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This analysis examines how concomitant peripheral arterial disease (PAD) influences the progression of coronary atherosclerosis in patients with coronary artery disease.

June 15, 2026Journal of the American College of Cardiology110 citations

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Peripheral Arterial Disease and Progression of Coronary Atherosclerosis

AHAyman A. HusseinElectrophysiology KUKiyoko UnoTeikyo University KWKathy WolskiPreventive Cardiology

Key Points

This analysis examines how concomitant peripheral arterial disease (PAD) influences the progression of coronary atherosclerosis in patients with coronary artery disease.
Analyzed data from 3,479 patients with coronary artery disease, with 216 having concomitant PAD.
Utilized serial intravascular ultrasound imaging across 7 clinical trials to assess coronary atherosclerosis burden and progression.
Evaluated percent atheroma volume, lumen volume, vessel wall volume, and lipid levels.
Patients with PAD showed a higher percent atheroma volume (40.4% vs. 38.5%, p = 0.002) and smaller lumen volume (275.7 mm³ vs. 301.4 mm³, p < 0.001).
Greater progression of percent atheroma volume in PAD patients (+0.58% vs. +0.23%, p = 0.009).
Lower levels of low-density lipoprotein cholesterol were linked to less disease progression, emphasizing the need for intensive lipid lowering (p < 0.001).

Abstract

OBJECTIVES: The purpose of this analysis was to characterize the progression of coronary atherosclerosis in patients with concomitant peripheral arterial disease (PAD). BACKGROUND: Peripheral arterial disease is associated with adverse cardiovascular outcomes. The impact of concomitant PAD on coronary atherosclerosis progression in patients with coronary artery disease has not been well established. METHODS: The burden and progression of coronary atherosclerosis was investigated in 3,479 patients with coronary artery disease with (n = 216) and without (n = 3,263) concomitant PAD who participated in 7 clinical trials that employed serial intravascular ultrasound imaging. RESULTS: Patients with PAD had a greater percent atheroma volume (40.4 ± 9.2% vs. 38.5 ± 9.1%, p = 0.002) and percentage of images containing calcium (35.1 ± 26.2% vs. 29.6 ± 24.2%, p = 0.002), in association with smaller lumen volume (275.7 ± 101.6 mm(3) vs. 301.4 ± 110.3 mm(3), p < 0.001) and vessel wall volume (467.7 ± 166.8 mm(3) vs. 492.9 ± 169.8 mm(3), p = 0.01). On serial evaluation, patients with PAD demonstrated greater progression of percent atheroma volume (+0.58 ± 0.38 vs. +0.23 ± 0.3%, p = 0.009) and total atheroma volume (-0.17 ± 2.69 mm(3) vs. -2.05 ± 2.15 mm(3), p = 0.03) and experienced more cardiovascular events (26.3% vs. 19.8%, p = 0.03). In patients with PAD and without PAD, respectively, achieving levels of low-density lipoprotein cholesterol <70 mg/dl was associated with less progression of percent atheroma volume (+0.16 ± 0.27% vs. +0.76 ± 0.20%, p = 0.04; and +0.05 ± 0.14% vs. +0.29 ± 0.13%, p < 0.001) and total atheroma volume (-3.0 ± 1.9 mm(3) vs. +1.0 ± 1.4 mm(3), p = 0.04; and -3.3 ± 1.1 mm(3) vs. -1.6 ± 1.0 mm(3), p < 0.001). CONCLUSIONS: Patients with concomitant PAD harbor more extensive and calcified coronary atherosclerosis, constrictive arterial remodeling, and greater disease progression. These changes are likely to contribute to adverse cardiovascular outcomes. The benefit for all patients achieving low levels of low-density lipoprotein cholesterol supports the need for intensive lipid lowering in patients with PAD.

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Cite This Study

Hussein et al. (Tue,) studied this question.

synapsesocial.com/papers/6a2fc37de3464c25b599ee17 https://doi.org/https://doi.org/10.1016/j.jacc.2010.10.034

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