Incidence and course of occlusive peripheral artery disease in geriatric patients. Possibilities and limits of prevention.
The fate of patients with chronic and acute OPAD was analysed in order to delimit needs and limits of preventive measures. Chronic disease. A high 5 year incidence of OPAD and a strong correlation with the risk factors at entry was observed in 2630 men initially free of disease. The incidence was at 114% in men with 3 risk factors vs 20% in the subgroup free of risk at entry. In a 11 year follow-up study of 239 men with OPAD a high mortality of 37% was observed vs 13% in the age-matched randomized controls. Death was due to coronary heart disease (CHD) in 15.1% of OPAD vs 1.7%. The mortality was significantly correlated with the risk profile at entry 46% in persons with several risk factors vs 19% in those free of risk. The strong correlation between the risk profile and morbidity/mortality indicates that primary prevention by reduction or elimination of risk factors could successfully avoid or postpone CHD and OPAD, if started early and not only at the threshold of the 3d life. Acute disease. The analysis of a geriatric subgroup, 141 patients older than 70 years, demonstrated that acute artery occlusion is a limb-and life-threatening event with an in-hospital mortality of 33% and an amputation-rate of 19%. Life together with limb salvage was obtained, in spite of thrombectomy thrombolysis or anti-coagulants, in only 57%. The subgroup at increased risk could have been recognised in advance by antecedent atrial fibrillation, OPAD and/or myocardial infarction; 50% presented indeed with several, 33% with one and only 17% without the mentioned conditions.(ABSTRACT TRUNCATED AT 250 WORDS)
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000671:Amputation, Surgical; D001157:Arterial Occlusive Diseases / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D002908:Chronic Disease; D005121:Extremities / Q000098:blood supply; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012306:Risk; D013557:Switzerland