Need for surveillance of concomitant peripheral artery disease in patients with coronary disease: results of the AGATHA survey in Malaysia

( views:1029, downloads:0 )
Kui Hian Sim(Department of Cardiology, Sarawak General Hospital, Sarawak, Malaysia)
Kok Han Chee(Department of Cardiology, Universiti Malaya Medical Centre, Petaling Jaya, Malaysia)
Inderjit Singh(Department of Cardiology, Penang General Hospital, Penang, Malaysia)
Choon Kiat Ang(Department of Cardiology, Sarawak General Hospital, Sarawak, Malaysia)
Houng Bang Liew(Department of Cardiology, Sarawak General Hospital, Sarawak, Malaysia)
Kim Heung Tan(Department of Cardiology, Universiti Malaya Medical Centre, Petaling Jaya, Malaysia)
Omar Ismail(Department of Cardiology, Penang General Hospital, Penang, Malaysia)
Journal Title:
Volume 4, Issue 04, 2007
Key Word:
arteriosclerosis; atherothrombosis; Malaysia; cardiovascular diseases; epidemiologic factors; anklebrachial index; peripheral arterial disease

Abstract´╝Ü Background For patients with cardiovascular disease (CVD), co-existence of peripheral artery disease (PAD) predicts increased mortality, and such patients are also more likely to benefit from aggressive therapy. Surveillance of PAD is often neglected at health clinics. Our aim is to highlight the importance and ease of surveillance of PAD in patients with CVD. Objective To determine the prevalence of symptomatic and asymptomatic PAD in a Malaysian patient population with documented CVD. Methods and Results A total of 393 subjects with established CVD were recruited from three centres (85 women and 308 men), as part of a larger international (AGATHA) survey. PAD, determined by presence of claudicant symptoms on interview and/or abnormal ankle-brachial index (ABI)score of less than 0.9, was present in 21.4% of patients - of whom 64% were asymptomatic. Abnormal ABI is associated with higher systolic blood pressure and number of arterial beds affected. Conclusions Concomitant PAD is prevalent among CVD patients in Malaysia. ABI screening is simple and yields a high proportion of patients with extensive atherosclerosis who may require more aggressive atherosclerotic risk management.

  • [1]World Health Organization.The World Health Report 2004[online].2004.Available from:URL:
  • [2]Khor GL.Cardiovascular epidemiology in the Asia-Pacific region.Asia Pac J Clin Nutr 2001; 10:76-80.
  • [3]Coccheri S.Distribution of symptomatic atherothrombosis and influence of the atherosclerotic disease burden on risk of secondary ischaemic events:Results from CAPRIE.Eur Heart J 1998; 19:P1268.
  • [4]Kannel WB.Overview of atherosclerosis.Clin Ther 1998; 20:B2-17.
  • [5]Droste DW,Ringelstein EB.Evaluation of progression and spread of atherothrombosis.Cerebrovasc Dis 2002; 13 (Suppl 1):7-11.
  • [6]The Health Outcome Prevention Evaluation Investigators.Effects of an angiotensin-converting-enzyme inhibitor,ramipril,on cardiovascular events in high risk patients.N Engl J Med 2000; 342:145-53.
  • [7]Hankey GJ.Current oral antiplatelet agents to prevent atherothrombosis.Cerebrovasc Dis 2001; 11(Suppl 2):11-7.
  • [8]Mafauzy M,Mokhtar N,Mohamad WB,et al.Diabetes mellitus and associated cardiovascular risk factors in north-east Malaysia.Asia Pac J Public Health 1999; 11:16-9.
  • [9]Mohamad WB,Mokhtar N,Mafauzy M,et al.Prevalence of obesity and overweight in northeastern peninsular Malaysia and their relationship with cardiovascular risk factors.Southeast Asian J Trop Med Public Health 1996; 27:339-42.
  • [10]Vogel RA,Benitez RM.Noninvasive assessment of cardiovascular risk:from Framingham to the future.Rev Cardiovasc Med 2000; 1:34-42.
  • [11]McDermott MM,Mehta S,Ahn H et al.Atherosclerotic risk factors are less intensively treated in patients with peripheral arterial disease than in patients with coronary artery disease.J Gen Intern Med 1997;12:209-15.
  • [12]Criqui M.Peripheral arterial disease-epidemiological aspects.Vasc Med 2001; 6:S1-7.
  • [13]Amudha K,Chee KH,Tan KS,et al.Prevalence of peripheral artery disease in urban high-risk Malaysian patients.Int J Clin Pract 2003; 57:369-72.
  • [14]Fowkes FG,Low LP,Tuta S,Kozak J,for the AGATHA Investigators.Ankle-brachial index and extent of atherothrombosis in 8891 patients with or at risk of vascular disease:results of the international AGATHA study.Eur Heart J 2006;27:1861-7.
  • [15]Leng GC,Fowkes FG,Lee AJ,et al.Use of ankle brachial pressure index to predict cardiovascular events and death:a cohort study.BMJ 1996; 313:1440-4.
  • [16]Diehm C,Schuster A,Allenberg JR,et al.High prevalence of peripheral arterial disease and co-morbidity in 6880 primary care patients:cross-sectional study.Atherosclerosis 2004; 172:95-105.
  • [17]Dormandy JA.Ankle arm blood pressure index as a predictor of atherothrombotic events:evidence from CAPRIE[abstract].Cerebrovasc Dis 1999; 9 (Suppl 1):14.
  • [18]Al-Omran,Lindsay TF.Should all patients with peripheral arterial disease be treated with an angiotensin-converting enzyme inhibitor? Can J Cardiol 2005;21:189-93.
  • [19]Newman AB,Shemanski L,Manolio TA,et al.Ankle-arm index as a predictor of cardiovascular disease and mortality in the Cardiovascular Health Study.The Cardiovascular Health Study Group.Arterioscler Thromb Vasc Biol 1999;19:538-45.
  • [20]Antithrombotic Trialists' Collaboration.Collaborative metaanalysis of randomized trials of antiplatelet therapy for prevention of death,myocardial infarction,and stroke in high risk patients.BMJ 2002; 324:71-86.
  • [21]Aronow WS.Antiplatelet agents in the prevention of cardiovascular morbidity and mortality in older patients with vascular disease.Drugs Aging 1999;15:91-101.
  • [22]Blackenhom DH,Azen SP,Crawford DW,et al.Effects of colestipollniacin therapy on human femoral atherosclerosis.Circulation 1991;83:438-47.
WanfangData CO.,Ltd All Rights Reserved
About WanfangData | Contact US
Healthcare Department, Fuxing Road NO.15, Haidian District Beijing, 100038 P.R.China
Tel:+86-010-58882616 Fax:+86-010-58882615