From Arterial Stiffness to Inflammation: Peripheral Arterial Disease Screening in Patients with Coronary Artery Disease

Abstract

Peripheral arterial disease (PAD) frequently coexists with coronary artery disease (CAD) but remains underdiagnosed. This systematic review evaluated evidence supporting an integrative PAD screening strategy combining the cardio-ankle vascular index (CAVI), high-sensitivity C-reactive protein (hs-CRP), and clinical risk profiling in CAD patients. Seven databases were searched according to PRISMA 2020 guidelines. Eligible studies evaluated CAVI, CRP/hs-CRP, or clinical risk characteristics relevant to PAD detection in patients with CAD. Risk of bias was assessed using an adapted QUADAS-2 tool, and thematic narrative synthesis was performed. Twelve studies were included. Elevated CAVI was associated with greater atherosclerotic burden, incident PAD, and angiographically confirmed lower-extremity arterial disease. CAVI pseudonormalization occurred in 76% of above-knee chronic total occlusions, 28% of above-knee stenoses, and 19% of below-knee lesions, defining an important limitation of CAVI-based screening. Higher hs-CRP independently predicted incident PAD and adverse cardiovascular outcomes. Epidemiological studies demonstrated a high prevalence of PAD among patients with CAD, particularly those with type 2 diabetes or chronic kidney disease. No study evaluated an integrated screening model incorporating these components. The evidence supports a multimodal PAD screening strategy integrating CAVI, hs-CRP, and structured clinical risk profiling in patients with CAD. Prospective validation is warranted before clinical implementation. PROSPERO Registration: CRD420261426023.