Correlation of the Degree of Obliterative Disease of Peripheral and Coronary Arteries: A Cohort Study Volume 63- Issue 2

Samed Djedovic¹*, Enes Osmanovic¹, Elmir Jahic¹, Emir Mujanovic¹, Azra-Avdic Salihovic¹, Mirela Pirić¹, Jacob Bergsland^1,2, Denis Mrsic³, Senada Husarić¹ and Muhamed Djedovic⁴

• ¹Medical Institute Bayer, Tuzla, Bosnia and Herzegovina
• ²Oslo University Hospital, Norway
• ³University Clinical Center Tuzla, Bosnia and Herzegovina
• ⁴Clinical Center University of Sarajevo, Bosnia and Herzegovina

Received: August 25, 2025; Published: September 05, 2025

*Corresponding author: Samed Djedovic, Interventional cardiologist and electrophysiologist, Medical Institute Bayer, Tuzla, Bosnia and Herzegovina

DOI: 10.26717/BJSTR.2025.63.009854

Abstract PDF

Background: Atherosclerosis is affecting arteries throughout the human body, where the assessment of obliterative disease severity in one artery may indicate the extent of disease in other arteries. Objective: The aim of this study was to examine the correlation between the degree of obliterative disease in peripheral and coronary arteries.
Methods: This study included 200 patients admitted for elective coronary angiography at the Medical Institute Bayer from January 2022 to December 2024. During hospitalization, all participants underwent ultrasound examination of peripheral arteries, followed by coronary angiography. Based on coronary angiography findings, patients were divided into two groups: Group A (100 patients without coronary disease) and Group B (100 patients with coronary artery disease). A sequential approach enabled controlled data collection during medical procedures.
Results: A significant positive correlation was found between the degree of stenosis in peripheral and coronary arteries. Increased stenosis in peripheral arteries was as- sociated with higher degrees of stenosis in coronary arteries, suggesting a potential role of early detection of peripheral artery disease as an indicator of coronary artery disease.
Conclusion: The presence of obliterative changes in peripheral arteries indicates atherosclerotic changes in coronary arteries. Significant stenoses in peripheral arteries may serve as an indicator for significant coronary stenosis.

Keywords: Peripheral Arteries; Coronary Arteries; Coronary Angiography; Ultrasound

Abbreviations: CVD: Cardiovascular Disease; CAD: Coronary Artery Disease; PA: Peripheral Arteries; QCA: Quantitative Coronary Angiography; ICD-10–International Classification of Diseases; MIB: Medical Institute Bayer; SD: Standard Deviation; CI: Confidence Interval; STATA: Statistical Software STATA

Cardiovascular diseases, including coronary artery disease (CAD) and stroke, remain the leading cause of mortality and disability worldwide. Over the past decades, the number of individuals affected by cardiovascular diseases has significantly increased. According to data from 1990 to 2019, covering 204 countries and territories, the total number of affected individuals has doubled, rising from 271 million in 1990 to 523 million in 2019 [1]. Atherosclerosis is a systemic disease with focal manifestations in various arteries throughout the human body. It is characterized by a long latent period between disease onset and the development of clinical symptoms or organ damage. In most cases, atherosclerosis remains progressive and asymptomatic until the atherosclerotic plaque obstructs at least 50-70 % of the vascular lumen. Early detection of atherosclerosis in the asymptomatic stage is crucial for preventing myocardial infarction and other complications. As a systemic disease, changes in peripheral arteries may indicate atherosclerotic involvement of coronary arteries, high- lighting the potential for early intervention and prevention [2].

Study Design

The study was conducted as a cross-sectional study with prospective data col- lection, based on a cohort of patients admitted to the Medical Institute Bayer (MIB) from January 2022 to December 2024.

