Peripheral artery disease is a coronary heart disease risk equivalent among both men and women: results from a nationwide study

Sumeet Subherwal; Manesh R Patel; Lars Kober; Eric D Peterson; Deepak L Bhatt; Gunnar H Gislason; Anne-Marie Schjerning Olsen; William S Jones; Christian Torp-Pedersen; Emil L Fosbol

doi:10.1177/2047487313519344

Peripheral artery disease is a coronary heart disease risk equivalent among both men and women: results from a nationwide study

Sumeet Subherwal, Manesh R Patel, Lars Kober, Eric D Peterson, Deepak L Bhatt, Gunnar H Gislason, Anne-Marie Schjerning Olsen, William S Jones, Christian Torp-Pedersen, Emil L Fosbol

Department of Clinical Medicine

63 Citations (Scopus)

Abstract

Aims: Lower extremity peripheral artery disease (PAD) has been proposed as a coronary heart disease (CHD) risk equivalent. We aimed to examine whether PAD confers similar risk for mortality as incident myocardial infarction (MI) and whether risk differs by gender. Methods: Using nationwide Danish administrative registries (2000-2008), we identified patients aged ≥40 years with incident PAD (PAD only, n=35,628), incident PAD with a history of MI (PAD+MI, n=7029), and incident MI alone (MI alone, n=71,115). Results: Patients with PAD only tended to be younger, female, and have less comorbidity than the other groups. During follow up (median 1051 d, IQR 384-1938), we found that MI-alone patients had greater risk of adverse outcomes in the acute setting (first 90 d); however, the PAD-only and PAD+MI groups had higher long-term mortality at 7 years than those with MI alone (47.8 and 60.4 vs. 36.4%, respectively; p<0.0001). After adjustment, the PAD-only and PAD+MI groups had a higher long-term risk for mortality [hazard ratio (HR) 1.47, 95% confidence interval (CI) 1.44-1.51; and HR 1.65, 95% CI 1.58-1.72, respectively], cardiovascular mortality (HR 1.30, 95% CI 1.26-1.34; and HR 1.71, 95% CI 1.62- 1.80, respectively), and composite of death, MI, and ischaemic stroke, 95% CI HR, 1.38, 95% CI 1.36-1.42; and HR 1.68, 95% CI 1.61-1.75, respectively). The greater long-term risks of PAD were seen for both women and men. Conclusions: Both women and men with incident PAD have greater long-term risks of total and cardiovascular mortality vs. those with incident MI. PAD should be considered a CHD risk equivalent, warranting aggressive secondary prevention.

Original language	English
Journal	European Journal of Preventive Cardiology
Volume	22
Issue number	3
Pages (from-to)	317-325
Number of pages	9
ISSN	2047-4873
DOIs	https://doi.org/10.1177/2047487313519344
Publication status	Published - 14 Mar 2015

Keywords

Adult
Age Factors
Aged
Aged, 80 and over
Comorbidity
Denmark
Female
Humans
Incidence
Kaplan-Meier Estimate
Lower Extremity
Male
Middle Aged
Myocardial Infarction
Peripheral Arterial Disease
Proportional Hazards Models
Registries
Risk Assessment
Risk Factors
Sex Factors
Time Factors

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10.1177/2047487313519344

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Subherwal, S., Patel, M. R., Kober, L., Peterson, E. D., Bhatt, D. L., Gislason, G. H., Olsen, A-M. S., Jones, W. S., Torp-Pedersen, C., & Fosbol, E. L. (2015). Peripheral artery disease is a coronary heart disease risk equivalent among both men and women: results from a nationwide study. European Journal of Preventive Cardiology, 22(3), 317-325. https://doi.org/10.1177/2047487313519344

Subherwal, S, Patel, MR, Kober, L, Peterson, ED, Bhatt, DL, Gislason, GH, Olsen, A-MS, Jones, WS, Torp-Pedersen, C & Fosbol, EL 2015, 'Peripheral artery disease is a coronary heart disease risk equivalent among both men and women: results from a nationwide study', European Journal of Preventive Cardiology, vol. 22, no. 3, pp. 317-325. https://doi.org/10.1177/2047487313519344

