Key result
Peripheral artery disease was associated with lower brachial artery flow-mediated dilation (5.9% for PAD alone vs 7.0% for CAD alone and 8.1% for controls, p < 0.0001).
Why the study?
Is peripheral artery disease associated with a greater degree of impairment in vascular function compared to coronary artery disease or healthy controls?
Cross-Sectional (n=1,320)
Is peripheral artery disease associated with a greater degree of impairment in vascular function compared to coronary artery disease or healthy controls?
Absolute Event Rate: 5.9% vs 7%
p-value: p=< 0.0001
Patients with peripheral artery disease exhibit more severe impairment of endothelial vasodilator function than those with coronary artery disease alone, potentially contributing to their worse cardiovascular prognosis.
Endothelial impairment was greater in PAD than CAD alone; leaves open whether this drives excess events or warrants targeted intervention.
Patients with peripheral artery disease (PAD) have higher cardiovascular event rates than patients with established coronary artery disease (CAD) and abnormal endothelial function predicts cardiovascular risk in PAD and CAD. We investigated the hypothesis that PAD is associated with a greater degree of impairment in vascular function than CAD. We used several non-invasive tests to evaluate endothelial function in 1320 men and women with combined PAD and CAD (n = 198), PAD alone (n = 179), CAD alone (n = 466), or controls aged > 45 years without CAD or PAD (n = 477). Patients with PAD had lower brachial artery flow-mediated dilation (5.1 ± 3.9% PAD and CAD, 5.9 ± 4.4% PAD alone) compared to patients with CAD alone (7.0 ± 4.5%) and no PAD or CAD (8.1 ± 5.1%, p < 0.0001). In multivariable models adjusting for clinical covariates and the presence of CAD, PAD remained associated with lower flow-mediated dilation (p < 0.0001). PAD was associated also with lower nitroglycerin-mediated dilation and reactive hyperemia. Patients with both PAD and CAD had a lower digital pulse amplitude tonometry (PAT) ratio in unadjusted models but not in adjusted models. Flow-mediated dilation was modestly associated with PAT ratio in patients with atherosclerotic disease (r = 0.23, p < 0.0001) but not among control participants (r = 0.008, p = 0.93). Our findings indicate that patients with PAD have greater impairment of vasodilator function and are consistent with the possibility that endothelial dysfunction may contribute to adverse cardiovascular prognosis in PAD.
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Kiani et al. (2013) conducted a cross-sectional in Peripheral artery disease (n=1,320). Peripheral artery disease vs. Coronary artery disease alone or controls without CAD or PAD was evaluated on Brachial artery flow-mediated dilation (p=< 0.0001). Peripheral artery disease was associated with lower brachial artery flow-mediated dilation (5.9% for PAD alone vs 7.0% for CAD alone and 8.1% for controls, p < 0.0001).
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