Heart attacks and strokes as a result of atherosclerosis have been ranked for years among the most common causes of deaths in Europe. Another previously underestimated manifestation of atherosclerosis is peripheral arterial disease (PAD), which is closely associated with heart attack or a stroke.

The German epidemiological study on Ankle Brachial Index (getABI) was initiated in 2001 to answer questions about whether a simple screening test on atherosclerosis can be applied to identify it at an early stage, and if so, what risk such patients carry in the future. Professor Curt Diehm from the Clinic Karlsbad-Langensteinbach, an affiliated teaching hospital of the University in Heidelberg, and his co-workers from various renowned medical institutions in Germany presented a 5-year study follow-up.

Professor Diehm explained: We used the ankle brachial-index (ABI), which is simple to understand and to apply by physicians and nurses. In an individual in the supine position, the blood pressure in the leg arteries is equal to or a little higher than in the arm arteries. If atherosclerotic stenoses in the legs manifests (termed PAD), blood flow after the obstruction decreases, and the pressure in the leg artery is lower than in the arm. This sign is almost and reliable as angiography to identify your atherosclerotic risk patient.

The study included a total of 6,880 unselected patients in primary care, which underwent ABI testing by their primary care physician. Mean age of the patients was 72.5 years, 58% were females, 46% were past or current smokers, 74% had hypertension, 24% diabetes mellitus and 52% lipid disorders. Of all patients, 18.0% in the total cohort had a pathological ABI test, but the majority of these patients had no clinical signs or complaints.

After a 5-year observation period, all-cause mortality was 24% in patients with symptomatic PAD, 19% with asymptomatic PAD (i.e., pathological ABI but no complaints), and 9% in patients without PAD. Even when all other known risk factors for cardiovascular death were accounted for by statistical means, PAD had the best ability to predict future death, stroke or myocardial infarction.

Professor Diehm said, The bad news is: we showed that in primary care every fifth patient aged 65 years or older has atherosclerosis in the leg arteries. Because atherosclerosis is not a local process but at the same time progresses in the heart and brain vessels, such patients usually die from heart attacks or stroke. The good news is that the ABI test is not limited to expert use but can be performed in general practice. Thus, family physicians can identify high risk patients and initiate and maintain effective treatment in this large group.

The study also showed that the extent of the blood pressure difference between legs and arms matters: the higher the spread between both pressures is (in other words: the lower the ABI), the higher is the mortality of patients.

Professsor Diehm said that every effort should be made to implement the ABI screening in standard programs for elderly patients and patients with cardiac risk factors such as diabetes or hypertension. A huge number of lives could be saved if patients with atherosclerosis would be identified with the ABI, and treated timely.

Reference:

This study was presented at the ESC Congress 2007 in Vienna

Notes

The getABI study was funded trough an Unrestricted Educational Grant from Sanofi-Aventis, Berlin, Germany.

The European Society of Cardiology (ESC)

The ESC represents nearly 53,000 cardiology professionals across Europe and the Mediterranean. Its mission is to reduce the burden of cardiovascular disease in Europe.

The ESC achieves this through a variety of scientific and educational activities including the coordination of: clinical practice guidelines, education courses and initiatives, pan-European surveys on specific disease areas and the ESC Annual Congress, the largest medical meeting in Europe. The ESC also works closely with the European Commission and WHO to improve health policy in the EU.

The ESC comprises 3 Councils, 5 Associations, 19 Working Groups, 50 National Cardiac Societies and an ESC Fellowship Community (Fellow, FESC; Nurse Fellow, NFESC). For more information on ESC Initiatives, Congresses and Constituent Bodies see www.escardio.

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