on August 27, 2009
Published online before print August 27, 2009, doi: 10.1161/STROKEAHA.109.559278
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Submitted on May 31, 2009
From the Departments of Neurology (S.S., D.R.L., E.K., J.S.), Dental Ecology (J.B.), Epidemiology (W.R.), UNC Stroke Program University of North Carolina, Chapel Hill, NC; the Department of Neurology (J.K.), Wake Forest University, Winston-Salem, NC; and the Department of Cardiovascular Science (W.A.T.), Brody School of Medicine, East Carolina University, Greenville, NC. * To whom correspondence should be addressed. E-mail: SenS{at}neurology.unc.edu.
Background and Purpose—Patients with stroke and patients with transient ischemic attack (TIA) are at high risk for vascular events and may not exhibit the signs and symptoms of peripheral arterial disease (PAD). We investigated if asymptomatic PAD detected by ankle brachial index <0.9 is independently associated with recurrent vascular events in patients with stroke or TIA. Methods—In this prospective longitudinal hospital-based cohort study, asymptomatic PAD was detected by ankle brachial index measurement in consecutive patients with stroke and patients with TIA. They were assessed for stroke risk factors, ankle brachial index measurement, and laboratory parameters known to be associated with stroke risk. These patients were followed for composite vascular events, including stroke, TIA, myocardial infarction, and vascular death. Results—In a 1-year period, 102 patients were evaluated, of whom 26% had asymptomatic PAD. All patients were followed for a median period of 2.1 years from the index stroke/TIA (range, 1.0 to 2.7 years) for vascular events. Kaplan–Meier curve showed fewer patients with asymptomatic PAD remained free of composite vascular events (48% compared with 84% in the no-PAD group; log rank, P=0.0001). Asymptomatic PAD was significantly associated with composite vascular events before (hazard ratio, 4.2; 95% CI, 1.9 to 9.3; P=0.0003) and after adjustment for confounders (hazard ratio, from Model 1, 2.8; 95% CI, 1.1 to 7.2; P=0.03 and Model 2, 3.4; 95% CI, 1.4 to 8.2, P=0.006). Asymptomatic PAD was also significantly associated with stroke before (hazard ratio, 6.5; 95% CI, 2.1 to 19.9; P=0.001) and after adjustment for confounders (hazard ratio from Model 1, 4.8; 95% CI, 1.5 to 15.3; P=0.009 and Model 2, 5.2; 95% CI, 1.5 to 17.6; P=0.008). Conclusions—In patients with stroke or TIA, asymptomatic PAD is independently associated with recurrent vascular events and stroke.
Revised on July 6, 2009
Accepted on July 15, 2009
Association of Asymptomatic Peripheral Arterial Disease With Vascular Events in Patients With Stroke or Transient Ischemic Attack
Souvik Sen MD, MS, MPH, FAHA*;
Key words: claudication • peripheral vascular disease • propensity score • stroke