The risk of peripheral artery disease in older adults - seven-year results of the getABI study

Abstract. Background: To assess the risk of peripheral artery disease (PAD) in older adults and the contribution of traditional and novel risk factors to the incidence of PAD. Patients and methods: 344 general practitioners (GPs), trained by vascular specialists all over Germany, enrolled 6,880 unselected participants aged 65 years or older (getABI study). The onset of PAD was determined by a regression method in the course of repeated measurements of the ankle brachial index (ABI) over seven years. PAD onset was defined by the declining linear regression ABI line reaching 0.9 or by PAD symptoms. Results: The cumulative PAD incidence over seven years was 12.9%, corresponding to an incidence rate of 20.3 per 1000 person years (95% confidence interval [95%CI] 18.8 to 21.7). Logistic regression analysis showed that traditional risk factors contributed significantly to the risk of PAD: current smoker status (odds ratio 2.65, 95%CI 2.08 to 3.37), diabetes (1.35, 95%CI 1.13 to 1.62), and low-density lipoprotein >130 mg/dl (1.26, 95%CI 1.07 to 1.48). Three novel risk factor candidates showed significant impact on PAD incidence: elevated sensitive C-reactive protein level (1.23, 95%CI 1.05 to 1.45), impaired estimated glomerular filtration rate (1.27, 95%CI 1.03 to 1.56), and elevated homocysteine level (1.19, 95%CI 1.01 to 1.41). Conclusions: Older adults in Germany have a PAD risk of 12.9% per seven years. Potentially modifiable traditional PAD risk factors yield high impact on PAD incidence. Novel risk factor candidates may contribute to the risk of PAD

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Abstract 91: Are At Risk Outpatient Cardiology Patients being Appropriately Evaluated for Lower Extremity PAD as Recommended by ACC/AHA Guidelines?

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.5.suppl_1.a91 ◽

2012 ◽

Vol 5 (suppl_1) ◽

Author(s):

Rajesh M Kabadi ◽

Ankitkumar Patel ◽

Rajani Sharma ◽

Rita Schmidt ◽

Elias Iliadis

Keyword(s):

Risk Factors ◽

At Risk ◽

High Risk ◽

Lower Extremity ◽

Peripheral Artery Disease ◽

Ankle Brachial Index ◽

Heart Association ◽

Low Risk ◽

Peripheral Artery ◽

Artery Disease

Background: Lower extremity peripheral artery disease (PAD) is a common syndrome that afflicts many individuals and leads to significant morbidity. Once appropriate at risk patients are identified, ankle-brachial index (ABI) testing is a relatively quick and inexpensive test that is recommended for proper assessment of PAD, per the recommendations outlined in the American College of Cardiology (ACC)/American Heart Association (AHA) Guidelines for the Management of Peripheral Artery Disease (PAD) (JACC, 2006). Outpatient cardiology practices often take care of individuals at risk for PAD and have the opportunity to test and appropriately treat this condition. Methods: A randomly selected group of 367 outpatients seen in a large academic cardiology practice from September 2011 underwent retrospective chart review. Risk factors for PAD that were assessed include history of smoking, hypertension, diabetes, hyperlipidemia, homocysteine levels, and CRP. Those that had three or more risk factors were classified as high risk and those with less than that were classified as low risk and frequency of ABI testing was evaluated. Fishers exact test was utilized for statistical analysis. Results: Fifty-one percent (N=187) of our population were classified as high risk for PAD, forty-three percent (N=158) were low risk, and six percent (N=22) were known to already have PAD. Amongst the high risk individuals, only six percent (N=12) had ABI testing performed while there were three percent (N=6) of low risk individuals that had this test (p=-0.34). Conclusions: There was no difference in ABI testing between high and low risk populations. Limitations of this study include lack of information regarding other diagnostic modalities that may have been used in place of ABI testing. Quality improvement may be achieved by increased use of such testing as this would allow for quicker identification of the disease, prompter treatment, and better outcomes, at a minimal cost.

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Risk factors and clinical outcomes in chronic coronary and peripheral artery disease: An analysis of the randomized, double-blind COMPASS trial

European Journal of Preventive Cardiology ◽

10.1177/2047487319882154 ◽

2019 ◽

Vol 27 (3) ◽

pp. 296-307 ◽

Cited By ~ 11

Author(s):

Thomas Vanassche ◽

Peter Verhamme ◽

Sonia S Anand ◽

Olga Shestakovska ◽

Keith AA Fox ◽

...