Study Population

A total of 200 patients admitted for elective coronary angiography at MIB were included in the study. During hospitalization, data were collected sequentially, starting with an ultrasound examination of the peripheral arteries to assess the degree of obliterative disease. The ultrasound examinations were performed by a single investigator with extensive experience in detecting peripheral arterial disease (PAD) using this non-invasive method. The detection of PAD and the assessment of stenosis severity were conducted following current guidelines [3,4]. Subsequently, during the same hospitalization, an invasive coronary angiography was performed according to the standard protocol. The coronary angiography was conducted by an experienced interventional cardiologist who was blinded to the ultra-sound findings of peripheral arteries. Based on the coronary angiography findings, participants were divided into two groups: 100 patients without CAD and 100 patients with CAD. The CAD group included all participants in whom coronary artery disease was documented, with the degree of stenosis assessed using Quantitative Coronary Angiography (QCA) [5].

Inclusion Criteria:

• Adult patients over 18 years of age

• Successfully underwent both peripheral artery ultrasound and coronary angiography

Exclusion Criteria:

• Acute coronary syndrome

• Prior surgical or interventional procedures on coronary or peripheral arteries

• Conditions that prevented the adequate performance of the ultrasound and coronary angiography examination

Sample Size

The sample size was determined based on the estimated correlation between peripheral and coronary artery stenosis, using the sample size calculation procedure in the Stata® 18.0 BE 1 software.

• Assuming a significance level of 0.05 and a test power of 80%, a sample of 191 participants was required to detect a small correlation (ρ=0.2).

• For a moderate correlation (ρ =0.3), a sample of 82 participants was sufficient.

With a total of 200 participants included in the study, the sample size was adequate for reliable analysis of small to moderate correlations.

Study Outcomes

The primary outcome of this study was to determine the association between the degree of peripheral artery stenosis, assessed by ultrasound, and coronary artery stenosis, evaluated using coronary angiography. Secondary outcomes included the analysis of demographic characteristics of participants, such as age, sex, and the presence of risk factors for atherosclerosis (smoking, hypertension, hyperlipidemia, type 2 diabetes), as well as the assessment of comorbidities according to the International Classification of Diseases (ICD-10).

Statistical Methods

The statistical analysis was performed using STATA® 18.0 Basic Edition. Continuous variables were presented as means with standard deviation or medians with interquartile range, depending on the data distribution. Categorical variables were expressed as absolute and relative frequencies. Normality of distribution was assessed using the Shapiro-Wilk test, while correlations between variables were evaluated using Spearman’s correlation coefficient for non-normally distributed data. A p-value of less than 0.05 was considered statistically significant.

Table 1 shows the baseline characteristics of the study groups. Patients with CAD were significantly older (61.8±0.95 vs. 55.1±0.89 years, p=0.0001). No significant difference was observed in gender distribution (p=0.087) or hyperlipoproteinemia (p=0.117), while hypertension was more frequent in the CAD group (p=0.022). However, type II diabetes (p=0.001), positive family history of cardiovascular dis- ease (p=0.002), and smoking (p=0.007) were significantly more prevalent in patients with CAD. These findings underscore the importance of early identify and control of these risk factors through timely preventive strategies. The relationship between the degree of coronary and carotid artery stenosis, ex- pressed as a percentage, was analyzed using the non-parametric Spearman’s rank correlation due to the asymmetric data distribution. A positive and significant Spearman’s rho correlation coefficient was found (ρ = 0.2123, p = 0.0339; Figure 1). According to Cohen’s reference values, this correlation is classified as weak (r = 0.10–0.29). The relationship between the degree of coronary and femoral artery stenosis was analyzed using Spearman’s rank correlation, which showed a positive and significant association (ρ = 0.2642, p = 0.0079; Figure 2). According to Cohen’s reference values, this correlation is also classified as weak. The relationship between the degree of coronary and popliteal artery stenosis was not statistically significant, although the correlation was positive (ρ = 0.1052, p = 0.2976; Figure 3). These results suggest that popliteal arteries have a weaker association with coronary artery stenosis.

Figure 1

Figure 2

Figure 3

Table 1: Baseline characteristics of patients with and without CAD.

