IM - Original

Internal and Emergency Medicine

, Volume 6, Issue 6, pp 509-519

The PANDORA study: peripheral arterial disease in patients with non-high cardiovascular risk

  • Claudio CimminielloAffiliated withDepartment of Medicine, Vimercate Hospital Email author 
  • , Serge KownatorAffiliated withCardiology Department, Clinique Ambroise Paré
  • , Jean-Claude WautrechtAffiliated withDepartment of Vascular Diseases, Hôpital Erasme
  • , Christos P. CarvounisAffiliated withInternal Medicine Department, Kyanous Stavros Medical Center
  • , Stefanus Eliza KranendonkAffiliated withTweeSteden Hospital
  • , Beat KindlerAffiliated with
  • , Mario MangrellaAffiliated withR&D Department, AstraZeneca SpA
  • , Claudio BorghiAffiliated withInternal Medicine Unit, University Hospital Sant’Orsola-Malpighi
  • , for the PANDORA Study Investigators

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Few studies are available with sufficient sample size to accurately describe the prevalence of low ankle-brachial index (ABI) in patients at ‘non-high’ cardiovascular (CV) risk. The aim of this study was to evaluate the prevalence of asymptomatic peripheral arterial disease (PAD), as determined by using ABI, in this patient population. A non-interventional, cross-sectional, pan-European study was conducted in patients with ≥1 CV risk factor in addition to age, evaluating the prevalence of asymptomatic PAD (ABI ≤ 0.90). Secondary objectives included assessing the prevalence and treatment of CV risk factors. Patients were consecutively recruited during scheduled visits to the physician’s office, or were randomly selected by the physician from a list of eligible patients. Patients with diabetes were excluded as this condition was deemed to be a secondary prevention risk. 10,287 patients were enrolled (9,816 evaluable: mean age 64.3 years; 53.5% male). Prevalence of asymptomatic PAD was 17.8% (99% CI 16.84–18.83). Factors significantly associated with asymptomatic PAD included hypertension, age, alcohol intake, family history of coronary heart disease, low levels of high-density lipoprotein-cholesterol, and smoking (p < 0.0001). Patients treated with statins were significantly less likely to have asymptomatic PAD than those who were not (odds ratio 0.62; 95% CI 0.50–0.76; p < 0.0001). Asymptomatic PAD was highly prevalent in patients with non-high CV risk, the majority of whom would not typically be candidates for ABI assessment. These patients should be carefully screened, and ABI measured, so that therapeutic interventions known to diminish their increased CV risk may be offered.


Ankle-brachial index Atherosclerosis Peripheral vascular disease Prevention Risk factors