic systemic cause of instability of atherosclerotic plaques. Lancet. 2000;355:4–5[CrossRef][Web of Science][Medline]

Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?


This article has been cited by other articles:


Home page
 Eur Heart JHome page
G. G. Neri Serneri, S. Coccheri, E. Marubini, F. Violi, and for the Committees and the Investigators of the Dr
Picotamide, a combined inhibitor of thromboxane A2 synthase and receptor, reduces 2-year mortality in diabetics with peripheral arterial disease: the DAVID study
Eur. Heart J., October 2, 2004; 25(20): 1845 - 1852.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow E-letters: Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when E-letters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Disclaimer
Right arrow Request Permissions
Google Scholar
Right arrow Articles by Coccheri, S
Right arrow Articles by Palareti, G
Right arrow Search for Related Content
PubMed
Right arrow Articles by Coccheri, S
Right arrow Articles by Palareti, G
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?