title: Efficacy of a Guideline-Recommended Risk-Reduction Program to Improve Cardiovascular and Limb Outcomes in Patients With Peripheral Arterial Disease.
abstract: Patients with peripheral arterial disease (PAD) are at a high risk for cardiovascular events, yet, to our knowledge, no studies have examined the effect of a comprehensive risk-reduction program on long-term outcomes for patients with PAD.
  
  
  
  To investigative whether a program that focuses on 8 major guideline-recommended risk-management therapies reduces cardiovascular and limb events in patients with PAD.
  
  
  
  An observational cohort study with up to 7 years of follow-up was conducted using data from administrative databases from Ontario, Canada, between July 1, 2004, and March 31, 2013. Patients with symptomatic PAD who were enrolled in the Systematic Assessment of Vascular Risk (SAVR) program at a single tertiary vascular center in Ontario between July 2004 and April 2007 were matched with up to 2 (control) patients with PAD from other Ontario tertiary vascular centers not enrolled in the program using propensity score methods. Cox proportional hazards regression analysis was used to compare outcomes.
  
  
  
  Program that promoted antiplatelet agents, statins, angiotensin-converting enzyme inhibitors, blood pressure control, lipid control, diabetic glycemic control, smoking cessation, and target body mass index by engaging vascular surgeons, family physicians, and patients with PAD.
  
  
  
  The primary outcome was a composite risk ratio of death, acute myocardial infarction, or ischemic stroke. Secondary outcomes included rates of lower limb amputations, bypass surgical procedures, and peripheral angioplasties with and without a stent.
  
  
  
  A total of 791 patients were studied after propensity score matching; the mean (SD) age of patients in the SAVR group (n = 290) was 67.9 (10.4) years and 68.2 (11.2) years in the control group (n = 501). During follow-up, the SAVR group experienced the primary outcome at a significantly lower rate than the control group (adjusted hazard ratio [HR], 0.63; 95% CI, 0.52-0.77). Patients in the SAVR group were also less likely to have major amputation (adjusted HR, 0.47; 95% CI, 0.29-0.77), minor amputation (adjusted HR, 0.26; 95% CI, 0.13-0.54), bypass surgery (adjusted HR, 0.47; 95% CI, 0.30-0.73), or hospitalization due to heart failure (adjusted HR, 0.73; 95% CI, 0.53-1.00). The rate of peripheral angioplasty with or without a stent was higher among the SAVR group (adjusted HR, 2.97; 95% CI, 2.15-4.10).
  
  
  
  A guideline-recommended risk-reduction program targeted at patients with PAD was associated with fewer cardiovascular and limb events over the long-term. This finding emphasizes the need for well-designed prospective studies to develop and examine the effect of such programs on reducing PAD-related morbidity, mortality, and health care costs.
authors.affiliation: Division of Vascular Surgery, St Michael's Hospital, Toronto, Ontario, Canada2Department of Surgery, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Mohamad A
authors.initials: MA
authors.lastname: Hussain
authors.affiliation: Division of Vascular Surgery, St Michael's Hospital, Toronto, Ontario, Canada2Department of Surgery, University of Toronto, Toronto, Ontario, Canada3Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada4King Saud University-Li K.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al-Omran
authors.affiliation: Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada4King Saud University-Li Ka Shing Collaborative Research Program6Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada7Leslie.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Mamdani
authors.affiliation: Division of Vascular Surgery, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Naomi
authors.initials: N
authors.lastname: Eisenberg
authors.affiliation: Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Azra
authors.initials: A
authors.lastname: Premji
authors.affiliation: Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Lisa
authors.initials: L
authors.lastname: Saldanha
authors.affiliation: Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
authors.forename: Xuesong
authors.initials: X
authors.lastname: Wang
authors.affiliation: Department of Surgery, University of Toronto, Toronto, Ontario, Canada3Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada4King Saud University-Li Ka Shing Collaborative Research Program12Division of Cardiac Surgery, St Michae.
authors.forename: Subodh
authors.initials: S
authors.lastname: Verma
authors.affiliation: Department of Surgery, University of Toronto, Toronto, Ontario, Canada10Division of Vascular Surgery, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
authors.forename: Thomas F
authors.initials: TF
authors.lastname: Lindsay
mesh_terms: D000368:Aged; D000671:Amputation, Surgical / Q000706:statistics & numerical data*; D017130:Angioplasty / Q000706:statistics & numerical data; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D015992:Body Mass Index; D002545:Brain Ischemia / Q000150:complications; D016022:Case-Control Studies; D008078:Cholesterol, LDL / Q000097:blood; D005121:Extremities / Q000601:surgery; D005260:Female; D019983:Guideline Adherence; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000517:prevention & control; D009864:Ontario / Q000453:epidemiology; D058729:Peripheral Arterial Disease / Q000401:mortality / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D040242:Risk Reduction Behavior; D016540:Smoking Cessation; D015607:Stents; D020521:Stroke / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D013997:Time Factors
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D001786:Blood Glucose; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D010975:Platelet Aggregation Inhibitors