Original Article

Predictive Power of Cardiovascular Risk Factors for Detecting Peripheral Vascular Disease

Authors: Jeffrey J. Fine, MS, Patrick A.X. Hall, MD, FACC, J Huger Richardson, MD, FACC

Abstract

Objectives: Peripheral vascular disease (PVD) is underdiagnosed in primary care due to the absence of established criteria to warrant diagnostic testing. Our goal was to establish a risk factor hierarchy to enable earlier diagnosis of PVD.


Methods: Data sets of 142 patients with abnormal ankle brachial indices (ABI) were randomly selected from our patient database to determine the prevalence of specific cardiovascular risk factors and demographic data. An ABI score <0.90 is diagnostic of PVD. Patients were stratified into mild (0.75–0.89), moderate (0.50–0.74), and severe disease (<0.50).


Results: Mean age was 69 ± 9.9, ABI 0.65 ± 0.16. Risk factor prevalence: diabetes, 42%; hypertension, 87%; tobacco use, 34%; hyperlipidemia, 53%; obesity, 24%; cardiovascular disease (CVD), 69%; stroke, 15%. Total risk factors per patient υ = 3.2 ± 1.3. Disease severity stratifications: mild, n = 46 (age υ = 68.6 ± 10.4, ABI υ = 0.82 ± 0.05); moderate, n = 72 (age υ = 69.9 ± 9.4, ABI υ = 0.62 ± 0.07); severe, n = 24 (age υ = 67.5 ± 10.9, ABI υ = 0.40 ± 0.06). Independent variable mean differences: hypertension-CVD (P = 0.0002); CVD-hyperlipidemia (P = 0.002); hyperlipidemia-diabetes (P = 0.0008); diabetes-tobacco use (P = 0.001); tobacco use-obesity (P = 0.0003); obesity-stroke (P = 0.05). Independent variable mean differences were significant across disease severity (P < 0.00001).


Conclusions: Our study establishes the following hierarchy of cardiovascular risk factors as predictors of PVD: hypertension, cardiovascular disease, hyperlipidemia, diabetes, tobacco use, obesity, stroke.


Key Points


* Peripheral vascular disease has been traditionally underdiagnosed in the primary care setting due to the absence of established criteria to warrant diagnostic testing.


* Risk factors which increase the likelihood of peripheral vascular disease include hypertension, hyperlipidemia, tobacco use, diabetes, cardiovascular disease, obesity, and stroke.


* The aim of this analysis was to develop a hierarchy of cardiovascular risk factors with predictive power for peripheral vascular disease.


* Our study establishes the following hierarchy among cardiovascular risk factors as predictors of peripheral vascular disease: hypertension, cardiovascular disease, hyperlipidemia, diabetes, tobacco use, obesity, stroke.

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