The cardiovascular risk burden of intermittent claudication

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Abstract
Intermittent claudication is the main clinical feature of chronic symptomatic atherothrombotic disease of the lower limbs (peripheral arterial disease [PAD]). The natural history of these patients includes a relatively limited risk for deterioration toward acute or chronic critical limb ischaemia and amputation. Patients with PAD have a high cardiovascular mortality rate, however, which is related to acute myocardial infarction and stroke (fourfold to sixfold increase in l0-year risk for these conditions). In fact, PAD is often associated with multifocal atherothrombotic arterial involvement. The presence of diffuse atherothrombotic lesions in PAD patients significantly increases their cardiovascular risk burden. Conversely, in the general population as well as in coronary patients the presence of PAD is an independent risk factor for increased mortality. Evidence of plaque instability may occur simultaneously at different locations. Finally, increased intima-media thickness at the common carotid and femoral arteries can be associated with overt disease at other arterial regions.

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