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 tacking 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. (C) 2008 European Society for Vascular Surgery. Published by Elsevier Ltd. All rights reserved.