Peripheral artery disease assessed by ankle-brachial index in patients with established cardiovascular disease or at least one risk factor for atherothrombosis--CAREFUL study: a national, multi-center, cross-sectional observational study.
BACKGROUND
To investigate the presence of peripheral artery disease (PAD) via the ankle brachial index (ABI) in patients with known cardiovascular and/or cerebrovascular diseases or with at least one risk factor for atherothrombosis.


METHODS
Patients with a history of atherothrombotic events, or aged 50-69 years with at least one cardiovascular risk factor, or > = 70 years of age were included in this multicenter, cross-sectional, non-interventional study (DIREGL04074). Demographics, medical history, physical examination findings, and physician awareness of PAD were analyzed. The number of patients with low ABI (< = 0.90) was analyzed.


RESULTS
A total of 530 patients (mean age, 63.4 ± 8.7 years; 50.2% female) were enrolled. Hypertension and dyslipidemia were present in 88.7% and 65.5% of patients, respectively. PAD-related symptoms were evident in about one-third of the patients, and at least one of the pedal pulses was negative in 6.5% of patients. The frequency of low ABI was 20.0% in the whole study population and 30% for patients older than 70 years. Older age, greater number of total risk factors, and presence of PAD-related physical findings were associated with increased likelihood of low ABI (p < 0.001). There was no gender difference in the prevalence of low ABI, PAD symptoms, or total number of risk factors. Exercise (33.6%) was the most common non-pharmacological option recommended by physicians, and acetylsalicylic acid (ASA) (45.4%) was the most frequently prescribed medication for PAD.


CONCLUSIONS
Our results indicate that advanced age, greater number of total risk factors and presence of PAD-related physical findings were associated with increased likelihood of low ABI. These findings are similar to those reported in similar studies of different populations, and document a fairly high prevalence of PAD in a Mediterranean country.
Department of Cardiovascular Surgery, Istanbul University Cerrahpasa Medical School, Turkey. akbozkurt@yahoo.com
Ahmet K
AK
Bozkurt
Ilker
I
Tasci
Omur
O
Tabak
Mehmet
M
Gumus
Yesim
Y
Kaplan
D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index / Q000379:methods*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D012307:Risk Factors; D013927:Thrombosis / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology*; D014421:Turkey / Q000453:epidemiology
J Am Coll Cardiol. 2008 Apr 1;51(13):1292-8
18371562
JAMA. 2008 Jul 9;300(2):197-208
18612117
Am J Cardiol. 2000 Aug 1;86(3):280-4
10922433
J Endocrinol Invest. 2007 Oct;30(9):721-5
17993762
Arterioscler Thromb Vasc Biol. 1998 Feb;18(2):185-92
9484982
South Med J. 2008 Nov;101(11):1117-20
19088520
J Clin Epidemiol. 2007 Oct;60(10):1067-75
17884603
Atherosclerosis. 1997 May;131(1):115-25
9180252
JAMA. 2006 Feb 1;295(5):536-46
16449619
Arch Intern Med. 2003 Sep 8;163(16):1939-42
12963567
Circulation. 2004 Feb 17;109(6):733-9
14970108
Angiology. 1995 Mar;46(3):211-9
7879961
Arterioscler Thromb Vasc Biol. 2005 Jul;25(7):1463-9
15879302
Eur J Vasc Endovasc Surg. 2007;33 Suppl 1:S1-75
17140820
J Clin Epidemiol. 2004 Mar;57(3):294-300
15066690
Diabetologia. 1995 Jan;38(1):86-96
7744233
J Clin Epidemiol. 1992 Oct;45(10):1101-9
1474406
Int J Epidemiol. 1996 Apr;25(2):282-90
9119553
J Clin Epidemiol. 1991;44(1):15-20
1986053
Circulation. 2004 Aug 10;110(6):738-43
15262830
Atherosclerosis. 2007 Feb;190(2):459-64
16574125
Eur Heart J. 2006 Aug;27(15):1861-7
16820367
Circulation. 1995 Aug 15;92(4):720-6
7641349
J Gen Intern Med. 2001 Jun;16(6):384-90
11422635
Circulation. 2006 Mar 21;113(11):e463-654
16549646
Curr Med Res Opin. 2008 Sep;24(9):2509-22
18664318
Arterioscler Thromb Vasc Biol. 1999 Mar;19(3):538-45
10073955
Vasc Med. 2006 Feb;11(1):29-33
16669410
Circulation. 2002 Oct 8;106(15):1909-12
12370211
Eur J Cardiovasc Prev Rehabil. 2008 Jun;15(3):370-5
18525397
Eur J Vasc Surg. 1993 Sep;7(5):500-6
8405492
BMC Cardiovasc Disord. 2008 Feb 12;8:3
18267039
Circulation. 1993 Sep;88(3):837-45
8353913
Int Angiol. 1994 Sep;13(3):233-45
7822900
Eur Heart J. 2007 Jun;28(12):1462-536
17562668
Circulation. 2008 Aug 26;118(9):961-7
18697822
Diabetes Care. 2010 Jan;33 Suppl 1:S11-61
20042772
N Engl J Med. 1992 Feb 6;326(6):381-6
1729621
South Med J. 2009 Nov;102(11):1106-10
19864988
Int J Clin Pract. 2008 Jul;62(7):1001-7
18462371
JAMA. 2001 Sep 19;286(11):1317-24
11560536
J Clin Epidemiol. 1990;43(6):597-606
2189949
Am J Epidemiol. 2005 Jul 1;162(1):33-41
15961584
Atherosclerosis. 2004 Jan;172(1):95-105
14709362
JAMA. 2006 Jan 11;295(2):180-9
16403930