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Open Access Study protocol

Peripheral Arterial Disease Study (PERART): Prevalence and predictive values of asymptomatic peripheral arterial occlusive disease related to cardiovascular morbidity and mortality

María Teresa Alzamora123*, José Miguel Baena-Díez4, Marta Sorribes5, Rosa Forés1, Pere Toran3, Marisa Vicheto1, Guillem Pera3, María Dolores Reina6, Carlos Albaladejo7, Judith Llussà8, Magda Bundó9, Amparo Sancho10, Antonio Heras1, Joan Rubiés26, Juan Francisco Arenillas11 and the PERART study

Author Affiliations

1 Primary Healthcare Centre Riu Nord-Riu Sud, Institut Català de la Salut, Santa Coloma de Gramenet,, Spain

2 Department of Medicine, Universitat Autònoma de Barcelona, Spain

3 Research Unit Barcelonés Nord Maresme. ICS-IDIAP Jordi Gol. Mataró, Spain

4 Primary Healthcare Centre La Marina, Institut Català de la Salut, Barcelona, Spain

5 Primary Healthcare Centre Numància, Institut Català de la Salut, Barcelona, Spain

6 Primary Healthcare Centre Santa Coloma de Gramenet, Institut Català de la Salut, Santa Coloma de Gramenet, Spain

7 Primary Healthcare Centre Llefià, Institut Català de la Salut Badalona, Spain

8 Primary Healthcare Centre Sant Roc, Institut Català de la Salut, Badalona, Spain

9 Primary Healthcare Centre Ronda Prim, Institut Català de la Salut, Mataró, Spain

10 Primary Healthcare Centre Can Mariné, Institut Català de la Salut, Santa Coloma de Gramenet, Spain

11 Unitat de Neurociències. Hospital Germans Trias i Pujol. Institut Català de la Salut. Badalona, Spain

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BMC Public Health 2007, 7:348  doi:10.1186/1471-2458-7-348

Published: 11 December 2007



The early diagnosis of atherosclerotic disease is essential for developing preventive strategies in populations at high risk and acting when the disease is still asymptomatic. A low ankle-arm index (AAI) is a good marker of vascular events and may be diminished without presenting symptomatology (silent peripheral arterial disease). The aim of the PERART study (PERipheral ARTerial disease) is to determine the prevalence of peripheral arterial disease (both silent and symptomatic) in a general population of both sexes and determine its predictive value related to morbimortality (cohort study).


This cross-over, cohort study consists of 2 phases: firstly a descriptive, transversal cross-over study to determine the prevalence of peripheral arterial disease, and secondly, a cohort study to evaluate the predictive value of AAI in relation to cardiovascular morbimortality.

From September 2006 to June 2007, a total of 3,010 patients over the age of 50 years will be randomly selected from a population adscribed to 24 healthcare centres in the province of Barcelona (Spain).

The diagnostic criteria of peripheral arterial disease will be considered as an AAI < 0.90, determined by portable Doppler (8 Mhz probe) measured twice by trained personnel. Cardiovascular risk will be calculated with the Framingham-Wilson tables, with Framingham calibrated by the REGICOR and SCORE groups. The subjects included will be evaluted every 6 months by telephone interview and the clnical history and death registries will be reviewed. The appearance of the following cardiovascular events will be considered as variables of response: transitory ischaemic accident, ictus, angina, myocardial infartction, symptomatic abdominal aneurysm and vascular mortality.


In this study we hope to determine the prevalence of peripheral arterial disease, especially the silent forms, in the general population and establish its relationship with cardiovascular morbimortality. A low AAI may be a better marker of arterial disease than the classical cardiovascular risk factors and may, therefore, contribute to improving the predictive value of the equations of cardiovascular risk and thereby allowing optimisation of multifactorial treatment of atherosclerotic disease.