title: Prevalence and severity of asymptomatic coronary and carotid artery disease in patients with lower limbs arterial disease.
abstract: OBJECTIVE
  Lower limbs arterial disease (LLAD) portends high risk of cardiovascular events. Yet, the prevalence of significant occult coronary artery (CAD) and cerebrovascular (CVD) disease in patients without CAD and CVD has not been widely investigated. The purpose of this study was to evaluate the prevalence and severity of CAD and CVD in patients with LLAD of the lower extremities.
  
  
  METHODS
  From January 2008 through December 2011 we studied 200 consecutive patients admitted for symptomatic LLAD, with normal global and regional systolic function, no symptoms of angina or dyspnea. During hospital admission all patients underwent carotid Doppler study and invasive angiography.
  
  
  RESULTS
  Significant CAD was observed in 110 of 200 (55%) patients. Fifty-eight (53%) patients with significant CAD showed either left main (n = 7), 3 vessels (n = 35) or proximal left anterior descending (n = 16) CAD, corresponding to 29% of total cohort. CVD was detected in 86(43%) patients (69% with concomitant CAD), including 30(35%) with severe and 15(17%) with significant disease. In thirty-two (37%) patients with CVD either left main (n = 4), 3 vessels (n = 18) or proximal left anterior descending (n = 10) CAD was observed. The percent of patients with left main, 3 vessel or proximal left anterior descending stenosis among those with CVD was significantly higher (37%; p = 0.03) compared to those without CVD.
  
  
  CONCLUSIONS
  Severe asymptomatic CAD and CVD are quite prevalent in LLAD, and 29% of patients fulfill indications for coronary revascularization. Cost-effective strategies to detect occult CAD or CVD in LLAD patients need to be investigated in large multicenter studies.
authors.affiliation: Department of Advanced Biomedical Sciences, University of Naples Federico II, Via Pansini, 5, I-80131 Naples, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Marsico
authors.forename: Donatella
authors.initials: D
authors.lastname: Ruggiero
authors.forename: Antonio
authors.initials: A
authors.lastname: Parente
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Pirozzi
authors.forename: Francesca
authors.initials: F
authors.lastname: Musella
authors.forename: Francesco
authors.initials: F
authors.lastname: Lo Iudice
authors.forename: Gianluigi
authors.initials: G
authors.lastname: Savarese
authors.forename: Teresa
authors.initials: T
authors.lastname: Losco
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Giugliano
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rengo
authors.forename: Santo
authors.initials: S
authors.lastname: Dellegrottaglie
authors.forename: Dario
authors.initials: D
authors.lastname: Leosco
authors.forename: Giovanni
authors.initials: G
authors.lastname: Esposito
authors.forename: Bruno
authors.initials: B
authors.lastname: Trimarco
authors.forename: Pasquale
authors.initials: P
authors.lastname: Perrone-Filardi
mesh_terms: D000368:Aged; D058070:Asymptomatic Diseases; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology*; D016009:Chi-Square Distribution; D015897:Comorbidity; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging / Q000453:epidemiology*; D011237:Predictive Value of Tests; D015995:Prevalence; D012307:Risk Factors; D012720:Severity of Illness Index; D018608:Ultrasonography, Doppler