MedWire News: The presence of asymptomatic peripheral arterial disease (PAD) in patients with stroke or transient ischemic attack (TIA) is a major risk factor for recurrent vascular events, a study indicates.
The findings suggest that stroke and TIA patients constitute a high-risk group who would benefit from routine screening for PAD using ankle-brachial index (ABI) measurement, write the study authors in the journal Stroke.
The research, by Souvik Sen (University of North Carolina, Chapel Hill, USA) and team, involved 102 patients with a recent stroke or TIA. In all, 26% were found to have asymptomatic PAD, defined as an ABI value of less than 0.9.
During a median follow-up period of 2.1 years, 25 patients developed vascular events, including 13 strokes, three TIAs, four myocardial infarctions, and five deaths.
The cumulative frequency of vascular events was 52% among patients who had asymptomatic PAD at baseline versus 16% among those without PAD, a highly significant difference.
Further analysis revealed that asymptomatic PAD was significantly associated with the composite of vascular events (adjusted hazard ratio [HR]=2.8 or 3.4, depending on the choice of covariates) and with stroke (HR=4.8 or 5.2).
Commenting on their findings, Sen et al say that this is the first study to report a positive, independent association between asymptomatic PAD and vascular events, including stroke, TIA, myocardial infarction, and death, among patients with a prior stroke or TIA.
“The association between abnormal ABI and adverse outcome may be explained by an overall greater atherosclerotic burden, greater inflammation, inadequate management of risk factors, or all of these factors together,” they write.
The team concludes that ABI measurement “may be appropriate for screening patients with stroke and those with TIA who may be at high risk for vascular events,” but add that further studies are needed to determine the impact of such a strategy.
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