title: Mortality and vascular morbidity in older adults with asymptomatic versus symptomatic peripheral artery disease.
abstract: BACKGROUND
  Our aim was to assess the mortality and vascular morbidity risk of elderly individuals with asymptomatic versus symptomatic peripheral artery disease (PAD) in the primary care setting.
  
  
  RESULTS
  This prospective cohort study included 6880 representative unselected patients >or=65 years of age with monitored follow-up over 5 years. According to physician diagnosis, 5392 patients had no PAD, 836 had asymptomatic PAD (ankle brachial index <0.9 without symptoms), and 593 had symptomatic PAD (lower-extremity peripheral revascularization, amputation as a result of PAD, or intermittent claudication symptoms regardless of ankle brachial index). The risk of symptomatic compared with asymptomatic PAD patients was significantly increased for the composite of all-cause death or severe vascular event (myocardial infarction, coronary revascularization, stroke, carotid revascularization, or lower-extremity peripheral vascular events; hazard ratio, 1.48; 95% confidence interval, 1.21 to 1.80) but not for all-cause death alone (hazard ratio, 1.13; 95% confidence interval, 0.89 to 1.43), all-cause death/myocardial infarction/stroke (excluding lower-extremity peripheral vascular events and any revascularizations; hazard ratio, 1.18; 95% confidence interval, 0.92 to 1.52), cardiovascular events alone (hazard ratio, 1.20; 95% confidence interval, 0.89 to 1.60), or cerebrovascular events alone (hazard ratio, 1.33; 95% confidence interval, 0.80 to 2.20). Lower ankle brachial index categories were associated with increased risk. PAD was a strong factor for the prediction of the composite end point in an adjusted model.
  
  
  CONCLUSIONS
  Asymptomatic PAD diagnosed through routine screening in the offices of primary care physicians carries a high mortality and/or vascular event risk. Notably, the risk of mortality was similar in symptomatic and asymptomatic patients with PAD and was significantly higher than in those without PAD. In the primary care setting, the diagnosis of PAD has important prognostic value.
authors.affiliation: Department of Internal Medicine/Vascular Medicine, SRH-Klinikum Karlsbad-Langensteinbach, Affiliated Teaching Hospital, University of Heidelberg, Guttmannstr 1, D-76307 Karlsbad, Germany. curt.diehm@kkl.srh.de
authors.forename: Curt
authors.initials: C
authors.lastname: Diehm
authors.forename: Jens Rainer
authors.initials: JR
authors.lastname: Allenberg
authors.forename: David
authors.initials: D
authors.lastname: Pittrow
authors.forename: Matthias
authors.initials: M
authors.lastname: Mahn
authors.forename: Gerhart
authors.initials: G
authors.lastname: Tepohl
authors.forename: Roman L
authors.initials: RL
authors.lastname: Haberl
authors.forename: Harald
authors.initials: H
authors.lastname: Darius
authors.forename: Ina
authors.initials: I
authors.lastname: Burghaus
authors.forename: Hans Joachim
authors.initials: HJ
authors.lastname: Trampisch
mesh_terms: D000368:Aged; D055109:Ankle Brachial Index; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000175:diagnosis / Q000401:mortality*; D011446:Prospective Studies