2003 WHRG Grant Program

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Adverse Conditions and Diseases in Women: Noncardiac Vascular Disease
Vasana Cheanvechai, M.D.
School of Medicine, University of Maryland, Baltimore

BACKGROUND: The critical clinical importance of cardiovascular disease in this country grows exponentially with each decade among our aging population. Most people are aware of the importance of prevention, detection, and treatment of heart disease; but few appreciate the seriousness of noncardiac vascular disease, other than those who have suffered its complications. Noncardiac vascular diseases such as carotid artery disease and peripheral arterial disease (PAD) are "markers" for systemic atherosclerosis and are predictive of major adverse cardiovascular events (MACE). Yet these problems with their associated risks of stroke, limb loss, myocardial infarction, and death are often undiagnosed and untreated. It has been evident in the last decade that heart disease in women was under-diagnosed and under-treated in this country. It would be expected that, like heart disease, vascular disease in women has also been under-diagnosed and under-treated; perhaps to an even greater extent considering the low level of public awareness about vascular disease in this country. It is also to be expected that, like heart disease, earlier diagnosis of vascular disease in women could lead to safer and more effective risk factor modification with appropriate medical treatments that would significantly reduce MACE among older women in this country.

PURPOSE: This study will evaluate the prevalence and severity of carotid artery disease and PAD among women with known risk factors for atherosclerosis and those who reside in populations known to be at higher risk for more severe cardiovascular disease. Screening for carotid disease and PAD using noninvasive vascular testing will allow early detection of vascular disease in these high risk groups of women and the opportunity for early intervention when indicated. It is expected that this would ultimately lead to a significant reduction in MACE among the women with vascular disease detected in this program.

METHODS: A series of four noninvasive screening programs will be performed over a one year period to evaluate women for carotid artery disease and peripheral arterial disease. Women over the age of 60 with other risk factors (hypertension, smoking, diabetes, mellitus, hypercholesterolemia) will be recruited from the West Baltimore or Northwest Baltimore communities. Carotid ultrasound scanning will be used to evaluate patients for significant carotid artery stenosis (ICA stenosis >50%) and noninvasive Doppler-derived ankle-brachial index will be used to diagnose significant PAD (ABI <0.85). Baseline information including reported risk factors, current treatments, and past cardiovascular interventions will be obtained. It is expected that approximately 80 to 100 women would be screened during each session.

CONCLUSION: Unlike many life-threatening medical problems, major vascular diseases like carotid artery disease and PAD are easily detectable with simple, noninvasive tests. It has been clearly established that carotid artery disease and PAD are associated with increased risks of MACE like stroke and myocardial infarction; complications that increasingly tax our medical care resources and create permanent disability for our aging poplulation. Since high risk groups can be easily identified it stands to reason that early diagnosis in these women would enable the effective use of preventative interventions that have been shown to reduce the progression of disease and to reduce the incidence of MACE. The preliminary information from these community based screening programs could more precisely identify groups of women who may benefit from these preventative, non-interventional measures. Information about the prevalence of disease and associated reported risk factors may also help refine future screening programs to focus more effectively on the highest risk women's groups.