title: Peripheral Artery Disease and Its Clinical Relevance in Patients with Chronic Obstructive Pulmonary Disease in the COPD and Systemic Consequences-Comorbidities Network Study.
abstract: Knowledge about the prevalence of objectively assessed peripheral artery disease (PAD) and its clinical relevance in patients with chronic obstructive pulmonary disease (COPD) is scarce.
  
  
  
  We aimed to: (1) assess the prevalence of PAD in COPD compared with distinct control groups; and (2) study the association between PAD and functional capacity as well as health status.
  
  
  
  The ankle-brachial index was used to diagnose PAD (ankle-brachial index ≤ 0.9). The 6-minute-walk distance, health status (St. George's Respiratory Questionnaire), COPD Assessment Test, and EuroQol-5-Dimensions were assessed in patients enrolled in the German COPD and Systemic Consequences-Comorbidities Network cohort study. Control groups were derived from the Study of Health in Pomerania.
  
  
  
  A total of 2,088 patients with COPD (61.1% male; mean [SD] age, 65.3 [8.2] years, GOLD (Global Initiative for Chronic Obstructive Lung Disease) stages I-IV: 9.4, 42.5, 37.5, and 10.5%, respectively) were included, of which 184 patients (8.8%; GOLD stage I-IV: 5.1, 7.4, 11.1, and 9.5%, respectively, vs. 5.9% in patients with GOLD stage 0 in the COPD and Systemic Consequences-Comorbidities Network) had PAD. In the Study of Health in Pomerania, PAD ranged from 1.8 to 4.2%. Patients with COPD with PAD had a significantly shorter 6-minute-walk distance (356 [108] vs. 422 [103] m, P < 0.001) and worse health status (St. George's Respiratory Questionnaire: 49.7 [20.1] vs. 42.7 [20.0] points, P < 0.001; COPD Assessment Test: 19.6 [7.4] vs. 17.9 [7.4] points, P = 0.004; EuroQol-5-Dimensions visual analog scale: 51.2 [19.0] vs. 57.2 [19.6], P < 0.001). Differences remained significant after correction for several confounders.
  
  
  
  In a large cohort of patients with COPD, 8.8% were diagnosed with PAD, which is higher than the prevalence in control subjects without COPD. PAD was associated with a clinically relevant reduction in functional capacity and health status.
authors.affiliation: 1 Department of Research and Education, CIRO, Horn, the Netherlands.
authors.forename: Sarah
authors.initials: S
authors.lastname: Houben-Wilke
authors.affiliation: 2 Institute of Outpatient Clinic for Occupational, Social, and Environmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany.
authors.forename: Rudolf A
authors.initials: RA
authors.lastname: Jörres
authors.affiliation: 3 Department of Internal Medicine V-Pulmonology, Allergology, Respiratory Intensive Care Medicine, Saarland University Hospital, Homburg, Germany.
authors.forename: Robert
authors.initials: R
authors.lastname: Bals
authors.affiliation: 1 Department of Research and Education, CIRO, Horn, the Netherlands.|4 Department of Respiratory Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.
authors.forename: Frits M E
authors.initials: FM
authors.lastname: Franssen
authors.affiliation: 5 Department of Internal Medicine B-Cardiology, Intensive Care, Pulmonary Medicine, and Infectious Diseases, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Sven
authors.initials: S
authors.lastname: Gläser
authors.affiliation: 6 Institute of Health Economics and Health Care Management and.
authors.forename: Rolf
authors.initials: R
authors.lastname: Holle
authors.affiliation: 7 Institute for Biostatistics and.
authors.forename: Annika
authors.initials: A
authors.lastname: Karch
authors.affiliation: 7 Institute for Biostatistics and.
authors.forename: Armin
authors.initials: A
authors.lastname: Koch
authors.affiliation: 8 Pulmonary Research Institute at Lung Clinic Grosshansdorf, Airway Research Center North (Member of German Center for Lung Research), Grosshansdorf, Germany.
authors.forename: Helgo
authors.initials: H
authors.lastname: Magnussen
authors.affiliation: 5 Department of Internal Medicine B-Cardiology, Intensive Care, Pulmonary Medicine, and Infectious Diseases, University Medicine Greifswald, Greifswald, Germany.
authors.forename: Anne
authors.initials: A
authors.lastname: Obst
authors.affiliation: 9 Institute of Epidemiology I, Helmholtz Zentrum München (GmbH)-German Research Center for Environmental Health (Member of the German Center for Lung Research), Comprehensive Pneumology Center Munich, Neuherberg, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Schulz
authors.affiliation: 1 Department of Research and Education, CIRO, Horn, the Netherlands.|10 Rehabilitation Research Center, Biomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium; and.
authors.forename: Martijn A
authors.initials: MA
authors.lastname: Spruit
authors.affiliation: 6 Institute of Health Economics and Health Care Management and.
authors.forename: Margarethe E
authors.initials: ME
authors.lastname: Wacker
authors.affiliation: 11 Clinic for Pneumology (Member of the German Center for Lung Research), Hannover Medical School, Hannover, Germany.
authors.forename: Tobias
authors.initials: T
authors.lastname: Welte
authors.affiliation: 1 Department of Research and Education, CIRO, Horn, the Netherlands.|4 Department of Respiratory Medicine, Maastricht University Medical Center+, Maastricht, the Netherlands.
authors.forename: Emiel F M
authors.initials: EF
authors.lastname: Wouters
authors.affiliation: 12 Department of Medicine, Pulmonary, and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University (Member of the German Center for Lung Research), Marburg, Germany.
authors.forename: Claus
authors.initials: C
authors.lastname: Vogelmeier
authors.affiliation: 8 Pulmonary Research Institute at Lung Clinic Grosshansdorf, Airway Research Center North (Member of German Center for Lung Research), Grosshansdorf, Germany.
authors.forename: Henrik
authors.initials: H
authors.lastname: Watz
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D055109:Ankle Brachial Index; D015897:Comorbidity; D005260:Female; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D058729:Peripheral Arterial Disease / Q000150:complications* / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000453:epidemiology
keywords: chronic obstructive pulmonary disease; comorbidities; functional capacity; health status; peripheral vascular disease