Coronary artery disease associated with Carotid artery disease and lower extremity peripheral artery disease: Preliminary result study

Intensive antithrombotic therapy reduces major adverse cardiovascular events (MACE) and major adverse limb events (MALE) in patients with peripheral artery disease (PAD). Recent studies have suggested heterogeneity in risk and benefit in those with and without concomitant coronary artery disease (CAD) and peripheral revascularization. We evaluated the risk of MACE and MALE in patients with PAD stratified by history of concomitant CAD and prior peripheral revascularization and whether the efficacy and safety of vorapaxar were similar in these subgroups. The TRA 2°P-TIMI 50 trial randomized 26,449 patients with prior MI, ischemic stroke, or PAD to vorapaxar or placebo. This analysis examined the effect of vorapaxar in a broad population of 6136 patients with PAD. Overall, vorapaxar significantly reduced MACE (HR 0.85, 95% CI 0.73, 0.99; p = 0.034) and MALE (HR 0.70, 95% CI 0.53, 0.92; p = 0.011) in patients with PAD. The absolute risk reduction (ARR) for MACE was greater in patients with PAD and CAD versus those with PAD alone (–2.2% vs 0.1%: number needed to treat (NNT) 45 vs 1000). Conversely, the ARR for MALE was higher in those with prior lower extremity revascularization (2.5% vs 0.2%: NNT 40 vs 500). Vorapaxar increased major bleeding (HR 1.39, 95% CI 1.12, 1.71; p = 0.003). The net clinical outcome in all patients with PAD was reduced with vorapaxar (HR 0.82, 95% CI 0.72, 0.94; p = 0.004), with benefits driven by reductions in MACE for those with CAD and by reductions in MALE for those with prior peripheral revascularization. Among patients with PAD, vorapaxar resulted in a net clinical benefit; however, the drivers of benefit were heterogeneous, with greater reductions in MACE in those with concomitant CAD and greater reductions in MALE in those with prior lower extremity revascularization, and unclear benefit in patients with neither. These clinical characteristics may be useful in identifying the subgroups of patients with PAD most likely to benefit from potent antithrombotic therapies. ClinicalTrials.gov Identifier: NCT00526474

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Co-Existence of Carotid Artery Disease, Renal Artery Stenosis, and Lower Extremity Peripheral Arterial Disease in Patients With Coronary Artery Disease

The American Journal of Cardiology ◽

10.1016/j.amjcard.2013.09.015 ◽

2014 ◽

Vol 113 (1) ◽

pp. 30-35 ◽

Cited By ~ 33

Author(s):

Yoichi Imori ◽

Takeshi Akasaka ◽

Tomoki Ochiai ◽

Kazuma Oyama ◽

Kazuki Tobita ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Carotid Artery ◽

Peripheral Arterial Disease ◽

Lower Extremity ◽

Renal Artery ◽

Carotid Artery Disease ◽

Arterial Disease ◽

Artery Disease ◽

Peripheral Arterial

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Faculty Opinions recommendation of Co-existence of carotid artery disease, renal artery stenosis, and lower extremity peripheral arterial disease in patients with coronary artery disease.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718220370.793496013 ◽

2014 ◽

Author(s):

Wilbert Aronow

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Carotid Artery ◽

Peripheral Arterial Disease ◽

Lower Extremity ◽

Renal Artery ◽

Carotid Artery Disease ◽

Arterial Disease ◽

Artery Disease ◽

Peripheral Arterial

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Lower extremity and carotid artery disease in COPD

ERJ Open Research ◽

10.1183/23120541.00037-2016 ◽

2016 ◽

Vol 2 (4) ◽

pp. 00037-2016 ◽

Cited By ~ 3

Author(s):

Carmen Pizarro ◽

Fabian Linnhoff ◽

Fabian van Essen ◽

Simon Pingel ◽

Christian Alexander Schaefer ◽

...

Keyword(s):

Carotid Artery ◽

Lower Extremity ◽

Peripheral Artery Disease ◽

Odds Ratio ◽

Carotid Artery Disease ◽

Plaque Burden ◽

Chronic Obstructive ◽

Peripheral Artery ◽

Copd Patients ◽

Artery Disease

In view of their common chronic inflammatory process, we sought to determine the linkage between peripheral artery disease and chronic obstructive pulmonary disease (COPD).107 COPD patients (mean±sdage 64.6±10.4 years, 52.2% male) and 22 control smokers without previously diagnosed peripheral artery disease underwent standardised angiological examination for lower extremity artery disease (LEAD) and carotid artery disease.LEAD was significantly more prevalent in COPD patients than in controls (80.4%versus54.5%, p=0.002). Among COPD patients, 57.0%, 12.2%, 10.3% and 0.9% were found to be in Fontaine stages I, IIA, IIB and III, respectively. As with carotid artery disease, its frequency increased from 36.4% in controls to 58.9% in COPD patients (p=0.003). Carotid plaque burden, LEAD Fontaine degrees as well as pulse wave index and ankle–brachial index manifested significant impairment over percentage predicted forced expiratory volume in 1 s (FEV1% pred) (p=0.02, p<0.001, p=0.01 and p<0.001, respectively). Multivariate analysis revealed that COPD Global Initiative for Chronic Obstructive Lung Disease status was the strongest independent predictor for the presence of plaque in lower extremity arteries (odds ratio 1.63, 95% CI 1.19–2.25, p=0.003) and carotids (odds ratio 1.66, 95% CI 1.14–2.44, p=0.009).As compared with control smokers, peripheral artery disease is diagnosed in a sizeable proportion of COPD patients and exhibits significant distributive differences over FEV1% pred that exceed the susceptibility conferred by common cardiovascular stressors.

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