Early-onset peripheral arterial occlusive disease: Clinical features and determinants of disease severity and location

Simone Barretto, Karla V. Ballman, Thom W Rooke, Iftikhar Jan Kullo

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

Early-onset peripheral lower extremity arterial occlusive disease (PAD) is an uncommon, poorly characterized manifestation of atherosclerotic vascular disease. We studied the clinical presentation and correlates of disease severity and location in patients with early-onset PAD identified at non-invasive arterial evaluation. We identified a series of 159 patients who were younger than 50 years and had an abnormal resting or postexercise ankle brachial index (ABI) (<0.9) or, if arteries were noncompressible, monophasic arterial Doppler signals. Disease severity and location were determined based on results of noninvasive vascular laboratory testing. Presence of coexisting atherosclerosis in other arterial beds was ascertained by review of patient records. Multivariable logistic regression analyses were used to identify risk factors associated with disease severity and location. Mean age of the patients was 42.7 ± 4.2 years and 55% were women. Prevalence of risk factors was 76% for current or past smoking; 71%, dyslipidemia; 53%, hypertension; 35%, diabetes; and 53%, family history. Claudication was present in 50%, rest pain in 3%, ulceration in 31% and the remaining 16% did not have symptoms from PAD. Low high-density lipoprotein (HDL)-cholesterol and female sex were associated with severity. Of 102 patients in whom disease location could be determined noninvasively, 65% had aortoiliac disease. Female sex, low HDL-cholesterol, and absence of diabetes were associated with aortoiliac disease. Atherosclerosis in other arterial beds was identified in 53% of the patients. Conclusion: In this study population of early-onset atherosclerotic PAD, men and women were equally represented. The disease involved predominantly the aortoiliac location. Low HDL-cholesterol and female sex were associated with disease severity. An aggressive approach to diagnosis and treatment may be warranted as atherosclerosis in other arterial beds was prevalent in half of the patients.

Original languageEnglish (US)
Pages (from-to)95-100
Number of pages6
JournalVascular Medicine
Volume8
Issue number2
DOIs
StatePublished - 2003

Fingerprint

Arterial Occlusive Diseases
Peripheral Arterial Disease
LDL Cholesterol
HDL Cholesterol
Atherosclerosis
Ankle Brachial Index
Dyslipidemias
Vascular Diseases
Blood Vessels
Lower Extremity
Arteries
Logistic Models
Smoking
Regression Analysis
Hypertension
Pain

Keywords

  • Aortoiliac disease
  • Atherosclerosis
  • High-density lipoprotein cholesterol
  • Intermittent claudication

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Early-onset peripheral arterial occlusive disease : Clinical features and determinants of disease severity and location. / Barretto, Simone; Ballman, Karla V.; Rooke, Thom W; Kullo, Iftikhar Jan.

In: Vascular Medicine, Vol. 8, No. 2, 2003, p. 95-100.

Research output: Contribution to journalArticle

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abstract = "Early-onset peripheral lower extremity arterial occlusive disease (PAD) is an uncommon, poorly characterized manifestation of atherosclerotic vascular disease. We studied the clinical presentation and correlates of disease severity and location in patients with early-onset PAD identified at non-invasive arterial evaluation. We identified a series of 159 patients who were younger than 50 years and had an abnormal resting or postexercise ankle brachial index (ABI) (<0.9) or, if arteries were noncompressible, monophasic arterial Doppler signals. Disease severity and location were determined based on results of noninvasive vascular laboratory testing. Presence of coexisting atherosclerosis in other arterial beds was ascertained by review of patient records. Multivariable logistic regression analyses were used to identify risk factors associated with disease severity and location. Mean age of the patients was 42.7 ± 4.2 years and 55{\%} were women. Prevalence of risk factors was 76{\%} for current or past smoking; 71{\%}, dyslipidemia; 53{\%}, hypertension; 35{\%}, diabetes; and 53{\%}, family history. Claudication was present in 50{\%}, rest pain in 3{\%}, ulceration in 31{\%} and the remaining 16{\%} did not have symptoms from PAD. Low high-density lipoprotein (HDL)-cholesterol and female sex were associated with severity. Of 102 patients in whom disease location could be determined noninvasively, 65{\%} had aortoiliac disease. Female sex, low HDL-cholesterol, and absence of diabetes were associated with aortoiliac disease. Atherosclerosis in other arterial beds was identified in 53{\%} of the patients. Conclusion: In this study population of early-onset atherosclerotic PAD, men and women were equally represented. The disease involved predominantly the aortoiliac location. Low HDL-cholesterol and female sex were associated with disease severity. An aggressive approach to diagnosis and treatment may be warranted as atherosclerosis in other arterial beds was prevalent in half of the patients.",
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