TY - JOUR
T1 - Burden of peripheral artery disease on mortality and incident cardiovascular events
AU - Unkart, Jonathan T.
AU - Allison, Matthew A.
AU - Araneta, Maria Rosario G.
AU - Ix, Joachim H.
AU - Matsushita, Kunihiro
AU - Criqui, Michael H.
N1 - Funding Information:
Author affiliations: Department of Family Medicine and Public Health, University of California San Diego, La Jolla, California (Jonathan T. Unkart, Matthew A. Allison, Maria Rosario G. Araneta, Joachim H. Ix, Michael H. Criqui); and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland (Kunihiro Matsushita). This research was supported by the National Heart, Lung, and Blood Institute (grants R01-HL-088451 and contracts N01-HC-95159 through N01-HC-95165 and N01-HC-95169, as well as 2T32HL079891 (University of California San Diego training grant support to J.T.U.)). The authors thank the other investigators, the staff, and the participants of the Multi-Ethnic Study of Atherosclerosis study for their valuable contributions. A full list of participating Multi-Ethnic Study of Atherosclerosis investigators and institutions can be found at http://www.mesa-nhlbi.org. The authors also thank Matty James for assistance with Figure 1 creation. Conflict of interest: none declared.
Publisher Copyright:
© The Author(s) 2020. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
PY - 2020/9/1
Y1 - 2020/9/1
N2 - Using data from the Multi-Ethnic Study of Atherosclerosis (United States, 2000-2015), 6,527 racially/ethnically diverse adults (mean age, 62 (standard deviation, 10) years) free of known cardiovascular (CVD) had ankle brachial index (ABI) assessment of their bilateral dorsalis pedis/posterior tibial arteries (4 vessels total) and were followed for total mortality and incident CVD events/mortality. Individuals were classified into categories of 0-, 1-, 2-, 3- or 4-vessel peripheral artery disease (PAD) (ABI of ≤0.9). There were 1,202 deaths (18%), 656 incident CVD events (10%), and 282 CVD deaths (4.3%). Of the 6,527 individuals, 5,711 (87.5%) had 0-, 460 (7.0%) had 1-, 218 (3.3%) had 2-, 69 (1.1%) had 3-, and 69 (1.1%) had 4-vessel PAD, respectively. In multivariable Cox models, higher number of vessels with PAD was associated with higher risk of mortality (P for trend <0.001), CVD events (P for trend = 0.002), and CVD mortality (P for trend = 0.001). Compared with individuals who had 0-vessel disease, hazard ratios for mortality were 1.29 (95% confidence interval (CI): 1.06, 1.59) for 1-, 1.45 (95% CI: 1.14, 1.86) for 2-, 1.58 (95% CI: 1.13, 2.21) for 3-, and 2.15 (95% CI: 1.58, 2.94) for 4-vessel disease. A similar pattern was seen for CVD events/mortality. These results suggest the importance of accounting for ABI values of all 4 leg arteries in clinical practice and research.
AB - Using data from the Multi-Ethnic Study of Atherosclerosis (United States, 2000-2015), 6,527 racially/ethnically diverse adults (mean age, 62 (standard deviation, 10) years) free of known cardiovascular (CVD) had ankle brachial index (ABI) assessment of their bilateral dorsalis pedis/posterior tibial arteries (4 vessels total) and were followed for total mortality and incident CVD events/mortality. Individuals were classified into categories of 0-, 1-, 2-, 3- or 4-vessel peripheral artery disease (PAD) (ABI of ≤0.9). There were 1,202 deaths (18%), 656 incident CVD events (10%), and 282 CVD deaths (4.3%). Of the 6,527 individuals, 5,711 (87.5%) had 0-, 460 (7.0%) had 1-, 218 (3.3%) had 2-, 69 (1.1%) had 3-, and 69 (1.1%) had 4-vessel PAD, respectively. In multivariable Cox models, higher number of vessels with PAD was associated with higher risk of mortality (P for trend <0.001), CVD events (P for trend = 0.002), and CVD mortality (P for trend = 0.001). Compared with individuals who had 0-vessel disease, hazard ratios for mortality were 1.29 (95% confidence interval (CI): 1.06, 1.59) for 1-, 1.45 (95% CI: 1.14, 1.86) for 2-, 1.58 (95% CI: 1.13, 2.21) for 3-, and 2.15 (95% CI: 1.58, 2.94) for 4-vessel disease. A similar pattern was seen for CVD events/mortality. These results suggest the importance of accounting for ABI values of all 4 leg arteries in clinical practice and research.
KW - Ankle brachial index
KW - Claudication
KW - Multivessel
KW - Primary prevention
KW - Screening
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U2 - 10.1093/aje/kwaa051
DO - 10.1093/aje/kwaa051
M3 - Article
C2 - 32242233
AN - SCOPUS:85089518002
VL - 189
SP - 951
EP - 962
JO - American Journal of Epidemiology
JF - American Journal of Epidemiology
SN - 0002-9262
IS - 9
ER -