As part of an ancillary study to the Systolic Hypertension in the Elde
rly Program, carotid and lower extremity arterial disease (LEAD) were
evaluated in 369 subjects, 186 with a systolic blood pressure (SBP) gr
eater than or equal to 160 mmHg, and 183 with SBP < 160 mmHg. Both gro
ups had a diastolic blood pressure (DBP) < 90 mmHg. Internal carotid s
tenosis was identified by Doppler and LEAD was assessed using the ankl
e to arm systolic blood pressure ratio, commonly called the ankle/arm
index (AAI). Lp(a) values were obtained from frozen sera and values gr
eater than or equal to 20 mg/dl were considered elevated. Rates of car
otid stenosis were 24% among those with an Lp(a) greater than or equal
to 20 mg/dl and 14% among those with an Lp(a) level < 20 mg/dl (P = 0
.020). The relationship between Lp(a) and LEAD was even stronger. Thos
e with an Lp(a) greater than or equal to 20 mg/dl had a 36% prevalence
of a low AAI vs 14% among those with a Lp(a) level < 20 mg/dl (P < 0.
001). Lp(a) values were also associated with the severity of LEAD. Con
trolling for other risk factors did not reduce the association between
either LEAD or carotid stenosis and an Lp(a) greater than or equal to
20 mg/dl. Thus, Lp(a) appears to be independently associated with per
ipheral atherosclerosis in older adults, both men and women. The relat
ionship is particularly strong for atherosclerotic disease of the lowe
r extremities.