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19-05-2010 | Stroke | Article

PAD is a ‘strong’ indicator of stroke risk


Free abstract

MedWire News: Having peripheral artery disease (PAD) doubles people’s risk for stroke, shows a large, observational study.

The risk is equally strong for people with symptomatic and asymptomatic PAD, reveal the findings published in the journal Cerebrovascular Disease.

Roman Haberl (Städtisches Klinikum München, Germany) and colleagues monitored 6880 primary care patients aged at least 65 years. All patients had their Ankle-Brachial Index (ABI) calculated at baseline, with PAD defined as an ABI lower than 0.9.

During 5 years of follow-up, 183 patients suffered a stroke. The stroke rate among the 5867 patients with PAD was 10.6 per 1000 patient-years, which was more than double the rate of 5.0 per 1000 patient-years seen among the 24,048 patients without PAD.

Ischemic stroke rates were 9.7 versus 4.0 per 1000 patient-years in patients with and without PAD, respectively. The corresponding rates for fatal strokes were 2.4 versus 0.7 per 1000 patient-years and for nonfatal strokes were 8.0 versus 4.2 per 1000 patient-years.

These rates significantly increased risk 1.57 fold for all stroke, 1.73 fold for ischemic stroke, and 2.53 fold for fatal stroke, after accounting for variables including diabetes, hypertension, dyslipidemia, history of stroke or cardiovascular disease, age, gender, body mass index, and smoking.

The adjusted 1.41-fold increase in risk for nonfatal stroke was not statistically significant, and hemorrhagic stroke rates were not affected by the presence of PAD.

Patients with asymptomatic PAD had an adjusted 1.91-fold increased risk for stroke, while those with symptomatic PAD had a nonsignificant 1.51-fold risk increase.

In an accompanying commentary, Dirk Sander (University of Technology, Munich, Germany) said: “An important prerequisite for the use of surrogate parameters for risk prediction, particularly in the primary care setting, is that these parameters add substantial incremental value in risk prediction beyond the traditional Framingham-type risk scores.”

This has already been shown for the ABI with respect to mortality and cardiovascular risk, he said. In addition, the ABI is cheap and simple to perform in primary care and community settings.

Sander therefore recommended that elderly patients in primary care be screened for asymptomatic PAD.

But he cautioned: “Whether this screening is cost-effective remains to be established.”

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Eleanor McDermid