High Prevalence of Peripheral Arterial Disease in Patients with Acute Ischaemic Stroke

Abstract

Background: After acute ischaemic stroke (AIS) or transient ischaemic attack (TIA), the detection of peripheral arterial disease (PAD) as a marker of generalized atherosclerosis may improve the risk stratification and prevention of future atherothrombotic events. We aimed to determine the prevalence of PAD indicated by an ankle-brachial index (ABI) of ≤0.9 in a large cohort of patients with AIS/TIA. Methods: In this prospective, multicentre, Austrian, cross-sectional study (OECROSS), 759 patients with AIS or TIA were recruited for a systematic assessment of cardiovascular risk profiles and Doppler ultrasound at the ankle and brachial artery to calculate the ABI from systolic blood pressure readings. Results: 739 patients (97.4%) had a complete ABI assessment. The mean age was 69.5 (± 12.1) years, and 55.8% of the patients were men. 81.6% of the patients had AIS and 18.4% had TIA. Only 6.2% of the patients had a history of PAD, but an abnormal ABI of ≤0.9 was found in 44.9%. Patients with an ABI of ≤0.9 were more likely (p < 0.05) to be older and have a history of PAD, hypertension, diabetes and congestive heart failure. An ABI of ≤0.9 was significantly associated (p < 0.0005) with a presence of carotid stenosis of >50% and an Essen Stroke Risk Score of >2, indicating a risk of ≧4% per year of stroke recurrence. Discussion: A high proportion of patients with AIS/TIA have subclinical PAD, a cross-risk stroke physicians should be aware of. Large longitudinal studies are needed to elucidate whether the ABI can improve our estimation of the risk of future atherothrombotic events and help in optimizing secondary prevention.

CHADS₂ Score and Risk of New-onset Peripheral Arterial Occlusive Disease in Patients without Atrial Fibrillation: A Nationwide Cohort Study in Taiwan

“…In addition, several studies have reported that the CHADS2 score can be used to predict subsequent cardiovascular events and new-onset AF in non-AF populations [11][12][13] . As an older age, hypertension, diabetes, congestive heart failure and stroke are all risk factors for PAOD [1][2][3][4][5][6][7] , our recent cross-sectional study demonstrated that the CHADS2 score is significantly associated with an ankle-brachial index (ABI) of 0.9 in non-AF patients 14) . However, divided the study patients into four groups: group 1 (score 0), group 2 (score 1-2), group 3 (score 3-4) and group 4 (score 5-6).…”

“…This condition shares similar risk factors with both coronary artery and cerebrovascular disease. Risk factors for PAOD include an advanced age, smoking, hypertension, diabetes, dyslipidemia, chronic kidney disease, congestive heart failure, stroke, race, obesity, elevated inflammatory markers and so on [1][2][3][4][5][6][7] . The CHADS2 score is a useful and well-known clinical score for assessing the risk of stroke in patients with AF 8,9) .…”

“…Major risk factors for PAOD include hypertension, diabetes mellitus, dyslipidemia, an advanced age and cigarette smoking 1,2) . In addition, chronic kidney disease, stroke, congestive heart failure, race, obesity and elevated inflammatory markers have also been reported to be associated with PAOD onset [1][2][3][4][5][6][7] . The CHADS2 score is a simple and reliable clinical score for assessing the risk of stroke in patients with atrial fibrillation (AF) 8,9) .…”

Annual Forecast in Patients With Acute Ischemic Stroke: Role of Pathological Ankle-Brachial Index

“…В последние годы стали обращать внимание на тот факт, что оценка ЛПИ может иметь прогностическое значение в различных когортах обследованных [11], не только в эпидемиологических исследованиях, но и у па-циентов с наличием ССЗ [12]. Недавно опубликованы исследования по прогностическому значению ЛПИ у больных ОНМК [13], однако до сих пор такие иссле-дования проводили в зарубежных странах, отече-ственные исследования ЛПИ при ОНМК только стали появляться, и касаются только отдельных клинических вопросов данной тематики [14]. В российской практике лечения больных после ОНМК до сих пор сохраняет-ся проблема назначения оптимальной медикамен-тозной терапии [15], что сопровождается более высо-кой частотой ССО и смертностью после перенесенного инсульта [4].…”

Association between the CHADS2 Score and an Ankle-Brachial Index of ＜0.9 in Patients without Atrial Fibrillation

“…PAOD is a systemic atherosclerotic process for whichthemajorriskfactorsaresimilartoatherosclerosisinthecoronaryandcarotidarteries 6) .Majorrisk factors for PAOD include an advanced age, cigarette smoking, diabetes mellitus, dyslipidemia and hypertension [6][7] . In addition, chronic kidney disease, race, obesity, elevated inflammatory markers, stroke and congestiveheartfailurehavealsobeenreportedtobe associatedwithPAOD [6][7][8][9][10][11][12] . The CHADS2 (congestive heart failure, hypertension,age≧75years,diabetes,priorstroke)scoreis a reliable, simple and popular clinical score that is usedtoassesstheriskofstrokeinpatientswithatrial surementwasperformedonceineachpatient.…”