Self-reported peripheral arterial disease predicts future vascular events in a community-based cohort.
BACKGROUND
Lower extremity peripheral arterial disease (PAD) is highly prevalent and strongly associated with cardiovascular morbidity and mortality. The ankle-brachial index used to screen for PAD is not routinely performed in primary care settings.


OBJECTIVE
To determine if self-reported PAD is an independent predictor of combined vascular events (myocardial infarction, ischemic stroke, and vascular death).


METHODS
Ongoing population-based prospective cohort (the Northern Manhattan Study). Subjects enrolled between July 1993 and June 2001 with a mean follow-up time of 7.1 years.


METHODS
Subjects (n = 2,977), aged 40 years or older and free of prior stroke or myocardial infarction, were classified as having self-reported PAD if they answered affirmatively to one of two questions regarding exercise-induced leg pain or a prior diagnosis of PAD.


METHODS
Combined vascular outcome defined as incident myocardial infarction, incident ischemic stroke, or vascular death.


RESULTS
The mean age of the cohort was 68.9 +/- 10.4 years; 64% were women; 54% Hispanic, 25% African-American, 21% Caucasian; 15% reported having PAD. After a mean follow-up of 7.1 years, self-reported PAD was significantly predictive of combined events (n = 484) in the univariate model (HR 1.5, 95% CI, 1.2-1.9) and after adjustment for traditional cardiovascular risk factors (HR 1.3, 95% CI, 1.0-1.7).


CONCLUSIONS
Self-reported PAD is an independent risk factor for future vascular events in this predominantly non-white cohort. The addition of two simple PAD questions to the routine medical history in general medicine settings could identify high-risk patients who would benefit from further vascular evaluation and risk factor modification.
Salameh
Maya J
MJ
Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY 10032, USA. ms3033@columbia.edu
Rundek
Tatjana
T
Boden-Albala
Bernadette
B
Jin
Zhezhen
Z
Ratchford
Elizabeth V
EV
Di Tullio
Marco R
MR
Homma
Shunichi
S
Sacco
Ralph L
RL
D000368:Aged; D005260:Female; D006306:Health Surveys; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008487:Medical History Taking; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D016491:Peripheral Vascular Diseases / Q000150:complications* / Q000175:diagnosis*; D011446:Prospective Studies; D012307:Risk Factors; D020521:Stroke / Q000150:complications*