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J Am Coll Cardiol. 2008 Nov 18;52(21):1736-42. doi: 10.1016/j.jacc.2008.07.060.

Progression of peripheral arterial disease predicts cardiovascular disease morbidity and mortality.

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  • 1Department of Family and Preventive Medicine, University of California, San Diego, California, USA. mcriqui@ucsd.edu

Abstract

OBJECTIVES:

The purpose of this study was to examine the association of progressive versus stable peripheral arterial disease (PAD) with the risk of future cardiovascular disease (CVD) events.

BACKGROUND:

An independent association between PAD, defined by low values of the ankle-brachial index (ABI), and future CVD risk has been demonstrated. However, the prognostic significance of declining versus stable ABI has not been studied.

METHODS:

We recruited 508 subjects (59 women, 449 men) from 2 hospital vascular laboratories in San Diego, California. ABI and CVD risk factors were measured at Visit 2 (1990 to 1994). ABI values from each subject's earliest vascular laboratory examination (Visit 1) were abstracted from medical records. Mortality and morbidity were tracked for 6 years after Visit 2 using vital statistics and hospitalization data.

RESULTS:

In multivariate models adjusted for CVD risk factors, very low (<0.70) and, in some cases, low (0.70 < or = ABI <0.90) Visit 2 ABIs were associated with significantly elevated all-cause mortality, CVD mortality, and combined CVD morbidity/mortality at 3 and 6 years. Decreases in ABI of more than 0.15 between Visit 1 and Visit 2 were significantly associated with an increased risk of all-cause mortality (risk ratio [RR]: 2.4) and CVD mortality (RR: 2.8) at 3 years, and CVD morbidity/mortality (RR: 1.9) at 6 years, independent of Visit 2 ABI and other risk factors.

CONCLUSIONS:

Progressive PAD (ABI decline >0.15) was significantly and independently associated with increased CVD risk. Patients with decreasing ABI may be candidates for more intensive cardiovascular risk factor management.

Comment in

PMID:
19007695
[PubMed - indexed for MEDLINE]
PMCID:
PMC2871035
Free PMC Article
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