Peripheral Arterial Disease as an Independent Predictor for Excess Stroke Morbidity and Mortality in Primary-Care Patients: 5-Year Results of the getABI Study

Abstract

Background:There is controversial evidence with regard to the significance of peripheral arterial disease (PAD) as an indicator for future stroke risk. We aimed to quantify the risk increase for mortality and morbidity associated with PAD. Methods:In an open, prospective, noninterventional cohort study in the primary care setting, a total of 6,880 unselected patients ≧65 years were categorized according to the presence or absence of PAD and followed up for vascular events or deaths over 5 years. PAD was defined as ankle-brachial index (ABI) <0.9 or history of previous peripheral revascularization and/or limb amputation and/or intermittent claudication. Associations between known cardiovascular risk factors including PAD and cerebrovascular mortality/events were analyzed in a multivariate Cox regression model. Results:During the 5-year follow-up [29,915 patient-years (PY)], 183 patients had a stroke (incidence per 1,000 PY: 6.1 cases). In patients with PAD (n = 1,429) compared to those without PAD (n = 5,392), the incidence of all stroke types standardized per 1,000 PY, with the exception of hemorrhagic stroke, was about doubled (for fatal stroke tripled). The corresponding adjusted hazard ratios were 1.6 (95% confidence interval, CI, 1.1–2.2) for total stroke, 1.7 (95% CI 1.2–2.5) for ischemic stroke, 0.7 (95% CI 0.2–2.2) for hemorrhagic stroke, 2.5 (95% CI 1.2–5.2) for fatal stroke and 1.4 (95% CI 0.9–2.1) for nonfatal stroke. Lower ABI categories were associated with higher stroke rates. Besides high age, previous stroke and diabetes mellitus, PAD was a significant independent predictor for ischemic stroke. Conclusions:The risk of stroke is substantially increased in PAD patients, and PAD is a strong independent predictor for stroke.

CHADS₂ Score and Risk of New-onset Peripheral Arterial Occlusive Disease in Patients without Atrial Fibrillation: A Nationwide Cohort Study in Taiwan

“…In addition, several studies have reported that the CHADS2 score can be used to predict subsequent cardiovascular events and new-onset AF in non-AF populations [11][12][13] . As an older age, hypertension, diabetes, congestive heart failure and stroke are all risk factors for PAOD [1][2][3][4][5][6][7] , our recent cross-sectional study demonstrated that the CHADS2 score is significantly associated with an ankle-brachial index (ABI) of 0.9 in non-AF patients 14) . However, divided the study patients into four groups: group 1 (score 0), group 2 (score 1-2), group 3 (score 3-4) and group 4 (score 5-6).…”

“…Major risk factors for PAOD include hypertension, diabetes mellitus, dyslipidemia, an advanced age and cigarette smoking 1,2) . In addition, chronic kidney disease, stroke, congestive heart failure, race, obesity and elevated inflammatory markers have also been reported to be associated with PAOD onset [1][2][3][4][5][6][7] . The CHADS2 score is a simple and reliable clinical score for assessing the risk of stroke in patients with atrial fibrillation (AF) 8,9) .…”

Outcomes of medical management of peripheral arterial disease in general practice: follow-up results of the PACE-PAD Study

“…PAD patients carry a high risk of premature death, and of cardiovascular and cerebrovascular events (Meves et al 2010). According to a recent metaanalysis of Heald et al, this risk is doubled, even if all other conventional cardiovascular risk factors are accounted for (Heald et al 2006).…”

“…In addition, we added 2 additional publications to the reference list, which were published very recently and fit well in the context of this study , Meves 2010). …”

“…Consequently, the definitions are no longer needed. In addition, we added 2 additional publications to the reference list, which were published very recently and fit well in the context of this study , Meves 2010.In Tables 4a and 4b the sequence of n and % was changed (now: % (n)), to have a consistent format across all tables . 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 1 …”