Coronary Artery Disease and Peripheral Artery Disease
Etiopathogenic Differences in Coronary Artery Disease and Peripheral Artery Disease: Results From the National Health and Nutrition Examination Survey
Angiology 2014, Vol. 65(10) 883-890 ª The Author(s) 2013 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0003319713509303 ang.sagepub.com
Shikhar Agarwal, MD, MPH, CPH, FACP1, and Sahar Naderi, MD, MHS1
Abstract Cross-sectional data from the National Health and Nutrition Examination Surveys 1999 to 2004 were pooled for this study. Compared with coronary artery disease (CAD), a greater proportion of individuals with peripheral artery disease (PAD) were female, black, and active smokers. Patients with PAD had significantly higher serum concentrations of low-density lipoprotein cholesterol and C-reactive protein than those with CAD alone. The risk of CAD increased with serum cotinine levels >0.02 ng/mL. However, the risk of PAD increased only with serum cotinine levels >138 ng/mL. Despite this association, there was no significant association of secondhand smoke exposure with CAD or PAD. In conclusion, patients with CAD and PAD differed with respect to several demographic and biochemical factors. The relationship between PAD and cotinine demonstrated a threshold phenomenon (serum cotinine levels >138 ng/mL). Keywords coronary artery disease, peripheral artery disease, cotinine, smoker, low-density lipoprotein cholesterol, C-reactive protein
Introduction
Study Variables
Coronary artery disease (CAD) and peripheral artery disease (PAD) are manifestations of systemic atherosclerosis. Although both diseases share risk factors, it is not uncommon to encounter CAD without any concomitant PAD or vice versa.1 This finding might suggest differences in the etiopathogenesis of these diseases. In 1992, Fowkes et al demonstrated differences in smoking characteristics and lipid profiles between patients with CAD and patients with PAD.2 In this study, we aim to examine the differences in demographic characteristics, traditional cardiovascular risk factors, and serum vitamin concentrations between patients with known CAD and those with evidence of PAD in a large nationally representative database.
Ankle brachial index (ABI) was measured in all individuals over the age of 40 years at the time of the survey. PAD was defined as an ABI 0.05 ng/mL who reported no active tobacco use.5 Demographic information regarding age, gender, and race/ ethnicity was based on self-report. Hypertension was documented if the participant had a systolic blood pressure >140 mm Hg, diastolic pressure >90 mm Hg, a prior diagnosis of hypertension, or reported the use of antihypertensive medication. Hypercholesterolemia was documented if the participant had a serum cholesterol of >240 mg/dL, a prior diagnosis of hyperlipidemia, or reported the use of antihyperlipidemic medication. Diabetes was based on self-reported physician diagnosis. Body mass index was calculated by dividing weight (in Kg) by measured height squared (in m). Glomerular filtration rate (GFR), a measure of kidney function, was estimated using the Modification of Diet in Renal Disease study formula,6,7 which uses serum creatinine, age, gender, and race. Standardized creatinine was estimated using previously published calibration equations.8 In the present analysis, chronic kidney disease was defined as an estimated GFR
Etiopathogenic Differences in Coronary Artery Disease and Peripheral Artery Disease: Results From the National Health and Nutrition Examination Survey
Angiology 2014, Vol. 65(10) 883-890 ª The Author(s) 2013 Reprints and permission: sagepub.com/journalsPermissions.nav DOI: 10.1177/0003319713509303 ang.sagepub.com
Shikhar Agarwal, MD, MPH, CPH, FACP1, and Sahar Naderi, MD, MHS1
Abstract Cross-sectional data from the National Health and Nutrition Examination Surveys 1999 to 2004 were pooled for this study. Compared with coronary artery disease (CAD), a greater proportion of individuals with peripheral artery disease (PAD) were female, black, and active smokers. Patients with PAD had significantly higher serum concentrations of low-density lipoprotein cholesterol and C-reactive protein than those with CAD alone. The risk of CAD increased with serum cotinine levels >0.02 ng/mL. However, the risk of PAD increased only with serum cotinine levels >138 ng/mL. Despite this association, there was no significant association of secondhand smoke exposure with CAD or PAD. In conclusion, patients with CAD and PAD differed with respect to several demographic and biochemical factors. The relationship between PAD and cotinine demonstrated a threshold phenomenon (serum cotinine levels >138 ng/mL). Keywords coronary artery disease, peripheral artery disease, cotinine, smoker, low-density lipoprotein cholesterol, C-reactive protein
Introduction
Study Variables
Coronary artery disease (CAD) and peripheral artery disease (PAD) are manifestations of systemic atherosclerosis. Although both diseases share risk factors, it is not uncommon to encounter CAD without any concomitant PAD or vice versa.1 This finding might suggest differences in the etiopathogenesis of these diseases. In 1992, Fowkes et al demonstrated differences in smoking characteristics and lipid profiles between patients with CAD and patients with PAD.2 In this study, we aim to examine the differences in demographic characteristics, traditional cardiovascular risk factors, and serum vitamin concentrations between patients with known CAD and those with evidence of PAD in a large nationally representative database.
Ankle brachial index (ABI) was measured in all individuals over the age of 40 years at the time of the survey. PAD was defined as an ABI 0.05 ng/mL who reported no active tobacco use.5 Demographic information regarding age, gender, and race/ ethnicity was based on self-report. Hypertension was documented if the participant had a systolic blood pressure >140 mm Hg, diastolic pressure >90 mm Hg, a prior diagnosis of hypertension, or reported the use of antihypertensive medication. Hypercholesterolemia was documented if the participant had a serum cholesterol of >240 mg/dL, a prior diagnosis of hyperlipidemia, or reported the use of antihyperlipidemic medication. Diabetes was based on self-reported physician diagnosis. Body mass index was calculated by dividing weight (in Kg) by measured height squared (in m). Glomerular filtration rate (GFR), a measure of kidney function, was estimated using the Modification of Diet in Renal Disease study formula,6,7 which uses serum creatinine, age, gender, and race. Standardized creatinine was estimated using previously published calibration equations.8 In the present analysis, chronic kidney disease was defined as an estimated GFR
