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Long-Term Morbidity and Mortality after First and Recurrent Cardiovascular Events in the ARTPER Cohort
Marina Escofet Peris1,2, Maria Teresa Alzamora1,3, Marta Valverde1,4
1Unitat de Suport a la Recerca Metropolitana Nord, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), 08303 Mataró, Spain.
Insights
Recurrence of cardiovascular events is common, especially in older patients with diabetes or peripheral arterial disease. Ankle-Brachial Index less than 0.9 predicts higher recurrence risk.
Area of Science:
- Cardiology
- Neurology
- Vascular Medicine
Background:
- Cardiovascular events are a leading cause of death globally.
- Recurrence risk after a first event is documented but less studied in low-risk Mediterranean populations.
- Conflicting data exists on stroke and myocardial infarction (MI) recurrence and associated factors, including Ankle-Brachial Index (ABI).
Purpose of the Study:
- To investigate patient evolution after a first cardiovascular event in a low-risk Mediterranean population.
- To analyze overall, cardiac, and cerebral recurrence rates and associated risk factors.
- To evaluate the Ankle-Brachial Index (ABI) as a predictor of cardiovascular recurrence.
Main Methods:
- Prospective observational cohort study (ARTPER) of 520 patients with a first cardiovascular event.
- Exclusion of patients with unconfirmed events, arterial calcification, or death at baseline.
- Analysis focused on recurrence type, risk factors, and ABI behavior.
Main Results:
- 46% of patients experienced recurrence; most were of the same type as the initial event.
- Recurrence risk was higher after MI than stroke.
- Increased recurrence linked to age, peripheral arterial disease (PAD), diabetes, and antiplatelet use. Diabetes mellitus predicted all recurrence types. ABI < 0.9 indicated higher recurrence.
Conclusions:
- Cardiac event recurrence typically manifests as another cardiac event.
- Post-stroke, the risk of another stroke or a cardiac event is similar.
- Ankle-Brachial Index (ABI) < 0.9 is a potential predictor of cardiovascular recurrence risk.
Background:
Cardiovascular events are a major cause of mortality and morbidity worldwide. The risk of recurrence after a first cardiovascular event has been documented in the international literature, although not as extensively in a Mediterranean population-based cohort with low cardiovascular risk. There is also ample, albeit contradictory, research on the recurrence of stroke and myocardial infarctions (MI) after a first event and the factors associated with such recurrence, including the role of pathological Ankle-Brachial Index (ABI).
Methods:
The Peripheral Arterial ARTPER study is aimed at deepening our knowledge of patient evolution after a first cardiovascular event in a Mediterranean population with low cardiovascular risk treated at a primary care centre. We study overall recurrence, cardiac and cerebral recurrence. We studied participants in the ARTPER prospective observational cohort, excluding patients without cardiovascular events or with unconfirmed events and patients who presented arterial calcification at baseline or who died. In total, we analyzed 520 people with at least one cardiovascular event, focusing on the presence and type of recurrence, the risk factors associated with recurrence and the behavior of the ankle-brachial index (ABI) as a predictor of risk.
Results:
Between 2006 and 2017, 46% of patients with a first cardiovascular event experienced a recurrence of some type; most recurrences fell within the same category as the first event. The risk of recurrence after an MI was greater than after a stroke. In our study, recurrence increased with age, the presence of peripheral arterial disease (PAD), diabetes and the use of antiplatelets. Diabetes mellitus was associated with all types of recurrence. Additionally, patients with an ABI < 0.9 presented more recurrences than those with an ABI ≥ 0.9.
Conclusions:
In short, following a cardiac event, recurrence usually takes the form of another cardiac event. However, after having a stroke, the chance of having another stroke or having a cardiac event is similar. Lastly, ABI < 0.9 may be considered a predictor of recurrence risk.
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