title: Peripheral artery disease and risk of cardiovascular events in patients with coronary artery disease: insights from the Heart and Soul Study.
abstract: Among patients with coronary artery disease (CAD), those with peripheral artery disease (PAD) have a greater vulnerability to cardiovascular (CV) events than those with CAD alone. In a prospective cohort study of patients with CAD, we evaluated potential mechanisms that might explain the adverse CV outcomes associated with PAD. We performed a prospective cohort study of 1018 patients with stable CAD who were recruited from 2000 to 2002. Incident symptomatic PAD events were adjudicated during a follow-up period of 7.2 ± 2.6 years. We used Cox proportional hazards models to evaluate the association between incident symptomatic PAD events and subsequent risk of CV events or death. Models were adjusted for demographics, traditional risk factors, inflammation, insulin resistance and health behaviors. Among the 1018 patients, 50 patients who did not report a history of PAD at baseline suffered incident symptomatic PAD events during the follow-up period. Those patients had a higher risk of subsequent CV events and death compared to those who did not develop PAD. After adjustment for traditional risk factors, symptomatic PAD events remained associated with a 70% increased risk of subsequent CV events (adjusted HR 1.7; 95% CI 1.0, 2.9; p = 0.04) and an 80% increased risk of death (adjusted HR 1.8; 95% CI 1.2, 2.7; p = 0.006). Inflammatory biomarkers were the strongest risk factor contributing to the excess risk. In a contemporary cohort of patients with CAD, incident symptomatic PAD events were associated with an increased risk for subsequent CV events. The increased vulnerability to CV events was partially explained by shared CV risk factors and inflammation.
authors.affiliation: Department of Surgery, University of California, San Francisco, San Francisco, CA, USA. marlene.grenon@ucsfmedctr.org
authors.forename: S Marlene
authors.initials: SM
authors.lastname: Grenon
authors.forename: Eric
authors.initials: E
authors.lastname: Vittinghoff
authors.forename: Christopher D
authors.initials: CD
authors.lastname: Owens
authors.forename: Michael S
authors.initials: MS
authors.lastname: Conte
authors.forename: Mary
authors.initials: M
authors.lastname: Whooley
authors.forename: Beth E
authors.initials: BE
authors.lastname: Cohen
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D003324:Coronary Artery Disease / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D018450:Disease Progression; D005260:Female; D006801:Humans; D015994:Incidence; D018836:Inflammation Mediators / Q000097:blood; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058729:Peripheral Arterial Disease / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012495:San Francisco / Q000453:epidemiology; D013997:Time Factors
chemical_list: D015415:Biomarkers; D018836:Inflammation Mediators
keywords: coronary disease; peripheral artery disease