Imori et al demonstrated that carotid artery stenosis, renal artery stenosis, and lower extremity peripheral arterial disease often coexist in patients with coronary artery disease (CAD) and that CAD severity is related to that of other atherosclerotic lesions.

This study verifies the results of an earlier retrospective study investigating the presence of concomitant carotid artery stenosis and peripheral arterial disease in patients with versus without left main (LM) CAD. Patients with LM (i.e., more advanced) CAD had more frequently concomitant significant (≥60%) carotid artery stenosis (31.2% vs 15.2%, respectively, p <0.0001) and lower mean ankle-brachial indexes (0.78 vs 0.87, respectively, p = 0.042) compared with patients without LM CAD. The conclusion reached was that patients with LM CAD have a greater burden of advanced atherosclerosis in the carotid and lower extremity arteries compared with patients without LM CAD.

These 2 studies support the theory that severe (but not moderate) atherosclerosis in 1 arterial bed (e.g., the coronary or the carotid arteries) may predict concomitant advanced vascular disease in ≥1 additional arterial beds. The aggressive management of all modifiable risk factors (e.g., smoking, hyperlipidemia, hypertension, diabetes) and the employment of optimal medical treatment are essential to reduce not only cardiac events (e.g., myocardial infarctions) but also the complications and/or manifestations of atherosclerosis from the cerebrovascular (e.g., strokes) and lower extremity (e.g., amputations) arterial systems.