This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. BACKGROUND The critical clinical importance of cardiovascular disease in this country grows exponentially with each decade of our aging population. Most people are well aware of the importance of prevention, detection, and treatment of heart disease; but few people are aware of the seriousness of non-cardiac vascular disease, other than those who have suffered its complications. Noncardiac vascular diseases such as carotid artery disease, peripheral arterial disease (PAD), and abdominal aortic aneurysms (AAA) combined; cause almost as much death and disability in this country as heart disease and more than any cancer. Yet these diseases with their associated risks of stroke, limb loss and death are undiagnosed and untreated in the majority of cases, even in groups at obvious high risk for atherosclerotic disease. It has become evident in the last decade that even heart disease has been under-diagnosed and under-treated among women in this country. Further, while it was generally accepted that the prevalence of vascular disease is greater in men than women, this gap narrows progressively with increasing age. As our population ages, this gap will quickly close and the incidence of non-cardiac vascular disease will increase progressively making it a leading cause of mortality and morbidity for women. Emphasis on the importance of disease prevention and detection of non cardiac vascular disease in women cannot be overlooked. PURPOSE To evaluate the prevalence and incidence of carotid artery disease, peripheral arterial disease and abdominal aneurysmal disease among women through noninvasive screening programs. To delineate identifiable parameters of major vascular disease as markers for cardiovascular comorbidity and predictors of serious morbidity and death. METHODS Obtain a random sampling of women over the age of 60 residing in Baltimore City and Baltimore County to undergo noninvasive screening exams. Establishment of noninvasive screening programs over a period of 2 years to evaluate patients for carotid artery disease and peripheral arterial disease. Carotid Duplex scanning will be used to evaluate patients for hemodynamically significant carotid artery stenosis and noninvasive Doppler examination using ankle-brachial indices will be used as an indicator of peripheral arterial disease. Baseline data including other medical risk factors, smoking history and blood pressure will also be obtained. Those patients that test positive for disease during the screening will undergo a full carotid artery duplex or lower extremity arterial doppler exam. In addition, those patients will undergo serologic evaluation to further delineate risk factors. CONCLUSION Screening for carotid and peripheral arterial disease is simple, safe, and non-invasive. It has been demonstrated that community based screening programs can help to identify those patients who may benefit from preventative measures. Clearly, there is a definite independent association between atherosclerosis and cardiovascular morbidity and death. This study will help to identify unique issues involved in the management and detection of noncardiac vascular disease in women. The key to major vascular problems is early detection which allows successful treatment of critical problems and effective treatment of less severe situations preventing them from getting worse. Unlike most life-threatening medical problems, major vascular disease is all easily detectable with simple noninvasive tests. Such tests can aid in the early identification of women with subclinical or asymptomatic vascular disease which may allow early modification of risk factors and ultimately prevent or delay the onset of clinical atherosclerotic disease.
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