Keyword(s):

Risk Factors ◽

Risk Factor ◽

Peripheral Artery Disease ◽

Low Dose ◽

Cardiovascular Death ◽

Peripheral Artery ◽

Double Blind ◽

Artery Disease ◽

Risk Factor Status ◽

Ischemic Events

Aims Secondary prevention in patients with coronary artery disease and peripheral artery disease involves antithrombotic therapy and optimal control of cardiovascular risk factors. In the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) study, adding low-dose rivaroxaban on top of aspirin lowered cardiovascular events, but there is limited data about risk factor control in secondary prevention. We studied the association between risk factor status and outcomes, and the impact of risk factor status on the treatment effect of rivaroxaban, in a large contemporary population of patients with coronary artery disease or peripheral artery disease. Methods and results We reported ischemic events (cardiovascular death, stroke, or myocardial infarction) in participants from the randomized, double-blind COMPASS study by individual risk factor (blood pressure, smoking status, cholesterol level, presence of diabetes, body mass index, and level of physical activity), and by number of risk factors. We compared rates and hazard ratios of patients treated with rivaroxaban plus aspirin vs aspirin alone within each risk factor category and tested for interaction between risk factor status and antithrombotic regimen. Complete baseline risk factor status was available in 27,117 (99%) patients. Status and number of risk factors were both associated with increased risk of ischemic events. Rates of ischemic events (hazard ratio 2.2; 95% confidence interval 1.8–2.6) and cardiovascular death (hazard ratio 2.0; 1.5–2.7) were more than twofold higher in patients with 4–6 compared with 0–1 risk factors ( p < 0.0001 for both). Rivaroxaban reduced event rates independently of the number of risk factors ( p interaction 0.93), with the largest absolute benefit in patients with the highest number of risk factors. Conclusion More favorable risk factor status and low-dose rivaroxaban were independently associated with lower risk of cardiovascular events.

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Abstract P339: Angina and Silent Myocardial Infarction are Associated with Isolated Small Vessel Peripheral Artery Disease in Community-Dwelling Older Adults: The Rancho Bernardo Study

Circulation ◽

10.1161/circ.129.suppl_1.p339 ◽

2014 ◽

Vol 129 (suppl_1) ◽

Author(s):

Jan M Hughes-Austin ◽

Michael H Criqui ◽

Elizabeth Barrett-Connor

Keyword(s):

Risk Factors ◽

Older Adults ◽

Peripheral Artery Disease ◽

Community Dwelling ◽

Cardiac Ischemia ◽

Cvd Risk Factors ◽

Peripheral Artery ◽

Cvd Risk ◽

Artery Disease ◽

Community Dwelling Older Adults

Background: Classic CVD risk factors associated with isolated small vessel peripheral artery disease (iSV-PAD) include older age, male sex, longer smoking duration, and higher LDL cholesterol levels. These CVD risk factors have been linked to atherosclerosis in several vascular beds and to cardiac ischemia. It is not known whether iSV-PAD shares these same links, especially in community-dwelling older adults. Thus, in the Rancho Bernardo (RB) Study, we investigated whether iSV-PAD was associated with measures of atherosclerosis and cardiac ischemia. Methods: Among 965 RB Study participants with complete measures of ankle-brachial index (ABI), toe-brachial index (TBI), and measures of cardiac ischemia [self-reported angina, major Q wave on electrocardiogram (ECG), and any ECG abnormality], we evaluated associations between cardiac ischemia and iSV-PAD. In a subset of 387 RB participants free of diagnosed CVD, we evaluated associations between measures of atherosclerosis [coronary artery calcium (CAC) (Agatston scores and calcium volume) and internal carotid intima-media thickness (cIMT)] with iSV-PAD. Isolated SV-PAD was defined by bilateral normal ABI (1.0-1.4) with bilateral TBI < 0.7. Associations of measures of atherosclerosis and cardiac ischemia with iSV-PAD were evaluated using logistic regression in staged models, adjusted for age, sex, anthropometrics, lifestyle, comorbidities, and medications. Results: More likely to have iSV-PAD were participants who ever had angina (OR=2.1, 95% CI: 1.04-4.2) or had major Q wave on ECG (OR=4.2, 95% CI: 1.1-15.5). There were too few to stratify by sex. No statistically significant associations were observed for measures of atherosclerosis with iSV-PAD. (Figure 1) Conclusion: Strong associations of cardiac ischemia, coupled with null associations of atherosclerosis, with iSV-PAD suggest that iSV-PAD may indicate vascular pathology different from atherosclerosis. Further investigation of endothelial dysfunction and iSV-PAD may elucidate underlying pathology.

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Epidemiology of peripheral artery disease in Palestine

VASA ◽

10.1024/0301-1526/a000871 ◽

2020 ◽

Vol 49 (4) ◽

pp. 323-329

Author(s):

Amal Jamee ◽

Victor Aboyans ◽

Julien Magne ◽

Mohammed Elhendy ