The Association of Peripheral Arterial Occlusive Disease with Major Coronary Events in a Mediterranean Population with Low Coronary Heart Disease Incidence

Objectives: The association of peripheral arterial occlusive disease (PAD) association with major coronary events (MCE) has been well documented, nevertheless data are lacking for populations with a low incidence of coronary heart disease (CHD). We aimed to assess the association of PAD with MCE in a Mediterranean population. Design: Prospective survey of 699 55-74 year-old men representative of an urban district near Barcelona (Spain). Methods: Baseline cardiovascular risk factors, CHD and PAD (ankle/brachial index < 0.9) were recorded. MCE were evaluated during the 5-year follow-up. Results: At recruitment 94 subjects (13.4%) had PAD. During follow-up (mean 69.3 months), 35 (5%) subjects suffered a MCE, of whom 12 had PAD, 9 previous symptomatic CHD and 1 subject both conditions. Higher CHD related mortality (8.6% vs 1.4%; p < 0.001) and lower MCE-free survival (78.67% vs 93.26%; p < 0.001) was observed for PAD subjects. On Cox regression analysis PAD (RR = 3; p = 0.003) and previous symptomatic CHD (RR = 4.1; p < 0.001) were associated independently with MCE during follow-up. Conclusions: Even in a population with a low incidence of CHD there is a strong relationship between PAD and future MCE. Screening for PAD may improve the selection of patients targeted for cardiovascular risk prevention. © 2008 European Society for Vascular Surgery.