Supporting a call to action for peripheral artery disease: insights from two prospective clinical registries.
BACKGROUND
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.


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.
Hackam
Daniel G
DG
Canadian Heart Research Center, Toronto, Canada. Daniel.Hackam@ices.on.ca
Tan
Mary K
MK
Lin
Peter J
PJ
Mehta
Pravinsagar G
PG
Jaffer
Shahin
S
Kates
Martin
M
Oh
Mona
M
Grima
Etienne A
EA
Langer
Anatoly
A
Goodman
Shaun G
SG
D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001157:Arterial Occlusive Diseases / Q000150:complications* / Q000188:drug therapy / Q000453:epidemiology; D002170:Canada / Q000453:epidemiology; D002561:Cerebrovascular Disorders / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D016001:Confidence Intervals; D003327:Coronary Disease / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D015996:Survival Rate
D000806:Angiotensin-Converting Enzyme Inhibitors; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors