Vascular disease's triple threat

W. Kent Williamson, M.D.
Medical director, Providence Noninvasive Vascular Labs
Chairman, Providence Vascular Quality Council-Oregon
Pacific Vascular Specialists

Published September 2012

When it comes to screening for cardiovascular health, most physicians stress the cardio part. However, evidence shows that screening for vascular disease is as important as a focused cardiac evaluation. Patients with peripheral artery disease, for example, are five times more likely to have an ischemic cardiac event.

Yet because many of these patients are entirely asymptomatic, the disease goes largely unnoticed.

Carotid stenosis is another major vascular disease category worthy of focused screening. For many physicians, listening for a carotid bruit may be the extent of a screening unless a patient has presented with a focal neurological issue or a history of cerebrovascular disease.

Studies have shown, however, that bruits present in only 30 to 40 percent of patients with carotid lesions. This means that 60 percent of patients with high-risk carotid lesions may never be identified.

Lastly, abdominal aortic aneurysm, while the least prevalent of the above conditions, is a silent killer. Generally asymptomatic until a catastrophic rupture occurs, AAAs are more common in populations with certain risk factors, including a family history of aneurysms; hypertension; high cholesterol; age; male gender and smoking.

For symptomatic patients, it’s best to contact a vascular specialist. For those with no symptoms, consider the following guidelines:

  • An abdominal ultrasound screen beginning at age 55 for patients with a family history of AAA and a history of smoking

  • An ankle-brachial index for patients 60 or older with a history of smoking, diabetes, coronary disease or hypertension; family history of vascular disease; or prior stroke or heart attack
  • Carotid disease screening, particularly for men who are 60 or older with a history of diabetes, smoking, peripheral artery disease, hypertension or coronary disease

Vascular disease is a leading cause of death and disability in the United States. Screening remains a powerful weapon to combat the potentially devastating effects of these conditions.

Clinical vascular research associate David A. Ellis, MS, contributed to this report.

Clinical articles by W. Kent Williamson, M.D.