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title = "Peripheral artery disease is a coronary heart disease risk equivalent among both men and women: results from a nationwide study",

abstract = "Aims: Lower extremity peripheral artery disease (PAD) has been proposed as a coronary heart disease (CHD) risk equivalent. We aimed to examine whether PAD confers similar risk for mortality as incident myocardial infarction (MI) and whether risk differs by gender. Methods: Using nationwide Danish administrative registries (2000-2008), we identified patients aged ≥40 years with incident PAD (PAD only, n=35,628), incident PAD with a history of MI (PAD+MI, n=7029), and incident MI alone (MI alone, n=71,115). Results: Patients with PAD only tended to be younger, female, and have less comorbidity than the other groups. During follow up (median 1051 d, IQR 384-1938), we found that MI-alone patients had greater risk of adverse outcomes in the acute setting (first 90 d); however, the PAD-only and PAD+MI groups had higher long-term mortality at 7 years than those with MI alone (47.8 and 60.4 vs. 36.4%, respectively; p<0.0001). After adjustment, the PAD-only and PAD+MI groups had a higher long-term risk for mortality [hazard ratio (HR) 1.47, 95% confidence interval (CI) 1.44-1.51; and HR 1.65, 95% CI 1.58-1.72, respectively], cardiovascular mortality (HR 1.30, 95% CI 1.26-1.34; and HR 1.71, 95% CI 1.62- 1.80, respectively), and composite of death, MI, and ischaemic stroke, 95% CI HR, 1.38, 95% CI 1.36-1.42; and HR 1.68, 95% CI 1.61-1.75, respectively). The greater long-term risks of PAD were seen for both women and men. Conclusions: Both women and men with incident PAD have greater long-term risks of total and cardiovascular mortality vs. those with incident MI. PAD should be considered a CHD risk equivalent, warranting aggressive secondary prevention.",

keywords = "Adult, Age Factors, Aged, Aged, 80 and over, Comorbidity, Denmark, Female, Humans, Incidence, Kaplan-Meier Estimate, Lower Extremity, Male, Middle Aged, Myocardial Infarction, Peripheral Arterial Disease, Proportional Hazards Models, Registries, Risk Assessment, Risk Factors, Sex Factors, Time Factors",

author = "Sumeet Subherwal and Patel, {Manesh R} and Lars Kober and Peterson, {Eric D} and Bhatt, {Deepak L} and Gislason, {Gunnar H} and Olsen, {Anne-Marie Schjerning} and Jones, {William S} and Christian Torp-Pedersen and Fosbol, {Emil L}",

note = "{\textcopyright} The European Society of Cardiology 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.",

year = "2015",

month = mar,

day = "14",

doi = "10.1177/2047487313519344",

language = "English",

volume = "22",

pages = "317--325",

journal = "European Journal of Preventive Cardiology",

issn = "2047-4873",

publisher = "SAGE Publications",

number = "3",

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TY - JOUR

T1 - Peripheral artery disease is a coronary heart disease risk equivalent among both men and women

T2 - results from a nationwide study

AU - Subherwal, Sumeet

AU - Patel, Manesh R

AU - Kober, Lars

AU - Peterson, Eric D

AU - Bhatt, Deepak L

AU - Gislason, Gunnar H

AU - Olsen, Anne-Marie Schjerning

AU - Jones, William S

AU - Torp-Pedersen, Christian

AU - Fosbol, Emil L

N1 - © The European Society of Cardiology 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

