Peripheral arterial disease and atrial fibrillation and risk of stroke, heart failure hospitalization and cardiovascular death: A nationwide cohort study

Lin, Yu‐Sheng; Tung, Tao‐Hsin; Wang, Jui; Chen, Yu-Fen; Chen, Tien-Hsing; Lin, Ming-Sheng; Chi, Ching‐Chi; Chen, Mien‐Cheng

doi:10.1016/j.ijcard.2015.10.091

Cited by 37 publications

(32 citation statements)

References 37 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…4 Coronary artery disease and peripheral artery disease are frequent comorbidities in AF patients, with a documented prevalence that ranges from 18% to 45% and 4%-17%, respectively. [9][10][11][12][13][14][15] These patients are at high risk for stroke, myocardial infarction and cardiovascular death, [16][17][18][19] and that often leads to prescription of concomitant antiplatelet therapy in addition to OAC. However, several previous studies have shown a higher risk of bleeding 20,21 without a risk reduction in ischaemic events with OAC plus antiplatelet combination vs OAC monotherapy.…”

Section: Introductionmentioning

confidence: 99%

Effect of concomitant antiplatelet therapy in patients with nonvalvular atrial fibrillation initiating non‐vitamin K antagonists

Ruíz

Martínez

Flores-Blanco

et al. 2019

Eur J Clin Investigation

View full text Add to dashboard Cite

Background Antiplatelet therapy (APT) use in combination with oral anticoagulation is common among patients with atrial fibrillation, but there is scarce information regarding its effect on outcomes in patients on non‐vitamin K antagonist oral anticoagulants (NOAC). We aimed to evaluate the safety and efficacy of APT use in a ‘real‐world’ cohort of nonvalvular atrial fibrillation (NVAF) patients initiating NOAC. Design We conducted a retrospective multicentre study including 2361 consecutive NVAF patients initiating NOAC between January 2013 and December 2016. Patients with an acute ischaemic event within the last 12 months (acute coronary syndrome, stroke or revascularization) were excluded. Patients were followed up, and all clinical events were recorded at 3 months. The primary outcome of the study was major bleeding, and the secondary outcomes were stroke, nonfatal myocardial infarction, intracranial bleeding and death. Results One hundred forty‐five (6.1%) patients received concomitant APT, and aspirin was the more common (79%). At 3 months, 25 (1.1%) patients had major bleeding, 8 (0.3%) had nonfatal myocardial infarction, 7 (0.3%) had ischaemic stroke, and 40 (1.7%) died. After multivariate adjustment, concomitant APT was associated with higher risk for major bleeding (HR = 3.62, 95% CI 1.32‐9.89; P = .012), but was not associated with a higher risk of other clinical outcomes. Conclusions Concomitant APT use is uncommon among these patients and does not seem to be associated with lower rates of ischaemic events or death. However, there are signals for an increased risk of bleeding, which reinforces current guideline recommendations.

show abstract

Section: Introductionmentioning

confidence: 99%

Effect of concomitant antiplatelet therapy in patients with nonvalvular atrial fibrillation initiating non‐vitamin K antagonists

Ruíz

Martínez

Flores-Blanco

et al. 2019

Eur J Clin Investigation

View full text Add to dashboard Cite

show abstract

“…It is associated with an increased risk of cardiovascular disease [6–8], and is particularly common in patients with type 2 diabetes [9–12]. Previous studies have shown poor survival and cardiovascular outcomes in patients with both type 2 diabetes and PAD [13–15].…”

Section: Introductionmentioning

confidence: 99%

Presentations of major peripheral arterial disease and risk of major outcomes in patients with type 2 diabetes: results from the ADVANCE-ON study

Mohammedi

Woodward

Hirakawa

et al. 2016

Cardiovasc Diabetol

View full text Add to dashboard Cite

Background: Peripheral arterial disease (PAD) is known to be associated with high cardiovascular risk, but the individual impact of PAD presentations on risk of macrovascular and microvascular events has not been reliably compared in patients with type 2 diabetes. We aimed to evaluate the impact of major PAD, and its different presentations, on the 10-year risk of death, major macrovascular events, and major clinical microvascular events in these patients. Methods:Participants in the action in diabetes and vascular disease: PreterAx and DiamicroN modified-release controlled evaluation (ADVANCE) trial and the ADVANCE-ON post-trial study were followed for a median of 5.0 (in-trial), 5.4 (post-trial), and 9.9 (overall) years. Major PAD at baseline was subdivided into lower-extremity chronic ulceration or amputation secondary to vascular disease and history of peripheral revascularization by angioplasty or surgery.Results: Among 11,140 participants, 516 (4.6 %) had major PAD at baseline: 300 (2.7 %) had lower-extremity ulceration or amputation alone, 190 (1.7 %) had peripheral revascularization alone, and 26 (0.2 %) had both presentations. All-cause mortality, major macrovascular events, and major clinical microvascular events occurred in 2265 (20.3 %), 2166 (19.4 %), and 807 (7.2 %) participants, respectively. Compared to those without PAD, patients with major PAD had increased rates of all-cause mortality (HR 1.35, 95 % CI 1.15-1.60, p = 0.0004), and major macrovascular events (1.47 [1.23-1.75], p < 0.0001), after multiple adjustments for region of origin, cardiovascular risk factors and treatments, peripheral neuropathy markers, and randomized treatments. We have also observed a trend toward an association of baseline PAD with risk of major clinical microvascular events [1.31 (0.96-1.78), p = 0.09]. These associations were comparable for patients with a lower-extremity ulceration or amputation and for those with a history of peripheral revascularization. Furthermore, the risk of retinal photocoagulation or blindness, but not renal events, increased in patients with lower-extremity ulceration or amputation [1.53 (1.01-2.30), p = 0.04].Conclusions: Lower-extremity ulceration or amputation, and peripheral revascularization both increased the risks of death and cardiovascular events, but only lower-extremity ulceration or amputation increased the risk of severe retinopathy in patients with type 2 diabetes. Screening for major PAD and its management remain crucial for cardiovascular prevention in patients with type 2 diabetes (ClinicalTrials.gov number, NCT00949286).

show abstract

“…3 Ankle-Brachial Index and AF Some data suggest that a direct link can exist between the presence of PAD and an increased risk of incident AF. 4,5 In particular, it has been reported that an inverse "dose-effect response" relationship exists between ankle-brachial index (ABI) and the risk of newly detected AF. 6,7 ABI is a simple, costless, and noninvasive test used as the first-line diagnostic approach to PAD.…”

mentioning

confidence: 99%

Association Between Peripheral Artery Disease and Incident Risk of Atrial Fibrillation: Strong Evidence Coming From Population‐Based Cohort Studies

Proietti

Farcomeni

2018

JAHA

View full text Add to dashboard Cite

Peripheral arterial disease and atrial fibrillation and risk of stroke, heart failure hospitalization and cardiovascular death: A nationwide cohort study

Cited by 37 publications

References 37 publications

Effect of concomitant antiplatelet therapy in patients with nonvalvular atrial fibrillation initiating non‐vitamin K antagonists

Effect of concomitant antiplatelet therapy in patients with nonvalvular atrial fibrillation initiating non‐vitamin K antagonists

Presentations of major peripheral arterial disease and risk of major outcomes in patients with type 2 diabetes: results from the ADVANCE-ON study

Association Between Peripheral Artery Disease and Incident Risk of Atrial Fibrillation: Strong Evidence Coming From Population‐Based Cohort Studies

Contact Info

Product

Resources

About