Contribution of cardiovascular risk factors to coronary risk in patients with intermittent claudication in the PRIME Cohort Study of European men.
BACKGROUND
Intermittent claudication (IC) is associated with an increased cardiovascular morbidity. The goal of the present study was to assess the contribution of conventional cardiovascular risk factors (CVRFs) to this increased risk.


METHODS
The PRIME Study is a multicenter Prospective Cohort Study of 10 602 men recruited in 1991-1993, aged 50-59 at baseline and followed over 10 years. At baseline, a questionnaire on socio demographic data was self-administered and CVRFs were measured. Composite outcome consisted of incident MI, effort angina, unstable angina and coronary death. The standardized questionnaire of the London School of hygiene was used to identify claudicants. Data were analyzed using multivariate Cox models.


RESULTS
Probable and possible cases of IC were reported by 1.4% (135) and 4.6% (442) of subjects, respectively. Compared to subjects with no claudication, the probable cases demonstrated higher rates of CVRFs. The incidence of CAD events was 7.23/1000 person-year. Compared to non claudicants, probable claudicants had an increased age and country adjusted risk of coronary events (HR (95% CI), 2.4 (1.5-3.7), p<0.0001). After further adjustments for school duration, family history of early myocardial infarction, tobacco consumption, alcohol consumption, BMI, systolic blood pressure, antihypertensive treatment, diabetes, total cholesterol, HDL-cholesterol, triglycerides and lipid-lowering treatment, participants with probable claudication had an increased risk of coronary events but this was no longer significant (HR (95% CI), 1.3 (0.8-2.1), p=0.23).


CONCLUSIONS
IC is associated with an increased risk of developing coronary events. This association is largely explained by the coexistence of CVRFs.
Tilloy
Emmanuelle
E
Institut Pasteur de Lille, INSERM U744, Université de Lille 2, Lille, France.
Montaye
Michèle
M
Kee
Frank
F
Bingham
Annie
A
Arveiler
Dominique
D
Ruidavets
Jean-Bernard
JB
Evans
Alun
A
Haas
Bernadette
B
Ferrières
Jean
J
Ducimetière
Pierre
P
Amouyel
Philippe
P
Dallongeville
Jean
J
D000789:Angina, Unstable; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007383:Intermittent Claudication / Q000150:complications* / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology; D009660:Northern Ireland / Q000453:epidemiology; D016491:Peripheral Vascular Diseases / Q000209:etiology; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects