Internal and Emergency Medicine

, Volume 6, Issue 6, pp 509–519 | Cite as

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

  • Claudio Cimminiello
  • Serge Kownator
  • Jean-Claude Wautrecht
  • Christos P. Carvounis
  • Stefanus Eliza Kranendonk
  • Beat Kindler
  • Mario Mangrella
  • Claudio Borghi
  • for the PANDORA Study Investigators
IM - Original


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 



This study was funded by AstraZeneca. The authors thank Jennifer Stewart, MSc, from QXV Communications, Macclesfield, UK, for her assistance in the manuscript preparation which was funded by AstraZeneca.

Conflict of interest

The authors of this paper have full control of all primary data and, if requested, agree that Internal and Emergency Medicine can review the data.

Prof C Cimminiello has acted as a speaker and chairman at scientific meetings sponsored by AstraZeneca, Sanofi-Aventis and Bristol-Myers-Squibb. Prof C Borghi has acted as a consultant or speaker on occasions for Recordati, AstraZeneca, Merck, MSD, Novartis, Boehringer Ingelheim, Takeda, and Schering-Plough and has received research funding from Boehringer Ingelheim, Sanofi-Aventis, Takeda, Italian Society of Hypertension, and Regional Drug Agency; he does not have any conflict of interest regarding the present activity. Dr S Kownator has been occasional consultant or speaker for AstraZeneca, Bristol-Myers-Squibb, Daichi-Sankyo, MSD, Novartis, Pfizer, Sanofi-Aventis, Schering-Plough, Solvay. Prof JC Wautrecht has no conflict of interests. Prof CP Carvounis has received grants and acted as a consultant for AstraZeneca. Dr S.E. Kranendonk has acted as occasional speaker and is national study coordinator in the Netherlands. Dr B Kindler participated as investigator in AstraZeneca-sponsored clinical trial. Dr M Mangrella is an employee of AstraZeneca.


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Copyright information

© SIMI 2011

Authors and Affiliations

  • Claudio Cimminiello
    • 1
  • Serge Kownator
    • 2
  • Jean-Claude Wautrecht
    • 3
  • Christos P. Carvounis
    • 4
  • Stefanus Eliza Kranendonk
    • 5
  • Beat Kindler
    • 6
  • Mario Mangrella
    • 7
  • Claudio Borghi
    • 8
  • for the PANDORA Study Investigators
  1. 1.Department of MedicineVimercate HospitalVimercate (MI)Italy
  2. 2.Cardiology DepartmentClinique Ambroise ParéThionvilleFrance
  3. 3.Department of Vascular DiseasesHôpital ErasmeBrusselsBelgium
  4. 4.Internal Medicine DepartmentKyanous Stavros Medical CenterAthensGreece
  5. 5.TweeSteden HospitalTilburgThe Netherlands
  6. 6.ZurichSwitzerland
  7. 7.R&D DepartmentAstraZeneca SpABasiglioItaly
  8. 8.Internal Medicine UnitUniversity Hospital Sant’Orsola-MalpighiBolognaItaly

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