PY - 2015/3/14

Y1 - 2015/3/14

N2 - Aims: Lower extremity peripheral artery disease (PAD) has been proposed as a coronary heart disease (CHD) risk equivalent. We aimed to examine whether PAD confers similar risk for mortality as incident myocardial infarction (MI) and whether risk differs by gender. Methods: Using nationwide Danish administrative registries (2000-2008), we identified patients aged ≥40 years with incident PAD (PAD only, n=35,628), incident PAD with a history of MI (PAD+MI, n=7029), and incident MI alone (MI alone, n=71,115). Results: Patients with PAD only tended to be younger, female, and have less comorbidity than the other groups. During follow up (median 1051 d, IQR 384-1938), we found that MI-alone patients had greater risk of adverse outcomes in the acute setting (first 90 d); however, the PAD-only and PAD+MI groups had higher long-term mortality at 7 years than those with MI alone (47.8 and 60.4 vs. 36.4%, respectively; p<0.0001). After adjustment, the PAD-only and PAD+MI groups had a higher long-term risk for mortality [hazard ratio (HR) 1.47, 95% confidence interval (CI) 1.44-1.51; and HR 1.65, 95% CI 1.58-1.72, respectively], cardiovascular mortality (HR 1.30, 95% CI 1.26-1.34; and HR 1.71, 95% CI 1.62- 1.80, respectively), and composite of death, MI, and ischaemic stroke, 95% CI HR, 1.38, 95% CI 1.36-1.42; and HR 1.68, 95% CI 1.61-1.75, respectively). The greater long-term risks of PAD were seen for both women and men. Conclusions: Both women and men with incident PAD have greater long-term risks of total and cardiovascular mortality vs. those with incident MI. PAD should be considered a CHD risk equivalent, warranting aggressive secondary prevention.

AB - Aims: Lower extremity peripheral artery disease (PAD) has been proposed as a coronary heart disease (CHD) risk equivalent. We aimed to examine whether PAD confers similar risk for mortality as incident myocardial infarction (MI) and whether risk differs by gender. Methods: Using nationwide Danish administrative registries (2000-2008), we identified patients aged ≥40 years with incident PAD (PAD only, n=35,628), incident PAD with a history of MI (PAD+MI, n=7029), and incident MI alone (MI alone, n=71,115). Results: Patients with PAD only tended to be younger, female, and have less comorbidity than the other groups. During follow up (median 1051 d, IQR 384-1938), we found that MI-alone patients had greater risk of adverse outcomes in the acute setting (first 90 d); however, the PAD-only and PAD+MI groups had higher long-term mortality at 7 years than those with MI alone (47.8 and 60.4 vs. 36.4%, respectively; p<0.0001). After adjustment, the PAD-only and PAD+MI groups had a higher long-term risk for mortality [hazard ratio (HR) 1.47, 95% confidence interval (CI) 1.44-1.51; and HR 1.65, 95% CI 1.58-1.72, respectively], cardiovascular mortality (HR 1.30, 95% CI 1.26-1.34; and HR 1.71, 95% CI 1.62- 1.80, respectively), and composite of death, MI, and ischaemic stroke, 95% CI HR, 1.38, 95% CI 1.36-1.42; and HR 1.68, 95% CI 1.61-1.75, respectively). The greater long-term risks of PAD were seen for both women and men. Conclusions: Both women and men with incident PAD have greater long-term risks of total and cardiovascular mortality vs. those with incident MI. PAD should be considered a CHD risk equivalent, warranting aggressive secondary prevention.

KW - Adult

KW - Age Factors

KW - Aged

KW - Aged, 80 and over

KW - Comorbidity

KW - Denmark

KW - Female

KW - Humans

KW - Incidence

KW - Kaplan-Meier Estimate

KW - Lower Extremity

KW - Male

KW - Middle Aged

KW - Myocardial Infarction

KW - Peripheral Arterial Disease

KW - Proportional Hazards Models

KW - Registries

KW - Risk Assessment

KW - Risk Factors

KW - Sex Factors

KW - Time Factors

U2 - 10.1177/2047487313519344

DO - 10.1177/2047487313519344

M3 - Journal article

C2 - 24398369

SN - 2047-4873

VL - 22

SP - 317

EP - 325

JO - European Journal of Preventive Cardiology

JF - European Journal of Preventive Cardiology

IS - 3

ER -

Peripheral artery disease is a coronary heart disease risk equivalent among both men and women: results from a nationwide study

Abstract

Keywords

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