TY - JOUR
T1 - Peripheral arterial disease and progression of coronary atherosclerosis
AU - Hussein, Ayman A.
AU - Uno, Kiyoko
AU - Wolski, Kathy
AU - Kapadia, Samir
AU - Schoenhagen, Paul
AU - Tuzcu, E. Murat
AU - Nissen, Steven E.
AU - Nicholls, Stephen J.
N1 - Copyright:
Copyright 2011 Elsevier B.V., All rights reserved.
PY - 2011/3/8
Y1 - 2011/3/8
N2 - Objectives: The purpose of this analysis was to characterize the progression of coronary atherosclerosis in patients with concomitant peripheral arterial disease (PAD). Background: Peripheral arterial disease is associated with adverse cardiovascular outcomes. The impact of concomitant PAD on coronary atherosclerosis progression in patients with coronary artery disease has not been well established. Methods: The burden and progression of coronary atherosclerosis was investigated in 3,479 patients with coronary artery disease with (n = 216) and without (n = 3,263) concomitant PAD who participated in 7 clinical trials that employed serial intravascular ultrasound imaging. Results: Patients with PAD had a greater percent atheroma volume (40.4 ± 9.2% vs. 38.5 ± 9.1%, p = 0.002) and percentage of images containing calcium (35.1 ± 26.2% vs. 29.6 ± 24.2%, p = 0.002), in association with smaller lumen volume (275.7 ± 101.6 mm3 vs. 301.4 ± 110.3 mm3, p < 0.001) and vessel wall volume (467.7 ± 166.8 mm3 vs. 492.9 ± 169.8 mm3, p = 0.01). On serial evaluation, patients with PAD demonstrated greater progression of percent atheroma volume (+0.58 ± 0.38 vs. +0.23 ± 0.3%, p = 0.009) and total atheroma volume (-0.17 ± 2.69 mm3 vs. -2.05 ± 2.15 mm3, p = 0.03) and experienced more cardiovascular events (26.3% vs. 19.8%, p = 0.03). In patients with PAD and without PAD, respectively, achieving levels of low-density lipoprotein cholesterol <70 mg/dl was associated with less progression of percent atheroma volume (+0.16 ± 0.27% vs. +0.76 ± 0.20%, p = 0.04; and +0.05 ± 0.14% vs. +0.29 ± 0.13%, p < 0.001) and total atheroma volume (-3.0 ± 1.9 mm3 vs. +1.0 ± 1.4 mm3, p = 0.04; and -3.3 ± 1.1 mm3 vs. -1.6 ± 1.0 mm3, p < 0.001). Conclusions: Patients with concomitant PAD harbor more extensive and calcified coronary atherosclerosis, constrictive arterial remodeling, and greater disease progression. These changes are likely to contribute to adverse cardiovascular outcomes. The benefit for all patients achieving low levels of low-density lipoprotein cholesterol supports the need for intensive lipid lowering in patients with PAD.
AB - Objectives: The purpose of this analysis was to characterize the progression of coronary atherosclerosis in patients with concomitant peripheral arterial disease (PAD). Background: Peripheral arterial disease is associated with adverse cardiovascular outcomes. The impact of concomitant PAD on coronary atherosclerosis progression in patients with coronary artery disease has not been well established. Methods: The burden and progression of coronary atherosclerosis was investigated in 3,479 patients with coronary artery disease with (n = 216) and without (n = 3,263) concomitant PAD who participated in 7 clinical trials that employed serial intravascular ultrasound imaging. Results: Patients with PAD had a greater percent atheroma volume (40.4 ± 9.2% vs. 38.5 ± 9.1%, p = 0.002) and percentage of images containing calcium (35.1 ± 26.2% vs. 29.6 ± 24.2%, p = 0.002), in association with smaller lumen volume (275.7 ± 101.6 mm3 vs. 301.4 ± 110.3 mm3, p < 0.001) and vessel wall volume (467.7 ± 166.8 mm3 vs. 492.9 ± 169.8 mm3, p = 0.01). On serial evaluation, patients with PAD demonstrated greater progression of percent atheroma volume (+0.58 ± 0.38 vs. +0.23 ± 0.3%, p = 0.009) and total atheroma volume (-0.17 ± 2.69 mm3 vs. -2.05 ± 2.15 mm3, p = 0.03) and experienced more cardiovascular events (26.3% vs. 19.8%, p = 0.03). In patients with PAD and without PAD, respectively, achieving levels of low-density lipoprotein cholesterol <70 mg/dl was associated with less progression of percent atheroma volume (+0.16 ± 0.27% vs. +0.76 ± 0.20%, p = 0.04; and +0.05 ± 0.14% vs. +0.29 ± 0.13%, p < 0.001) and total atheroma volume (-3.0 ± 1.9 mm3 vs. +1.0 ± 1.4 mm3, p = 0.04; and -3.3 ± 1.1 mm3 vs. -1.6 ± 1.0 mm3, p < 0.001). Conclusions: Patients with concomitant PAD harbor more extensive and calcified coronary atherosclerosis, constrictive arterial remodeling, and greater disease progression. These changes are likely to contribute to adverse cardiovascular outcomes. The benefit for all patients achieving low levels of low-density lipoprotein cholesterol supports the need for intensive lipid lowering in patients with PAD.
KW - atherosclerosis
KW - intravascular ultrasound
KW - peripheral arterial disease
KW - risk factors
UR - http://www.scopus.com/inward/record.url?scp=79952310013&partnerID=8YFLogxK
U2 - 10.1016/j.jacc.2010.10.034
DO - 10.1016/j.jacc.2010.10.034
M3 - Article
C2 - 21371639
AN - SCOPUS:79952310013
SN - 0735-1097
VL - 57
SP - 1220
EP - 1225
JO - Journal of the American College of Cardiology
JF - Journal of the American College of Cardiology
IS - 10
ER -