Note: CAD – coronary artery disease; No CAD – without coronary disease. Two-sample t-test with equal variances; Pearson Chi-square (Fisher’s exact test).

The rapid advancement of non-invasive di- agnostic techniques has significantly im- proved the detection of atherosclerotic changes in carotid and coronary arteries. Although invasive coronary angiography re- mains the gold standard for assessing CAD, methods such as ultrasound examination of peripheral arteries offer numerous advantages [6]. Ultrasound is widely available, non-invasive, and does not involve exposure to contrast agents or radiation, making it a valuable The rapid advancement of non-invasive di- agnostic techniques has significantly im- proved the detection of atherosclerotic changes in carotid and coronary arteries. Although invasive coronary angiography re- mains the gold standard for assessing CAD, methods such as ultrasound examination of peripheral arteries offer numerous advantages [6]. Ultrasound is widely available, non-invasive, and does not involve exposure to contrast agents or radiation, making it a valuable tool for detecting atherosclerosis, particularly in its subclinical stages [7,8]. Detecting atherosclerosis in its subclinical phase is crucial for primary prevention, aiming to re- duce morbidity and mortality [9]. In this study, we analyzed the association between the degree of stenosis in peripheral arteries (carotid, femoral, and popliteal) and coronary arteries. Our findings align with previous studies that indicate a positive correlation between carotid and coronary artery stenosis [10,11]. The correlation between coronary and carotid artery stenosis in our study was positive and statistically significant (Spearman’s rho = 0.2123, p = 0.0339), but weak in strength according to Cohen’s criteria. These results suggest that while assessing carotid artery stenosis may indicate coronary artery changes, the degree of association is not strong enough for reliable prediction. Similarly, a relationship exists between atherosclerotic changes in femoral and coronary arteries [12,13]. Our data analysis showed comparable results. The correlation between the degree of stenosis in coronary and femoral arteries was positive and statistically significant (rho = 0.2642, p = 0.0079), but also weak in strength. How- ever, our findings confirm that the degree of stenosis in the femoral arteries alone is insufficient for a reliable assessment the degree of coronary artery stenosis. Regarding popliteal arteries, the correlation with coronary artery stenosis was positive but not statistically significant (rho = 0.1052, p = 0.2976). This suggests a weaker relationship between popliteal and coronary arteries compared to carotid and femoral arteries. Although previous studies have linked popliteal artery atherosclerosis with increased cardiovascular risk [14,15], our results did not confirm a significant as- sociation in this study. These findings highlight the potential of ultrasound assessment of peripheral arteries as an additional diagnostic tool but also underscore its limitations in predicting CAD based on individual arterial segments.

The moderate relationship established be- tween the degree of stenosis in peripheral and coronary arteries has significant clinical implications. These findings not only aid in identifying patients at higher risk of atherosclerotic disease but also highlight the necessity for early interventions. Peripheral artery ultrasound assessment is a simple and non-invasive method for recognizing patients who require strict control of modifiable risk factors, such as hyper- tension, hyperlipidemia, and diabetes mellitus. Timely identify and optimized risk management could potentially reduce the incidence of severe atherosclerotic com- plications, including myocardial infarction and stroke.

This study has several limitations. First, the study design is cross-sectional with prospective data collection, which limits the ability to establish causal relationships. Second, although the sample size of 200 participants is statistically adequate for detecting correlations, its generalizability to the broader population may be limited.

The results of this study confirm that atherosclerosis off both peripheral and coronary arteries, although the changes do not always manifest in an identical manner. A moderate correlation was found between the degree of stenosis in peripheral and coronary arteries, highlighting the importance of ultrasound assessment of peripheral arteriesm should be part of routine cardiological evaluation. This method can enable early identify of patients at increased risk of CAD and timely intervention through risk factor optimization. The integration of ultrasound into daily clinical practice could significantly contribute to the prevention and treatment of atherosclerotic disease.

Authors do not report on relationships that may be considered a conflict of interest.

Those was no external funding of this project.

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