title: Adverse outcomes in patients with atrial fibrillation and peripheral arterial disease: a report from the EURObservational research programme pilot survey on atrial fibrillation.
abstract: OBJECTIVE
  Peripheral arterial disease (PAD) is highly prevalent in general population. Data on the prevalence of symptomatic PAD in patients with atrial fibrillation (AF) are limited, and the impact of PAD on adverse outcomes in AF patients is controversial. Our aims were: (i) to define the prevalence of symptomatic PAD in European AF patients and describe its associated clinical risk factors and (ii) to establish the relationship of PAD to adverse events in AF, especially all-cause death.
  
  
  RESULTS
  Atrial fibrillation patients enrolled in the EORP-AF Pilot study with data about PAD status were included in this analysis. Event rates were determined at 1-year follow-up. Peripheral arterial disease was recorded in 328 (11%) patients. Age (P < 0.0001), hypertension (P = 0.0059), diabetes mellitus (P = 0.0001), chronic heart failure (P < 0.0001), previous stroke/transient ischaemic attack (P = 0.0060), and antiplatelet drug treatment (P = 0.0001) were associated with the presence of PAD, while female gender was inversely associated (P = 0.0002). Peripheral arterial disease patients had higher absolute rates of both cardiovascular (CV) and all-cause death (both P < 0.0001). On Kaplan-Meier analysis, risk of all-cause death was higher in PAD patients compared with those without PAD (P < 0.0001), but PAD did not emerge as an independent risk factor for mortality on Cox regression analysis. A lower risk of all-cause death was associated with the prescription of statins (P = 0.0019), angiotensin-converting enzyme inhibitors (P = 0.0008), and calcium-channel blockers (P = 0.0071).
  
  
  CONCLUSIONS
  Peripheral arterial disease is prevalent in 11% of AF patients and related to various atherosclerotic risk factors. Even if PAD is associated with higher risk of all-cause death on univariate analysis, this risk was significantly lowered and was no longer evident after adjusting for the use of CV prevention drugs.
authors.affiliation: University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Dudley Road, Birmingham B18 7QH, UK.
authors.forename: Marco
authors.initials: M
authors.lastname: Proietti
authors.affiliation: Department of Experimental Medicine, Sapienza-University of Rome, Rome, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Raparelli
authors.affiliation: EURObservational Research Programme Department, European Society of Cardiology, Sophia Antipolis, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Laroche
authors.affiliation: University of Medicine, 'Carol Davila', Colentina University Hospital, Bucharest, Romania.
authors.forename: Georghe-Andrei
authors.initials: GA
authors.lastname: Dan
authors.affiliation: Swietokrzyskie Cardiology Centre, Faculty of Health Sciences, The Jan Kochanowski University, Kielce, Poland.
authors.forename: Marianna
authors.initials: M
authors.lastname: Janion
authors.affiliation: University of Medicine, 'Carol Davila', Colentina University Hospital, Bucharest, Romania.
authors.forename: Raluca
authors.initials: R
authors.lastname: Popescu
authors.affiliation: Cardiovascular Department, University Hospital Cattinara, AOU Ospedali Riuniti, Trieste, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Sinagra
authors.affiliation: Department of Cardiology, Jessa Hospitals, Hasselt, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: Vijgen
authors.affiliation: Institute of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, S.Orsola-Malpighi University Hospital, Bologna, Italy.|Cardiology Department, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Boriani
authors.affiliation: EURObservational Research Programme Department, European Society of Cardiology, Sophia Antipolis, France.|ANMCO Research Center, Firenze, Italy.
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
authors.affiliation: Maria Cecilia Hospital, GVM Care and Research, Ettore Sansavini Health Science Foundation, Cotignola, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Tavazzi
authors.affiliation: University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Dudley Road, Birmingham B18 7QH, UK.|Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
authors.forename: Gregory Y H
authors.initials: GYH
authors.lastname: Lip
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D002317:Cardiovascular Agents / Q000627:therapeutic use; D002423:Cause of Death; D016009:Chi-Square Distribution; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D010865:Pilot Projects; D015995:Prevalence; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors
chemical_list: D002317:Cardiovascular Agents
keywords: All-cause death; Atherosclerosis; Atrial fibrillation; Peripheral arterial disease