Common carotid intima-media thickness in peripheral arterial disease

Abstract

The common carotid intima-media thickness (IMT) is regarded as a reliable predictor of cardiovascular morbidity. Patients with peripheral arterial disease (PAD) have an increased risk of cardiovascular morbidity and mortality, and PAD is associated with increases in IMT. The aim of this study was to establish whether IMT would be a suitable parameter for predicting cardiovascular risk in individual patients with PAD and the factors involved in determining IMT in these patients. This prospective study included 314 subjects: 112 patients with isolated PAD, 85 patients with PAD and additional coronary and/or cerebrovascular atherosclerosis, and 117 subjects without atherosclerotic disease. Maximum IMT (mIMT) was measured using high-resolution B-mode ultrasonography. Patients with isolated PAD were examined for influencing factors on mIMT. The mIMT in patients with isolated PAD (1.01 ± 0.2 mm) was not significantly different from that of patients with PAD and additional systemic atherosclerosis (1.01 ± 0.17 mm). Controls showed a significantly lower mIMT (0.71 ± 0.15 mm). In multivariate stepwise regression analysis, the chief influencing factors on mIMT in patients with isolated PAD included age as well as fasting insulin and plasminogen activator inhibitor-1 (PAI-1). We found significant correlations between mIMT and the presence of microalbuminuria in nondiabetics with PAD. The highly increased mIMT values of patients with isolated PAD reflect the elevated cardiovascular risk which is already present in the early clinical stages of PAD. The links between fasting insulin, PAI-1, microalbuminuria, and older age with mIMT in isolated PAD are at the same time important predictors of the development of systemic atherosclerosis in PAD.