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Correlations Between Peripheral Artery Disease and Cardiovascular Disease Outcomes Open Access


Other title
Peripheral artery disease
Outcomes research
Cardiovascular disease
Ankle-brachial index
Type of item
Degree grantor
University of Alberta
Author or creator
Sebastianski, Meghan K
Supervisor and department
McMurtry, M Sean (Medicine)
Tsuyuki, Ross T (Medicine)
Examining committee member and department
Graham, Michelle M (Medicine)
Makowsky, Mark J (Pharmacy)
Bungard, Tammy J (Medicine)
Hemmelgarn, Brenda (Community Health Sciences)
Department of Medicine

Date accepted
Graduation date
Doctor of Philosophy
Degree level
Lower-extremity peripheral artery disease (PAD) is a manifestation of atherosclerotic disease in the lower limbs. PAD is a risk factor for poor outcomes including myocardial infarction, stroke, and mortality. Despite the potential benefits of early PAD detection, in the majority of PAD cases patients are asymptomatic, and as a result, PAD is underdiagnosed and undertreated. Furthermore, additional evidence is needed to clarify if PAD prevalence varies between ethnic groups. In short, the true burden of PAD is unknown. The main objective was to explore the prognostic relationship between PAD and outcomes in patients undergoing coronary angiography. Prospective collection of an ankle-brachial index (ABI), a non-invasive test with a high sensitivity and specificity for detecting PAD, was undertaken in 1100 patients. As ABI is often dichotomized for use in PAD detection and risk stratification, we examined continuous ABI as a risk marker and predictor of outcomes. We also undertook a systematic review of PAD prevalence studies and a cross-sectional analysis of cohort data to investigate the ethnic burden of PAD. Patients undergoing coronary angiography who have PAD (ABI ≤ 0.90) had 4.3 times more complex coronary artery disease (CAD) (adjusted OR 4.3, 95% CI 1.2, 14.9; p=0.022), 3.5 times more myocardium at risk (adjusted OR 3.5, 95% CI 1.7, 7.1; p=0.001), and less complete coronary revascularization (adjusted OR 3.0, 95% CI 1.1, 8.8; p=0.039) than patients with a normal ABI. At the other end of the ABI spectrum, there was no positive association between ABI > 1.40 and systolic inter-arm blood pressure difference (IAD) ≥ 10mmHg; rather there was a trend for a negative association (adjusted OR 0.3, 95% CI 0.1, 1.3; p=0.117). Differences in PAD prevalence were found in our systematic review where South Asians had significantly less PAD than White Europeans. Interestingly, no differences in PAD prevalence were found across six ethnic groups of patients undergoing hemodialysis. Our results support ABI use in screening and risk prediction in patients undergoing coronary angiography. More evidence is needed to determine the mechanisms for ethnic differences in PAD prevalence and further discussion of ABI is necessary to develop population appropriate guidelines.
Permission is hereby granted to the University of Alberta Libraries to reproduce single copies of this thesis and to lend or sell such copies for private, scholarly or scientific research purposes only. Where the thesis is converted to, or otherwise made available in digital form, the University of Alberta will advise potential users of the thesis of these terms. The author reserves all other publication and other rights in association with the copyright in the thesis and, except as herein before provided, neither the thesis nor any substantial portion thereof may be printed or otherwise reproduced in any material form whatsoever without the author's prior written permission.
Citation for previous publication
Sebastianski M, Makowsky MJ, Dorgan M, Tsuyuki RT. Paradoxically lower prevalence of peripheral arterial disease in South Asians: a systematic review and meta-analysis. Heart. 2013; 1–8. doi:10.1136/heartjnl-2013-303605.

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