Supporting a call to action for peripheral artery disease: Insights from two prospective clinical registries

• Published in: Journal of vascular surgery 2006-10, Vol.44 (4), p.776-781
• Main Authors: Hackam, Daniel G., Tan, Mary K., Lin, Peter J., Mehta, Pravinsagar G., Jaffer, Shahin, Kates, Martin, Oh, Mona, Grima, Etienne A., Langer, Anatoly, Goodman, Shaun G.
• Format: Article
• Language: English
• Subjects: Aged; Angiotensin-Converting Enzyme Inhibitors - therapeutic use; Arterial Occlusive Diseases - complications; Arterial Occlusive Diseases - drug therapy; Arterial Occlusive Diseases - epidemiology; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Blood and lymphatic vessels; Canada - epidemiology; Cardiology. Vascular system; Cardiovascular system; Cerebrovascular Disorders - epidemiology; Cerebrovascular Disorders - etiology; Cerebrovascular Disorders - prevention & control; Confidence Intervals; Coronary Disease - epidemiology; Coronary Disease - etiology; Coronary Disease - prevention & control; Female; Follow-Up Studies; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - therapeutic use; Incidence; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Middle Aged; Platelet Aggregation Inhibitors - therapeutic use; Prognosis; Prospective Studies; Radionuclide investigations; Registries; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Survival Rate; Vascular surgery: aorta, extremities, vena cava. Surgery of the lymphatic vessels
• ISSN: 0741-5214; 1097-6809
• DOI: 10.1016/j.jvs.2006.05.057

Patients affected by peripheral arterial disease (PAD) incur a heightened risk of adverse cardiovascular events, including stroke, myocardial infarction, and vascular mortality. We examined risk factors, medications, and prognosis of outpatients with PAD enrolled in two national, prospective, practice-based Canadian registries that encompassed 484 physician practices: the Vascular Protection and Guideline Oriented Approach in Lipid Lowering registries. The 2 registries were combined to analyze 9810 patients with vascular disease, diabetes mellitus, or age 65 years or older plus at least 2 additional cardiovascular risk factors. Risk factors, medications, and major cardiovascular events were recorded at baseline and again at 6 months’ follow-up. Compared with patients without PAD (n = 8303), those with PAD (n = 1507) had substantially worse risk factor profiles and were more likely to have coexisting coronary or cerebrovascular disease. Both groups received high rates of treatment with evidence-based therapies, including antiplatelet drugs, statins, and angiotensin-converting enzyme inhibitors. Despite this, patients with PAD had a nearly twofold higher risk of major cardiovascular events at 6 months than non-PAD patients (7.3% vs 4.1%; P < .0001). After adjustment for multiple confounding factors, the presence of PAD at baseline continued to predict a heightened risk of adverse vascular sequelae (odds ratio, 1.54; 95% confidence interval, 1.18-2.01; P < .0001). These data support a strong relationship between PAD and worsened vascular prognosis that is independent of both conventional vascular risk factors and concomitant cardiovascular disease. The presence of PAD should therefore provide a clear impetus for intensive risk factor modification and use of preventive medical therapy in affected patients.