Excess 1-year cardiovascular risk in elderly primary care patients with a low ankle-brachial index (ABI) and high homocysteine level.

Previous studies in selected patient samples suggested a high risk for total mortality and cardiovascular (CV) morbidity associated not only with symptomatic, but also with asymptomatic peripheral arterial disease (PAD). Our aim was to assess the 1-year risk of death and CV morbidity associated with PAD in primary care. Furthermore, we quantified the strength of association between low ankle-brachial index (ABI, as indicator for PAD), plasma homocysteine (HC) levels, and various accepted PAD risk factors, and death and outcomes. In a prospective cohort study, 6880 unselected patients > or =65 years were followed up by 344 primary care physicians in Germany. At 1 year, all-cause mortality was 2.8% in patients with PAD and 0.9% in patients without PAD (odds ratio [OR] adjusted for age and gender: 2.7 [95% confidence interval: 1.7; 4.2]; multivariate adjusted OR: 2.0 [1.3; 3.3]). Mortality due to CV events was 1.6 versus 0.4% (OR: 3.7 [2.0; 6.9], adjusted OR: 2.5 [1.3; 4.9]). Patients with PAD and high HC values (> or =fourth quintile) had a markedly increased risk of premature death: OR versus no PAD/low HC level (<first quintile): 9.8 [3.2, 29.9], adjusted OR 6.6 [2.1, 20.9]. Patients with a low ABI have a substantially increased risk of (short-term) all-cause mortality. The combination of a low ABI and high HC level is particularly useful for identifying patients at excess risk.