Polyvascular Atherosclerotic disease: Echocardiographic and metabolic determinants of adverse cardiac outcome

Peripheral Arterial Disease (PAD) is a multifactorial syndrome that most commonly affects people over 60 years of age. With the aging of the population, the prevalence of atherosclerotic disease and its associated adverse outcomes will increase. It has to be noted that the process of established atherothrombosis is not limited to a single arterial location, giving it the character of a systemic and generalized disease. The Reduction of Atherothrombosis for Continued Health (REACH) registry demonstrated that one out of six patients with (i) PAD, (ii) cerebrovascular disease, or (iii) coronary artery disease had involvement of one or two other arterial beds. Importantly, the presence of multiple affected arterial territories, called polyvascular disease, has been demonstrated to be an independent predictor of long-term cardiovascular outcome in the general population. In response to studies demonstrating the adverse prognosis of atherosclerotic disease, the need for adequate risk factor stratification and reduction has emerged. The importance of risk factor reduction in patients with PAD has resulted in universally recommended atherothrombotic risk factor reduction, with the objective of decreasing the high incidence of heart disease and cerebrovascular disease associated with PAD. In patients with PAD scheduled for vascular surgery, risk factor stratification is directed at the detection of (a)symptomatic atherosclerotic disease in other vascular beds than the primary symptomatic arterial location. Early detection of polyvascular atherosclerotic disease has important consequences for risk factor reduction strategies, including life-style interventions and medical therapy.

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