Multifocal atherosclerotic disease and the risk for cardiovascular events

Epidemiological studies have demonstrated that cardiovascular disease in one vascular bed is associated with the presence of atherosclerotic disease in another region as well as with subsequent cardiovascular and total mortality. Peripheral arterial occlusive disease (PAD) represents a sensitive marker of generalized atherosclerosis since it is commonly associated with the presence of coronary or cerebrovascular disease. The increased risk for cardiovascular events in subjects with concomitant atherosclerotic diseases was confirmed in different clinical studies. The Secondary Prevention Reinfarction Israeli Nifedipine Trial (SPRINT) showed that patients with the acute myocardial infarction and concomitant clinically diagnosed PAD exhibited an increased incidence of cardiovascular events. Similarly the CAPRI study indicated that even in patients with the previous myocardial infarction or stroke and in patients preferred for coronary angiography the occurrence of low ABI increased the risk for cardiovascular incidents further. The identification of concomitant preclinical and clinical forms of atherosclerotic disease enables the recognition of subjects at high risk for cardiovascular morbidity and mortality who may benefit to a greater extent by preventive treatments.