Underrecognized Peripheral Arterial Disease in Patients With Acute Coronary Syndrome: Prevalence of Traditional and Emergent Cardiovascular Risk Factors

• Published in: Revista española de cardiología (English ed.) Vol. 58; no. 12; pp. 1403 - 1410
• Main Authors: Huelmos, Ana, Jiménez, Julia, Guijarro, Carlos, Belinchón, Juan C., Puras, Enrique, Sánchez, Carmen, Casas, María L., López-Bescos, Lorenzo
• Format: Journal Article
• Language: English
• Published: Elsevier Espana 01.12.2005
• Subjects: Cardiovascular risk factors; Coronary disease; Enfermedad arterial periférica; Enfermedad coronaria; Factores de riesgo cardiovascular; Peripheral arterial disease; Enfermedad coronaria; ACS; PAD; Cardiovascular risk factors; Enfermedad arterial periférica; Factores de riesgo cardiovascular; CRF; CAD; Peripheral arterial disease; ABI; Coronary disease
• ISSN: 1885-5857; 1885-5857
• DOI: 10.1016/S1885-5857(06)60747-0

Peripheral arterial disease (PAD) frequently coexists with coronary artery disease. Our objective was to determine the prevalence of traditional and emergent cardiovascular risk factors in patients with acute coronary syndrome (ACS), with or without PAD. A prospective study of 141 consecutive patients (<70 years old) admitted to our hospital with ACS was performed. PAD was diagnosed when the ankle-brachial index (ABI) was <0.9. Traditional cardiovascular risk factors were evaluated. C-reactive protein, homocysteine, amyloid A, lipoprotein (a), fibrinogen, apolipoprotein A1, and apolipoprotein B100 serum levels, and microalbuminuria were measured. Specific genotypes were also determined. Patients were divided into two groups according to whether PAD was present (37 patients, 26% of total, ACS-PAD group) or absent (104 patients, ACS group). in the ACS-PAD group, patients were older, and diabetes and hypertension were significantly more common. Moreover, levels of C-reactive protein (3.1 mg/L vs 2.18 mg/L; P<.05), homocysteine (11.45 mmol/L vs 9.4 mmol/L; P<.01), amyloid A (5.2 mg/mL vs 3.7 mg/mL; P<.05), and microalbuminuria (4.89 mg/L vs 3.1 mg/L; P<.05) were significantly higher in this group. Logistic regression analysis showed that poorly controlled diabetes (OR=6.3; 95% CI, 1.1–36.7), time-dependent tobacco exposure (OR=1.5 per decade; 95% CI, 1.2–2.0), and high pulse pressure (OR=1.9 per 10 mm Hg; 95% CI, 1.3–2.7) were independent predictors of the presence of PAD. Several traditional and emergent cardiovascular risk factors were more prevalent in patients with acute coronary syndrome and peripheral arterial disease. Moreover, some factors were independent predictors of peripheral arterial disease. La enfermedad arterial/vascular periférica frecuentemente se asocia con enfermedad coronaia. El objetivo es evaluar la prevalencia de factores de riesgo cardiovascular tradicionales y emergentes entre pacientes con sindrome coronario agudo (SCA) con o sin enfermedad vascular periférica. Realizamos un estudio pros pectivo en 141 pacientes (< 70 años) que ingresaron consecutivamente por síndrome coronario agudo. El diagnóstico de enfermedad arterial periférica (EVP) se basó en un indice tobillo brazo ≤ 0,9. Se evaluaron los factores de riesgo cardiovascular tradicionales y se midieron las concentraciones séricas de proteína C reactiva, homocisteina, amiloide A, lipoproteina (a), fibrinógeno, apolipo-proteina A1 y B100, y microalbuminuria. Además, se determinaron varios genotipos. Los pacientes fueron estratificados en 2 grupos de acuerdo con la presencia ( n = 37, el 26% del total, grupo SCA-EVP) o ausencia ( n = 104, grupo SCA) de enfermedad arterial periférica. Los pacientes del grupo SCA-EVP eran más viejos y tenian una significativa mayor prevalencia de diabetes e hipertensión. Las concentraciones de proteina C reactiva, homoiisteiAna, amiloide A y microalbuminuria fueron significativamente mayores en el grupo SCA-EVP (3,1 frente a 2,18 mg/l [p < 0,05]; 11,45 frente a 9,4 mmol/l [p < 0,01]; 5,2 frente a 3,7mg/ml [p < 0,05], y 4,89 frente a 3,1 mg/l [p 0,05], respectivamente). El análisis de regresión logistica mostró que la diabetes mal controlada, la exposición al tabaco tiempo-dependiente y la presión de pulso fueron predictores independientes de la presencia de EVP. Varios factores de riesgo cardiovascular tradicionales y emergentes son más prevalentes en pacientes con SCA y enfermedad arterial periférica, y algunos de ellos son predictores independientes de ésta.