Correlation between predominantly subclinical peripheral arterial disease in patients with ischemic stroke: A study using ankle–brachial index from rural eastern India

Abstract

Introduction: Peripheral arterial disease (PAD) decreases arterial perfusion leading to limb ischemia. It is considered one of the markers of subclinical atherosclerosis process. For this reason, it can be a major risk factor for ischemic stroke. Early detection of PAD has an important role in preventing ischemic stroke. Materials and Methods: This study was carried out in District Hospital, Barasat, Kolkata, from March 2011 to March 2013. Eighty-two patients with ischemic stroke (aged 40–80 years) were recruited. Patients having atrial fibrillation and diabetes mellitus and embolic source were excluded. Ankle–brachial index (ABI) was performed with ultrasonography Doppler in each patient. PAD was diagnosed when the ABI was below 0.9. The severity of stroke was assessed by the National Institutes of Health Stroke Scale. Statistical Analysis: For continuous variables, analysis of variance was used to compare three or more groups of patients and Student’s t-test for two groups. Chi-square test or Fisher’s exact test was used for categorical variables. For all analytical purposes, a two-tailed P < 0.05 was considered statistically significant. Results: According to ABI, 62 patients had no pad, 13 patients had mild, and 7 patients had severe PAD. High total cholesterol and low-density lipoprotein were significantly associated with low ABI (P = 0.001). High total cholesterol levels and low ABI were significantly correlated (P < 0.001). A significant association between moderately-low ABI and recurrent stroke was noted (P = 0.019). Conclusion: PAD is significantly associated with recurrent ischemic strokes. Evaluation of ABI for PAD revealed increased risk of recurrent stroke.