title: Peripheral artery disease is a coronary heart disease risk equivalent among both men and women: results from a nationwide study.
abstract: OBJECTIVE
  Lower extremity peripheral artery disease (PAD) has been proposed as a 'coronary heart disease (CHD) risk equivalent'. We aimed to examine whether PAD confers similar risk for mortality as incident myocardial infarction (MI) and whether risk differs by gender.
  
  
  METHODS
  Using nationwide Danish administrative registries (2000-2008), we identified patients aged ≥40 years with incident PAD (PAD only, n = 35,628), incident PAD with a history of MI (PAD + MI, n = 7029), and incident MI alone (MI alone, n = 71,115).
  
  
  RESULTS
  Patients with PAD only tended to be younger, female, and have less comorbidity than the other groups. During follow up (median 1051 d, IQR 384-1938), we found that MI-alone patients had greater risk of adverse outcomes in the acute setting (first 90 d); however, the PAD-only and PAD + MI groups had higher long-term mortality at 7 years than those with MI alone (47.8 and 60.4 vs. 36.4%, respectively; p < 0.0001). After adjustment, the PAD-only and PAD + MI groups had a higher long-term risk for mortality [hazard ratio (HR) 1.47, 95% confidence interval (CI) 1.44-1.51; and HR 1.65, 95% CI 1.58-1.72, respectively], cardiovascular mortality (HR 1.30, 95% CI 1.26-1.34; and HR 1.71, 95% CI 1.62-1.80, respectively), and composite of death, MI, and ischaemic stroke, 95% CI HR, 1.38, 95% CI 1.36-1.42; and HR 1.68, 95% CI 1.61-1.75, respectively). The greater long-term risks of PAD were seen for both women and men.
  
  
  CONCLUSIONS
  Both women and men with incident PAD have greater long-term risks of total and cardiovascular mortality vs. those with incident MI. PAD should be considered a CHD risk equivalent, warranting aggressive secondary prevention.
authors.affiliation: Duke University Medical Center, Durham, NC, USA ssubherwal@gmail.com.
authors.forename: Sumeet
authors.initials: S
authors.lastname: Subherwal
authors.affiliation: Duke University Medical Center, Durham, NC, USA.
authors.forename: Manesh R
authors.initials: MR
authors.lastname: Patel
authors.affiliation: The Heart Centre, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
authors.forename: Lars
authors.initials: L
authors.lastname: Kober
authors.affiliation: Duke University Medical Center, Durham, NC, USA.
authors.forename: Eric D
authors.initials: ED
authors.lastname: Peterson
authors.affiliation: Harvard Medical School, Boston, MA, USA.
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.affiliation: Copenhagen University Hospital Gentofte, Copenhagen, Denmark.
authors.forename: Gunnar H
authors.initials: GH
authors.lastname: Gislason
authors.affiliation: Copenhagen University Hospital Gentofte, Copenhagen, Denmark.
authors.forename: Anne-Marie Schjerning
authors.initials: AM
authors.lastname: Olsen
authors.affiliation: Duke University Medical Center, Durham, NC, USA.
authors.forename: William S
authors.initials: WS
authors.lastname: Jones
authors.affiliation: Copenhagen University Hospital Gentofte, Copenhagen, Denmark.
authors.forename: Christian
authors.initials: C
authors.lastname: Torp-Pedersen
authors.affiliation: Duke University Medical Center, Durham, NC, USA Copenhagen University Hospital Gentofte, Copenhagen, Denmark.
authors.forename: Emil L
authors.initials: EL
authors.lastname: Fosbol
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D016016:Proportional Hazards Models; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors
keywords: Coronary heart disease; myocardial infarction; peripheral artery disease