Prevalence of asymptomatic peripheral artery disease in patients with non-cardioembolic ischemic stroke

Introduction. The prevalence of asymptomatic peripheral arterial disease (PAD) detected by the ankle-brachial index (ABI) measurement in stroke patients and its relation with the risk of vascular events recurrence is unknown. A main objective of the APICA study (prevalence of peripheral arterial disease and metabolic syndrome in acute cerebral ischemia) is to analyse the prevalence in our country and to identify clinical variables associated with higher risk of PAD. Methods. Epidemiologic, observational, longitudinal, multi-center study including patients older than 50 with non-cardioembolic transient ischemic attack (TIA) or ischemic stroke, consecutively recruited. PAD was determined if ABI <= 0.9. Statistical analysis was performed with SPSS 15.0. A logistic regression analysis was performed to find factors independently associated with asymptomatic PAD. Results. 977 patients were included. 651 (66.7%) were males and mean age was 69.1. 396 (40.5%) cases had PAD, after excluding patients with previously known PAD, 321 (35.6%) were defined as asymptomatic PAD. The factors indepently associated with asymptomatic PAD were: age (OR 1.020 [1.004-1.037], p = 0.017), previous stroke (1.52 [1.05-2.20], p = 0.027), coronary revascularization (1.97 [1.03-3.79], p = 0.041), established stroke (1.86 [1.20-2.88], p = 0.006), atherothrombotic etiology (1.54 [1.13-2.10], p = 0.006), systolic blood pressure (1.009 [1.001-1.017], p = 0.027) and waist perimeter (0.989 [0.978-1.000], p = 0.005). Conclusions. More than a third of the patients with non-cardioembolic ischemic stroke have asymptomatic PAD. Asymptomatic PAD is mainly observed in older patients, with hypertension, multiple vascular territories condition and with atherothrombotic etiology of stroke.