The prognostic value of various markers of lower limb atherosclerotic lesions in patients with high and very high cardiovascular risk

Abstract

Aim. To study the prognostic significance of various markers of atherosclerosis of lower limb arteries (LLA) in patients at high and very high cardiovascular risk (CVR).Methods. The study included 108 patients at high and very high CVR, the median age of which was 62.0 (55.7; 67.0) years. All patients underwent duplex scanning of the LLA, as well as measurement of the ankle-brachial index (ABI) by the Doppler method. The combined end point was cardiovascular death, nonfatal myocardial infarction or unstable angina, requiring hospitalization, nonfatal stroke, coronary revascularization.Results. Atherosclerotic plaques in LLA were detected in 69.4% of cases, while a decrease in ABI was detected in 22.2% of patients, and LLA stenosis more than 50% in 36.1%. The follow-up duration was 25.0 (14.5; 35.5) months. The adverse cardiovascular events occurred in 41 (37.9%) patients. According to the Cox regression results, the following indicators had an independent predictive value in relation to the development of adverse cardiovascular events: a decrease in ABI ≤0.9 (RR 2.23; 95% CI 1.01-4.94; p=0.048), LLA stenosis ≥40% (RR 3.17; 95% CI 1.27–7.92; p=0.013) and the presence of plaque in the popliteal arteries (RR 2.49; 95% CI 1.27–7.92; p=0.013).Conclusion. In the group of patients at high and very high CVR, among ultrasonographic markers of lower limb arteriosclerosis, independent predictive value regarding the development of adverse cardiovascular events had a decrease in ABI ≤0.9, the presence of plaque in the popliteal arteries and LLA stenosis more than 40%.