Long-term outcome of patients with mild intermittent claudication under secondary prevention.
BACKGROUND
The known natural history of peripheral arterial disease (PAD) is determined by the generalization of atherosclerosis with resulting high cardiovascular and cerebrovascular morbidity and mortality. The aim of this prospective study was to record all vascular and non-vascular events in patients with mild intermittent claudication (IC) undergoing secondary preventive measures in a 10-year follow-up and to determine the time-points at which systemic localizations of atherosclerotic events develop.


METHODS
Patients who originally had an isolated Fontaine stage IIa PAD were included in the follow-up which involved assessments carried out on an annual basis. The incidence and timepoints of vascular (i.e., myocardial infarction, stroke, critical limb ischemia, vascular death), and nonvascular events (i.e., cancer, non vascular death) were recorded and compared with the known natural history.


RESULTS
534 events (vascular: 433) concerning 109 claudicants (M/F: 88/21; 60.8 +/- 8.8 years; ABI 0.66 +/- 0.11) were recorded over an average follow-up period of 104 months. 25.7% of the claudicants died, 39% due to vascular events, 36% due to cancer disease and 25% due to other events. A deterioration of PAD (n = 108) was the most frequent event after 20 months, followed by angina pectoris (n = 41) and cancer diseases (n = 20) after 42 and 45 months, stroke (n = 19) after 58 months, myocardial infarction (n = 12) after 63 months, and finally critical limb ischemia (n = 27) and amputations (n = 10) after 80 and 114 months (median). 111 revascularizations were carried out. 62.3% of the claudicants developed a polyvascular disease, with 20% in a trivascular territory.


CONCLUSIONS
A high vascular comorbidity also develops under secondary prevention as an expression of the continuing generalization of the atherosclerotic process in PAD. The causes for death are determined both by the vascular and the tumor related comorbidity.
Taute
B-M
BM
Department of Internal Medicine III, Martin-Luther-University of Halle-Wittenberg, Halle, Germany. bettina.taute@medizin.uni-halle.de
Thommes
S
S
Taute
R
R
Rapmund
I
I
Lindner
K
K
Podhaisky
H
H
D000328:Adult; D000368:Aged; D000671:Amputation, Surgical; D002318:Cardiovascular Diseases / Q000209:etiology / Q000401:mortality; D002423:Cause of Death; D015897:Comorbidity; D018450:Disease Progression; D005260:Female; D006801:Humans; D007383:Intermittent Claudication / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016491:Peripheral Vascular Diseases / Q000150:complications / Q000401:mortality / Q000628:therapy*; D011446:Prospective Studies; D055502:Secondary Prevention; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome