TY - JOUR

T1 - Peripheral artery disease is a coronary heart disease risk equivalent among both men and women

T2 - results from a nationwide study

AU - Subherwal, Sumeet

AU - Patel, Manesh R

AU - Kober, Lars

AU - Peterson, Eric D

AU - Bhatt, Deepak L

AU - Gislason, Gunnar H

AU - Olsen, Anne-Marie Schjerning

AU - Jones, William S

AU - Torp-Pedersen, Christian

AU - Fosbol, Emil L

N1 - © The European Society of Cardiology 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

PY - 2015/3

Y1 - 2015/3

N2 - AIMS: Lower extremity peripheral artery disease (PAD) has been proposed as a 'coronary heart disease (CHD) risk equivalent'. We aimed to examine whether PAD confers similar risk for mortality as incident myocardial infarction (MI) and whether risk differs by gender.METHODS: Using nationwide Danish administrative registries (2000-2008), we identified patients aged ≥40 years with incident PAD (PAD only, n = 35,628), incident PAD with a history of MI (PAD + MI, n = 7029), and incident MI alone (MI alone, n = 71,115).RESULTS: Patients with PAD only tended to be younger, female, and have less comorbidity than the other groups. During follow up (median 1051 d, IQR 384-1938), we found that MI-alone patients had greater risk of adverse outcomes in the acute setting (first 90 d); however, the PAD-only and PAD + MI groups had higher long-term mortality at 7 years than those with MI alone (47.8 and 60.4 vs. 36.4%, respectively; p < 0.0001). After adjustment, the PAD-only and PAD + MI groups had a higher long-term risk for mortality [hazard ratio (HR) 1.47, 95% confidence interval (CI) 1.44-1.51; and HR 1.65, 95% CI 1.58-1.72, respectively], cardiovascular mortality (HR 1.30, 95% CI 1.26-1.34; and HR 1.71, 95% CI 1.62-1.80, respectively), and composite of death, MI, and ischaemic stroke, 95% CI HR, 1.38, 95% CI 1.36-1.42; and HR 1.68, 95% CI 1.61-1.75, respectively). The greater long-term risks of PAD were seen for both women and men.CONCLUSIONS: Both women and men with incident PAD have greater long-term risks of total and cardiovascular mortality vs. those with incident MI. PAD should be considered a CHD risk equivalent, warranting aggressive secondary prevention.

AB - AIMS: Lower extremity peripheral artery disease (PAD) has been proposed as a 'coronary heart disease (CHD) risk equivalent'. We aimed to examine whether PAD confers similar risk for mortality as incident myocardial infarction (MI) and whether risk differs by gender.METHODS: Using nationwide Danish administrative registries (2000-2008), we identified patients aged ≥40 years with incident PAD (PAD only, n = 35,628), incident PAD with a history of MI (PAD + MI, n = 7029), and incident MI alone (MI alone, n = 71,115).RESULTS: Patients with PAD only tended to be younger, female, and have less comorbidity than the other groups. During follow up (median 1051 d, IQR 384-1938), we found that MI-alone patients had greater risk of adverse outcomes in the acute setting (first 90 d); however, the PAD-only and PAD + MI groups had higher long-term mortality at 7 years than those with MI alone (47.8 and 60.4 vs. 36.4%, respectively; p < 0.0001). After adjustment, the PAD-only and PAD + MI groups had a higher long-term risk for mortality [hazard ratio (HR) 1.47, 95% confidence interval (CI) 1.44-1.51; and HR 1.65, 95% CI 1.58-1.72, respectively], cardiovascular mortality (HR 1.30, 95% CI 1.26-1.34; and HR 1.71, 95% CI 1.62-1.80, respectively), and composite of death, MI, and ischaemic stroke, 95% CI HR, 1.38, 95% CI 1.36-1.42; and HR 1.68, 95% CI 1.61-1.75, respectively). The greater long-term risks of PAD were seen for both women and men.CONCLUSIONS: Both women and men with incident PAD have greater long-term risks of total and cardiovascular mortality vs. those with incident MI. PAD should be considered a CHD risk equivalent, warranting aggressive secondary prevention.

KW - Adult

KW - Age Factors

KW - Aged

KW - Aged, 80 and over

KW - Comorbidity

KW - Denmark

KW - Female

KW - Humans

KW - Incidence

KW - Kaplan-Meier Estimate

KW - Lower Extremity

KW - Male

KW - Middle Aged

KW - Myocardial Infarction

KW - Peripheral Arterial Disease

KW - Proportional Hazards Models

KW - Registries

KW - Risk Assessment

KW - Risk Factors

KW - Sex Factors

KW - Time Factors

U2 - 10.1177/2047487313519344

DO - 10.1177/2047487313519344

M3 - Journal article

C2 - 24398369

VL - 22

SP - 317

EP - 325

JO - European Journal of Preventive Cardiology

JF - European Journal of Preventive Cardiology

SN - 2047-4873

IS - 3

ER -