Asymptomatic Peripheral Artery Disease and Increased Risk for Mortality, CV Outcomes

Among patients with other prevalent cardiovascular (CV) risk factors, ankle-brachial index could indicate increased risk for mortality and other CV events. These findings, from a population-based observational study, were published in the International Journal of Cardiology Cardiovascular Risk and Prevention.

Data for this analysis were sourced from the Swedish Study of Prevalence of Peripheral Artery Disease, which followed Swedish inhabitants (N=8000) aged 60 to 90 years in 2004 for 10 years. For this study, the prevalence of asymptomatic peripheral artery disease (APAD), classified as ankle-brachial index (ABI) of less than 0.9, was related to long-term outcomes.

Among the study population, 559 individuals were found to have APAD. The APAD cohort was 62.3% women, aged mean 75.6±8.0 years, BMI was 25.5±3.9, ABI was 0.78±0.11, and 26.7% had CV disease. Compared with a reference cohort (n=4100), the APAD group was older and more had comorbidities.

During the follow-up period, 56.2% of the APAD and 27.4% of the reference cohorts died. APAD was associated with increased risk for all-cause mortality after adjusting for age and comorbidities (adjusted hazard ratio [aHR], 1.53; 95% CI, 1.34-1.75; P <.001).

The highest mortality rate was observed among men with APAD who had a history of stroke or transient ischemic attack (78.6%) or cardiac disease (75.4%) and women with APAD who had diabetes (73%).

APAD was also associated with increased risk for CV mortality (aHR, 1.80; 95% CI, 1.45-2.22; P <.001). Women with APAD who had cardiac disease had a 3.5-times higher CV mortality rate than the reference group.

In addition, CV events occurred most frequently among individuals with APAD with comorbid cardiac disease (aHR, 2.54; 95% CI, 2.31-2.78) or diabetes (aHR, 2.57; 95% CI, 2.28-2.89). Having a history of smoking nearly doubled the risk for CV events among individuals with APAD.

This study may have been limited by only having access to data collected in hospitals, however, the outcomes of interest were not minor and would likely not be treated in a general practice setting.

“For subjects with hypertension, diabetes mellitus, and a smoking history, the addition of APAD contributes significantly to the age-adjusted CV risk, especially in women,’” the study authors wrote. “[We] suggest further studies of screening activities for APAD with ABI-measurements in subjects with hypertension, diabetes or smoking habits for randomized controlled trials with treatment programs including statins.”

Reference

Sartipy F, Filho AJGP, Lundin F, Wahlberg E, Sigvant B. Presence of asymptomatic Peripheral Arterial Disease in combination with common risk factors elevates the cardiovascular risk Substantially.IJCCRP. Published online April 18, 2022. doi:10.1016/j.ijcrp.2022.200130