Prognostic Significance of Carotid and Lower Extremity Artery Stenosis in Patients With High and Very High Cardiovascular Risk

Abstract

Aim      To study prognostic significance of the degree of stenosis of carotid and lower-extremity arteries (LEA) in patients at high and very high risk of cardiovascular complications (CVC).Material and methods  The study included men and women aged 40–67 years at high and very high risk of CVC. Duplex ultrasound scanning of carotid arteries and LEA was performed for all patients. Laboratory tests included measurements of glucose, glycated hemoglobin, total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), triglycerides, uric acid, creatinine with estimation of glomerular filtration rate (GFR) using the CKD-EPI Creatinine Equation formula, and high-sensitivity C-reactive protein (hsCRP). Composite endpoint was death from CVC, nonfatal myocardial infarction, nonfatal stroke, and coronary revascularization.Results The study included 214 patients from groups of high and very high risk of CVC. Median age of patients was 59.0 [53.2; 64.0] years. A very high risk was identified in 141 (65.8 %) patients and a high risk of CVC in 73 (34.1 %). Atherosclerotic plaques in at least one vascular bed were found in 191 (89.3 %) patients. Duration of the follow-up period was 32.0 [13.7; 49.1] months. Outcomes comprising the composite endpoint were observed in 36 (16.8 %) patients. Presence of carotid stenosis ≥35 % was not statistically significantly associated with the occurrence of outcomes comprising the composite endpoint (relative risk, RR: 1.22; 95 % confidence interval, CI: 0.56–2.66; p=0.607). In contrast, the presence of LEA stenosis ≥35 % was associated with a 2.51 times increased RR of CVC (95 % CI: 1.02–6.23; p=0.044).Conclusion      In patients from the groups of high risk and very high risk of CVC, the presence of LEA stenosis ≥35 % predicted the development of severe CVC with a 69.4% sensitivity and a 61.8% specificity. The presence of LEA stenosis ≥35 %, but not of carotid arteries, was an independent predictor of severe CVC (RR, 2.51; 95 % CI: 1.02–6.23; p=0.044) after adjustments for sex, age, presence of arterial hypertension, diabetes mellitus, ischemic heart disease, obesity, smoking, LDL-C, GFR, and drug therapy.