Peripheral Artery Disease and Coronary Artery Disease: A Strong Association
Yes, if you have bad PAD in your legs, you are very likely to also have coronary artery disease in your heart, even if you don't have symptoms. This is because both conditions are caused by the same underlying disease process—atherosclerosis—affecting different arterial beds throughout your body.
The Evidence for Coexisting Heart Disease
Between 60-80% of patients with PAD have significant coronary artery disease affecting at least one coronary artery, even when they have no heart symptoms 1. The prevalence varies depending on how thoroughly doctors look for it:
- One-third to one-half have CAD based on clinical history and electrocardiogram alone 1
- Two-thirds have CAD when stress testing is performed 1
- Up to 60-80% have significant coronary artery stenosis when coronary angiography is performed 1, 2
The 2024 ESC Guidelines report that among patients presenting with one form of atherosclerotic disease, the rates of disease in other territories are substantial, with CAD prevalence ranging from 10-70% in PAD patients depending on the diagnostic criteria used 1.
Why This Matters for Your Survival
The presence of PAD dramatically increases your risk of dying from heart attack and stroke, not from losing your leg 1. The data are striking:
- All-cause mortality is 3.1 times greater in PAD patients compared to those without PAD 1
- Cardiovascular death is 5.9 times greater in PAD patients 1
- 75% of PAD patients die from cardiovascular events, primarily heart attack and stroke 1
- Annual mortality rate is 4-6% per year, with most deaths due to myocardial infarction and stroke 1
If you have both PAD and known coronary disease, your risk is even higher—4.9 times greater risk of death compared to those without PAD 1. Among patients undergoing coronary interventions, one-year mortality is 5% in those with both PAD and CAD versus only 2.1% in those with CAD alone 1.
The Shared Disease Process
PAD is fundamentally a marker of systemic atherosclerosis 3, 4. The same risk factors that clog your leg arteries also clog your heart arteries:
- Smoking and diabetes show the strongest association with both conditions 1
- Hypertension and diabetes are independent predictors for having both CAD and PAD 2
- The severity of PAD correlates with the severity and extent of coronary disease 1
Even Without Leg Symptoms, Your Heart Risk Is High
Approximately 50% of all PAD patients have no leg symptoms whatsoever, yet they still face the same elevated cardiovascular risk 1. In one study, only 32.6% had classic claudication symptoms, while 19.8% had no leg pain at all 1. The risk of cardiovascular events is similar whether you have leg symptoms or not 1.
This is why PAD patients with asymptomatic disease still warrant aggressive cardiovascular risk reduction, including antiplatelet therapy, even though the evidence specific to this population is limited 1.
Clinical Implications
The 2024 ACC/AHA Guidelines emphasize that screening for CAD in PAD patients may be helpful to optimize medical treatment, though it's not intended to increase coronary interventions 1. The focus should be on:
- Aggressive antiplatelet therapy (aspirin or clopidogrel) 1
- High-intensity statin therapy 1
- Blood pressure control 2
- Diabetes management 2
- Smoking cessation 4
Common Pitfall to Avoid
The biggest mistake is undertreating PAD patients because they lack heart symptoms 1. Despite overwhelming evidence of elevated cardiovascular risk, PAD patients receive antiplatelet therapy and statins less frequently than CAD patients 1. This represents a critical care gap, as these patients should receive the same aggressive cardiovascular risk reduction as those with known coronary disease 5.
Bottom line: PAD in your legs is a red flag that atherosclerosis is likely affecting your heart arteries as well, dramatically increasing your risk of heart attack, stroke, and death—regardless of whether you have chest pain or leg pain 1, 3.