In postmenopausal women, lower limb peripheral arterial disease, assessed by ankle-brachial index, may be a strong predictor of cardiovascular risk.

• Awareness of peripheral arterial disease (PAD) is poor in postmenopausal women. • 850 postmenopausal women were tested for lower limb PAD in our Angiology Division. • Women with PAD were older, with higher rates of cardiovascular (CV) risk factors. • At multivariate regression analysis, PAD was a strong predictor of CV disease. Lower limb peripheral arterial disease (PAD) is a leading atherosclerotic disease in the elderly. However, awareness of the disease is poor, particularly in women. In this retrospective, cross-sectional study, postmenopausal women referred to our Angiology Division were tested for PAD, defined as an "ankle-brachial index" (ABI) ≤0.9 or ≥1.4 (in the latter case with a "toe-brachial index" <0.7), or a history of lower limb arterial revascularization. Aim of our study was to assess cardiovascular (CV) risk profile in postmenopausal women with and without PAD, and to evaluate the role of PAD and six classic CV risk factors (CVRFs), namely age, current smoking, hypertension, dyslipidaemia, severe chronic renal failure, and diabetes in predicting CV disease (CVD), defined as coronary artery disease and/or cerebrovascular disease. Overall, 850 patients were included, 39.4% of whom with PAD. Compared with women without PAD, those with PAD were older (75.2 vs 66 years, respectively; p <0.001), and displayed higher rates of other CVRFs (p <0.001 for each). A personal history of CVD was reported in 18.8% of women with PAD and in 6.1% of those without PAD (p <0.001). At multivariate regression analysis, PAD (odds ratio [OR]: 2.15; 95% confidence interval [CI]: 1.33–3.47), and hypertension (OR: 2.20; 95%CI: 1.24–3.88) were the strongest factors associated with CVD presence. PAD is a strong marker of CVD in this selected series of postmenopausal women. If confirmed in the general population, PAD screening through ABI calculation may be considered for CV risk assessment in postmenopausal women. Graphical Abstract [Display omitted]. [ABSTRACT FROM AUTHOR]