Abdominal Aortic Aneurysms, Peripheral Arterial Disease, and Carotid Artery Stenosis

In this issue of Angiology, Gray et al assessed the prevalence of carotid artery stenosis (CAS) and peripheral arterial disease (PAD) in patients with abdominal aortic aneurysms (AAAs); 30.4% of patients with AAA had concomitant CAS and 45.3% had PAD (resting ankle–brachial pressure index [ABPI] 50%) used to define ‘‘significant’’ carotid atherosclerosis. It was argued that severe carotid atherosclerosis is indeed a predictor of concomitant arterial disease in other vascular beds, whereas this does not apply to moderate forms of the disease. Specific factors may lead to the development of vascular disease in 1 vascular territory rather than in another. Crosssectional data from the National Health and Nutrition Examinations Surveys 1999 to 2004 were pooled (total 7550 patients). Active smoking was more common among patients with PAD (30.0% vs 23.9%, respectively; P 1⁄4 .02), whereas hyperlipidemia was more prevalent among patients with coronary heart disease (CHD; 68.4% vs 54.0%, respectively; P < .001). The CHD was more prevalent than PAD in whites (84.6% vs 76.6%, respectively; P 1⁄4 .001), whereas the opposite was true for blacks (6.7% vs 15.9%, respectively; P < .001). An increased risk of CHD was observed only with very low (<15 ng/mL) serum vitamin D concentrations (odds ratio [OR]: 1.48; 95% confidence interval [CI]: 1.02-2.14; P < 0.01). In contrast, there was a strong dose–response relationship between serum vitamin D concentration and PAD. Even a mild reduction in serum vitamin D levels (25-30 mg/dL) was associated with an increased risk of PAD (OR: 1.48; 95% CI: 1.06-2.07; P < .01). This association became considerably stronger at lower (<15 ng/mL) serum vitamin D concentrations (OR: 3.16; 95% CI: 2.05-4.87; P < .001). Increased age and smoking are strong risk factors for both vascular and malignant disease. Indeed, several multicenter randomized controlled trials publishing the long-term followup results of patients with AAA and PAD reported a high incidence of malignant neoplasms. Thus, a diagnosis of PAD, CAS, or AAAs should alert physicians to the possible concomitant presence, or future development, of several forms of cancer. Besides smoking cessation, another measure that should be implemented in vascular patients is statin treatment whether they are managed conservatively or undergo open surgical or endovascular procedures. Preoperative statin use is associated with lower perioperative/periprocedural death, myocardial infarction, and stroke rates. Additionally, statins may reduce postoperative complications, hospitalization rates, and associated costs. Furthermore, statins reduce the incidence of postoperative/postprocedural renal insufficiency and aid the earlier recovery of kidney function. Finally, statins reduce stroke risk in patients with CAS. Screening for AAAs and PAD is a controversial issue. The ABPI provides information not only for the peripheral circulation but also for the generalized atherosclerotic burden and the risk of cardiovascular events. Another emerging marker of