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. 2013 Apr;18(2):72-8.
doi: 10.1177/1358863X13480551. Epub 2013 Mar 18.

Peripheral Artery Disease Is Associated With Severe Impairment of Vascular Function

Free PMC article

Peripheral Artery Disease Is Associated With Severe Impairment of Vascular Function

Soroosh Kiani et al. Vasc Med. .
Free PMC article


Patients with peripheral artery disease (PAD) have higher cardiovascular event rates than patients with established coronary artery disease (CAD) and abnormal endothelial function predicts cardiovascular risk in PAD and CAD. We investigated the hypothesis that PAD is associated with a greater degree of impairment in vascular function than CAD. We used several non-invasive tests to evaluate endothelial function in 1320 men and women with combined PAD and CAD (n = 198), PAD alone (n = 179), CAD alone (n = 466), or controls aged > 45 years without CAD or PAD (n = 477). Patients with PAD had lower brachial artery flow-mediated dilation (5.1 ± 3.9% PAD and CAD, 5.9 ± 4.4% PAD alone) compared to patients with CAD alone (7.0 ± 4.5%) and no PAD or CAD (8.1 ± 5.1%, p < 0.0001). In multivariable models adjusting for clinical covariates and the presence of CAD, PAD remained associated with lower flow-mediated dilation (p < 0.0001). PAD was associated also with lower nitroglycerin-mediated dilation and reactive hyperemia. Patients with both PAD and CAD had a lower digital pulse amplitude tonometry (PAT) ratio in unadjusted models but not in adjusted models. Flow-mediated dilation was modestly associated with PAT ratio in patients with atherosclerotic disease (r = 0.23, p < 0.0001) but not among control participants (r = 0.008, p = 0.93). Our findings indicate that patients with PAD have greater impairment of vasodilator function and are consistent with the possibility that endothelial dysfunction may contribute to adverse cardiovascular prognosis in PAD.

Conflict of interest statement

Conflict of interest

The authors declare no conflicts of interest in preparing this article.


Figure 1
Figure 1
Displayed are mean (± standard error of the mean) flow-mediated dilation (n = 1320), nitroglycerin-mediated dilation (n = 559), hyperemic flow velocity (n = 1239), and lnPAT ratio (n = 497) by the four study groups: controls without CAD or PAD, CAD alone, PAD alone, and PAD combined with CAD. Overall ANOVA p < 0.01 for all four measures. The p-values detailed in the figure are from post hoc between-group testing by Tukey’s test.

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