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Mortality over a period of 10 years in patients with peripheral arterial disease
M H Criqui1, R D Langer, A Fronek
1Division of Epidemiology, University of California, San Diego, School of Medicine, La Jolla 92093-0607.
Insights
Large-vessel peripheral arterial disease significantly increases mortality risk, particularly from cardiovascular causes. Patients with this condition face a substantially higher chance of death, underscoring the need for proactive management.
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Epidemiology
Background:
- Peripheral arterial disease (PAD) is linked to increased mortality.
- Previous studies indicated elevated death rates in patients with intermittent claudication and large-vessel PAD.
- This study aimed to quantify the association between large-vessel PAD and mortality from cardiovascular disease (CVD) and coronary heart disease (CHD).
Purpose of the Study:
- To investigate the association between large-vessel peripheral arterial disease (PAD) and mortality rates.
- To determine the specific risks of death from all cardiovascular diseases and coronary heart disease in individuals with large-vessel PAD.
- To assess the impact of PAD on overall mortality.
Main Methods:
- A cohort of 565 individuals (average age 66) was assessed for large-vessel PAD using noninvasive techniques: segmental blood pressure measurement and Doppler ultrasound flow velocity.
- 11.9% (67 subjects) were diagnosed with large-vessel PAD and prospectively followed for 10 years.
- Mortality data for all causes, cardiovascular disease, and coronary heart disease were collected and analyzed.
Main Results:
- Subjects with large-vessel PAD exhibited significantly higher mortality rates compared to those without PAD.
- After adjusting for risk factors, the relative risk of all-cause mortality was 3.1, cardiovascular disease mortality was 5.9, and coronary heart disease mortality was 6.6.
- Severe and symptomatic large-vessel PAD was associated with a 15-fold increase in cardiovascular and coronary heart disease mortality.
Conclusions:
- Large-vessel peripheral arterial disease is a strong independent predictor of increased mortality from cardiovascular causes.
- Patients diagnosed with large-vessel PAD face a substantially elevated risk of death, particularly from cardiovascular and coronary heart disease.
- These findings highlight the critical importance of identifying and managing large-vessel PAD to mitigate cardiovascular mortality.
Background:
Previous investigators have observed a doubling of the mortality rate among patients with intermittent claudication, and we have reported a fourfold increase in the overall mortality rate among subjects with large-vessel peripheral arterial disease, as diagnosed by noninvasive testing. In this study, we investigated the association of large-vessel peripheral arterial disease with rates of mortality from all cardiovascular diseases and from coronary heart disease.
Methods:
We examined 565 men and women (average age, 66 years) for the presence of large-vessel peripheral arterial disease by means of two noninvasive techniques--measurement of segmental blood pressure and determination of flow velocity by Doppler ultrasound. We identified 67 subjects with the disease (11.9 percent), whom we followed prospectively for 10 years.
Results:
Twenty-one of the 34 men (61.8 percent) and 11 of the 33 women (33.3 percent) with large-vessel peripheral arterial disease died during follow-up, as compared with 31 of the 183 men (16.9 percent) and 26 of the 225 women (11.6 percent) without evidence of peripheral arterial disease. After multivariate adjustment for age, sex, and other risk factors for cardiovascular disease, the relative risk of dying among subjects with large-vessel peripheral arterial disease as compared with those with no evidence of such disease was 3.1 (95 percent confidence interval, 1.9 to 4.9) for deaths from all causes, 5.9 (95 percent confidence interval, 3.0 to 11.4) for all deaths from cardiovascular disease, and 6.6 (95 percent confidence interval, 2.9 to 14.9) for deaths from coronary heart disease. The relative risk of death from causes other than cardiovascular disease was not significantly increased among the subjects with large-vessel peripheral arterial disease. After the exclusion of subjects who had a history of cardiovascular disease at base line, the relative risks among those with large-vessel peripheral arterial disease remained significantly elevated. Additional analyses revealed a 15-fold increase in rates of mortality due to cardiovascular disease and coronary heart disease among subjects with large-vessel peripheral arterial disease that was both severe and symptomatic.
Conclusions:
Patients with large-vessel peripheral arterial disease have a high risk of death from cardiovascular causes.