期刊
CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES
卷 9, 期 2, 页码 S86-S93出版社
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1161/CIRCOUTCOMES.115.002180
关键词
ankle brachial index; epidemiology; mortality; peripheral artery disease; sex
资金
- National Institute of Diabetes and Digestive and Kidney Diseases [U01DK060990, U01DK060984, U01DK061022, U01DK061021, U01DK061028, U01DK060980, U01DK060963, U01DK060902]
- University of Pennsylvania Clinical and Translational Science Award National Institutes of Health (NIH)/NCATS [UL1TR000003]
- Johns Hopkins University [UL1 TR-000424]
- University of Maryland GCRC [M01 RR-16500]
- Clinical and Translational Science Collaborative of Cleveland [UL1TR000439]
- Michigan Institute for Clinical and Health Research [UL1TR000433]
- University of Illinois at Chicago CTSA [UL1RR029879]
- Tulane University Translational Research in Hypertension and Renal Biology [P30GM103337]
- Kaiser Permanente NIH/NCRR UCSF-CTSI [UL1 RR-024131, K01DK092353]
Background To define how the incidence of peripheral artery disease (PAD) in chronic kidney disease differs according to sex and age. Methods and Results The Chronic Renal Insufficiency Cohort (CRIC) is a multicenter, prospective cohort study of chronic kidney disease participants. Fine and Gray methods were used to determine the cumulative incidence of PAD, defined by an ankle brachial index <0.90 or a confirmed PAD event, with death as a competing event. Adjusted subdistribution hazard ratios from the Fine and Gray model determined the risk of PAD according to sex. A priori, we hypothesized that the relationship between sex and cumulative incidence of PAD differed according to age. The mean age of the 3174 participants in this study was 56.6 years and consisted of 55% males. During a median follow-up of 5.9 years, 17.8% developed PAD, 13.0% were lost to follow-up and 11.1% died. Females had a 1.53-fold greater adjusted PAD risk compared with males (95% confidence interval, 1.27-1.84; P<0.001). These sex-related differences in PAD risk also differed by age (P=0.013). Women, compared with men were at a markedly increased risk for PAD at younger ages; however, at ages >70 years, the risk was similar across both the sexes. Older men had a substantially greater PAD risk compared with younger men. In women, PAD risk did not vary with age. Conclusions Females with chronic kidney disease have a higher PAD risk compared with males at younger ages. There is an important need to improve our understanding of the biological and clinical basis for these differences.
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