Abstract 13431: Peripheral Arterial Disease and Progression of Coronary Atherosclerosis
Background: Peripheral arterial disease (PAD) is associated with adverse cardiovascular outcomes. The impact of concomitant PAD on coronary atherosclerosis progression in patients with coronary artery disease (CAD) has not been well established.
Methods: The burden and progression of coronary atherosclerosis was investigated in 3479 patients with CAD with (n=216) and without (n=3263) concomitant PAD who participated in 7 clinical trials that employed serial intravascular ultrasound imaging.
Results: Patients with PAD had a greater percent atheroma volume (PAV, 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 (275.7±101.6 vs. 301.4±110.3 mm3, p<0.001) and vessel wall (467.7±166.8 vs. 492.9±169.8 mm3, p=0.01) volumes. On serial evaluation, patients with PAD demonstrated greater progression of both PAV (+0.58±0.38 vs. +0.23±0.3%, p=0.009) and total atheroma volume (TAV, −0.17±2.69 vs. −2.05±2.15 mm3, p=0.03) and experienced more cardiovascular events (26.3 vs. 19.8%, p=0.03). Achieving levels of low-density lipoprotein cholesterol (LDL-C) <70 mg/dL was associated with less progression of PAV (+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 TAV (−3.0±1.9 vs. +1.0±1.4 mm3, p=0.04 and −3.3±1.1 vs. −1.6±1.0 mm3, p<0.001) in patients with and without PAD, respectively.
Conclusion: 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 the adverse cardiovascular outcome in patients with PAD. The finding of slower disease progression in all patients achieving low levels of LDL-C supports the need for intensive lipid lowering in patients with PAD.
- © 2010 by American Heart Association, Inc.