Researchers find link between asymptomatic PAD and cardiovascular events among stroke and TIA patients

American Heart Association rapid-access journal report

Measuring circulation in the ankle using a device similar to a blood pressure cuff can help identify asymptomatic peripheral artery disease (PAD) in stroke and transient ischemic attack (TIA) survivors, a group at much higher risk of subsequent cerebrovascular events, according to a study in Stroke: Journal of the American Heart Association.

The ankle brachial index (ABI) compares blood flow in the ankle and the arm to detect poor circulation caused by fatty plaque buildup in the lower body. Researchers used it to screen 102 stroke and TIA survivors. The investigators found that 26 percent of the survivors had asymptomatic PAD, and they had three times more subsequent cardiovascular events - stroke, heart attacks or death - in the following two years compared to those without PAD. Fifty percent with asymptomatic PAD suffered subsequent events, compared with 16 percent of those without the disease. In addition, PAD was significantly associated with future vascular events, especially strokes.

This is one of the first studies to find an independent positive association between asymptomatic PAD and cardiovascular events among stroke and TIA patients, according to the researchers.

PAD occurs when arteries in the extremities become obstructed by plaque. Leg pain, cramping, weakness and limping during physical exertion are the primary symptom, yet surveys show that up to one-third of patients never tell their physician about symptoms, and fewer than half of general physicians routinely ask.

"ABI measurement may be appropriate for screening stroke/TIA patients who may be at high risk for vascular events," said lead researcher Souvik Sen, M.D., M.P.H., director of the Stroke Center at the University of North Carolina, Chapel Hill. "The test is easily performed in less than 15 minutes at the physician's office or at bed-side in hospitalized patients."

PAD management guidelines developed by the American Heart Association and the American College of Cardiology recommend screening all high-risk patients.