4.6 Article

Comparative mortality according to peripheral artery disease and coronary heart disease/stroke in the United States

Journal

ATHEROSCLEROSIS
Volume 354, Issue -, Pages 57-62

Publisher

ELSEVIER IRELAND LTD
DOI: 10.1016/j.atherosclerosis.2022.04.029

Keywords

Peripheral artery disease; Coronary heart disease; Stroke; Mortality; Epidemiology

Funding

  1. NHLBI

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This study found that peripheral artery disease (PAD) contributes to increased mortality in individuals with and without coronary heart disease or stroke (CHD/stroke). The prognosis of PAD without CHD/stroke was not better than that of CHD/stroke without PAD.
Background and aims: A recent trial reported that patients with peripheral artery disease (PAD) without coronary heart disease or stroke (CHD/stroke) had worse prognosis than those with CHD/stroke without PAD. However, community-based data are lacking. The purpose of this study was to compare mortality according to the status of PAD and CHD/stroke in the general population. Methods: In 6780 participants (aged >= 40 years) from the National Health and Nutrition Examination Surveys 1999-2004, we compared mortality risk according to PAD (ankle-brachial index <= 0.9) and CHD/stroke (self-report) at baseline using the Kaplan-Meier method and multivariable Cox models accounting for sampling weights. Results: The prevalence of having both PAD and CHD/stroke was 1.6%. The prevalence of PAD without CHD/ stroke and CHD/stroke without PAD was 4.1% and 8.5%, respectively (85.8% without PAD or CHD/stroke). Over a median follow-up of 12.8 years, 21.2% died. Individuals with both PAD and CHD/stroke had the worst survival (25.5% at 12 years). Those with PAD without CHD/stroke had the second worst prognosis (47.7%), followed by those with CHD/stroke without PAD (53.2%) and those without CHD/stroke or PAD (87.2%). Adjusted hazard ratio of mortality was 2.70 (95% CI, 2.07-3.53) for PAD with CHD/stroke, 1.81 (1.54-2.12) in CHD/stroke without PAD, and 1.68 (1.35-2.08) in PAD without CHD/stroke vs. no CHD/stroke or PAD. Conclusions: In the US adults, PAD contributed to increased mortality in persons with and without CHD/stroke. The prognosis of PAD without CHD/stroke was no better than that of CHD/stroke without PAD. These results suggest the importance of recognizing the presence of PAD in the community.

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