Microvascular Disease, Peripheral Artery Disease, and Amputation

Area of Science:

• Vascular Medicine
• Epidemiology
• Diabetic Complications

Background:

• Peripheral artery disease (PAD) mechanisms for adverse limb events are not fully understood.
• Investigated microvascular disease's association with amputation in a large veteran cohort.
• Determined if microvascular disease increases amputation risk independently and with PAD.

Purpose of the Study:

• To assess the independent and combined association of microvascular disease and peripheral artery disease with amputation risk.
• To identify risk factors for adverse limb events in a veteran population.

Main Methods:

• Utilized data from the Veterans Aging Cohort Study (2003-2014).
• Employed time-updated Cox proportional hazards regression.
• Analyzed prevalent microvascular disease (retinopathy, neuropathy, nephropathy) and PAD status for incident amputation risk, adjusting for covariates.

Main Results:

• Among 125,674 veterans, 1185 amputations occurred over a median of 9.3 years.
• Microvascular disease alone increased amputation risk 3.7-fold (95% CI, 3.0-4.6).
• PAD alone increased risk 13.9-fold (95% CI, 11.3-17.1).
• Combined PAD and microvascular disease increased risk 22.7-fold (95% CI, 18.3-28.1).

Conclusions:

• Microvascular disease independently elevates amputation risk.
• Microvascular disease synergistically amplifies amputation risk in patients with PAD.
• Further research is needed to elucidate the underlying mechanisms.