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Peripheral arterial disease--natural outcome
Insights
Peripheral arterial disease significantly impacts survival, with advanced lower limb ischemia indicating a higher risk of fatal cardiovascular events in men. This study highlights the disease
Area of Science:
- Cardiovascular Medicine
- Vascular Surgery
- Epidemiology
Background:
- Peripheral arterial disease (PAD) affects a significant patient population.
- Understanding the natural history and prognostic factors of PAD is crucial for patient management.
Purpose of the Study:
- To assess the long-term natural history of peripheral arterial disease.
- To identify factors influencing outcomes in patients with PAD.
- To evaluate the prognostic significance of disease severity in PAD.
Main Methods:
- A prospective follow-up study of 312 patients with peripheral arterial disease.
- Long-term follow-up (8.75 to 11.75 years) to record mortality and causes of death.
- Analysis of risk factors including demographics, comorbidities, and disease severity.
Main Results:
- 188 (69%) of 312 patients died during follow-up, with 68% of deaths due to cardiovascular causes.
- 10-year relative survival rates were 0.61 for males and 0.48 for females.
- Advanced lower limb ischemia, independent of diabetes, was a significant predictor of increased mortality in men, indicating broader arterial involvement.
Conclusions:
- Peripheral arterial disease is associated with substantial long-term mortality, primarily from cardiovascular events.
- Disease severity, particularly advanced lower limb ischemia, is a critical independent risk factor for fatal outcomes in men with PAD.
- Advanced ischemia suggests systemic arterial disease and predicts cardiovascular events, necessitating aggressive management strategies.
Abstract:
Three hundred and twelve patients with peripheral arterial disease were followed up for 8 3/4 years or more (maximum 11 3/4 years) to assess the natural history of the disease and factors determining its outcome. Of the 312 patients, 188 (69%) died during the follow-up, 68% of the deaths having cardiovascular causes. The 10-year relative cumulative survival rate was 0.61 for males and 0.48 for females. The role of smoking as a risk factor could not be analysed without bias. In addition to known risk factors diabetes mellitus, cerebrovascular disease and coronary heart disease, the degree of peripheral arterial disease itself also proved to be a risk factor among men. The expected life lost for men with intermittent claudication was 20%, but 44.3% for men with advanced lower limb ischaemia (p less than 0.01). This difference could not be explained by the well-known association of advanced ischaemia and diabetes mellitus. The present results therefore suggest that the state of advanced ischaemia indicates larger involvement of the whole of the arterial tree and predicts fatal cardiovascular events among these patients.