Non-invasively detected carotid stenosis and ischaemic heart disease in men with leg arteriosclerosis.
Since the excess mortality rate associated with an ankle-brachial blood-pressure index (ABPI) less than 0.9 was only partly explained by an excess cardiovascular mortality, we believe that leg artery disease should not only be regarded as a marker of generalised arteriosclerosis but also as a sign associated with an increased risk of premature death. 439 men who were part of a prospective population study in Malmö, Sweden, were, at 68 years of age, invited to a health examination including, ABPI, carotid-artery ultrasonography, and 24 h ambulatory electrocardiographic monitoring. Cause-specific mortality and incidence of myocardial infarction (MI) during 8 years of follow-up was compared in men with and without signs of arteriosclerotic disease. Of 60 men with an ABPI < 0.9, 20 (33%) had angina pectoris or previous MI. Another 11 (18%) had silent ST-segment depression (> or = 1 mm); 3 (5%) had a history of stroke; and 17 (28%) had symptom-free carotid stenosis (> 30% reduction of the cross-sectional diameter). Total mortality rate in men with no signs of arteriosclerotic disease was 19.6 per 1000 person-years and cardiac event rate (fatal and non-fatal MI and death from chronic ischaemic heart disease was 8.6 per 1000 person-years). Leg artery disease, carotid stenosis, and ischaemic heart disease were in a univariate analysis all associated with an increased cardiac event rate and an increased total mortality rate. In a multivariate analysis an ABPI less than 0.9 was associated with a 2.4 times higher total mortality (95% CI 1.5-3.9) and a 2.0 times higher cardiac event rate (1.1-3.9). Carotid stenosis and ischaemic heart disease contributed to the risk for MI (RR 2.1; 95% CI 1.2-3.8; and 2.1; 1.2-3.9, respectively), whereas no independent association with total mortality was found.
Ogren
M
M
Department of Community Health Sciences, Lund University, Malmö General Hospital, Sweden.
Hedblad
B
B
Isacsson
S O
SO
Janzon
L
L
Jungquist
G
G
Lindell
S E
SE
D000368:Aged; D001161:Arteriosclerosis / Q000150:complications* / Q000453:epidemiology; D001794:Blood Pressure; D016893:Carotid Stenosis / Q000150:complications* / Q000453:epidemiology; D002784:Cholesterol / Q000097:blood; D015331:Cohort Studies; D006801:Humans; D007866:Leg; D008297:Male; D017202:Myocardial Ischemia / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D011446:Prospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D013548:Sweden
D002784:Cholesterol