Birgitta Sigvant1, Pål Hasvold2, Björn Kragsterman3, Mårten Falkenberg4, Saga Johansson2, Marcus Thuresson5, Joakim Nordanstig6. 1. Department of Vascular Surgery, Karlstad Central Hospital, Karlstad, Sweden; Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden. Electronic address: birgitta.sigvant@liv.se. 2. AstraZeneca Gothenburg, Mölndal, Sweden. 3. Department of Surgical Sciences, Vascular Surgery, Uppsala University, Uppsala, Sweden. 4. Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, Gothenburg, Sweden. 5. Statisticon AB, Uppsala, Sweden. 6. Department of Vascular Surgery and Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital and Academy, Gothenburg, Sweden.
Abstract
OBJECTIVE: Long-term progression of peripheral arterial disease (PAD) as initial manifestation of atherosclerotic arterial disease is not well described. Cardiovascular (CV) risk was examined in different PAD populations diagnosed in a hospital setting in Sweden. METHODS: Data for this retrospective cohort study were retrieved by linking data on morbidity, medication use, and mortality from Swedish national registries. Primary CV outcome was a composite of myocardial infarction, ischemic stroke (IS), and CV death. Kaplan-Meier analysis and Cox proportional hazards modeling was used for describing risk and relative risk. RESULTS: Of 66,189 patients with an incident PAD diagnosis (2006-2013), 40,136 had primary PAD, 16,786 had PAD + coronary heart disease (CHD), 5803 had PAD + IS, and 3464 had PAD + IS + CHD. One-year cumulative incidence rates of major CV events for the groups were 12%, 21%, 29%, and 34%, respectively. Corresponding numbers for 1-year all-cause death were 16%, 22%, 33%, and 35%. Compared with the primary PAD population, the relative risk increase for CV events was highest in patients with PAD + IS + CHD (hazard ratio [HR], 2.01), followed by PAD + IS (HR, 1.87) and PAD + CHD (HR, 1.42). Despite being younger, the primary PAD population was less intensively treated with secondary preventive drug therapy. CONCLUSIONS: PAD as initial manifestation of atherosclerotic disease diagnosed in a hospital-based setting conferred a high risk: one in eight patients experienced a major CV event and one in six patients died within 1 year. Despite younger age and substantial risk of future major CV events, patients with primary PAD received less intensive secondary preventive drug therapy.
OBJECTIVE: Long-term progression of peripheral arterial disease (PAD) as initial manifestation of atherosclerotic arterial disease is not well described. Cardiovascular (CV) risk was examined in different PAD populations diagnosed in a hospital setting in Sweden. METHODS: Data for this retrospective cohort study were retrieved by linking data on morbidity, medication use, and mortality from Swedish national registries. Primary CV outcome was a composite of myocardial infarction, ischemic stroke (IS), and CV death. Kaplan-Meier analysis and Cox proportional hazards modeling was used for describing risk and relative risk. RESULTS: Of 66,189 patients with an incident PAD diagnosis (2006-2013), 40,136 had primary PAD, 16,786 had PAD + coronary heart disease (CHD), 5803 had PAD + IS, and 3464 had PAD + IS + CHD. One-year cumulative incidence rates of major CV events for the groups were 12%, 21%, 29%, and 34%, respectively. Corresponding numbers for 1-year all-cause death were 16%, 22%, 33%, and 35%. Compared with the primary PAD population, the relative risk increase for CV events was highest in patients with PAD + IS + CHD (hazard ratio [HR], 2.01), followed by PAD + IS (HR, 1.87) and PAD + CHD (HR, 1.42). Despite being younger, the primary PAD population was less intensively treated with secondary preventive drug therapy. CONCLUSIONS: PAD as initial manifestation of atherosclerotic disease diagnosed in a hospital-based setting conferred a high risk: one in eight patients experienced a major CV event and one in six patients died within 1 year. Despite younger age and substantial risk of future major CV events, patients with primary PAD received less intensive secondary preventive drug therapy.
Authors: Corey A Kalbaugh; Laura Loehr; Lisa Wruck; Jennifer L Lund; Kunihiro Matsushita; Lindsay G S Bengtson; Gerardo Heiss; Anna Kucharska-Newton Journal: J Am Heart Assoc Date: 2018-04-13 Impact factor: 5.501
Authors: Kate Levenberg; David N Proctor; Stephan R Maman; J Carter Luck; Amanda J Miller; Faisal Aziz; John F Radtka; Matthew D Muller Journal: SAGE Open Med Date: 2020-06-13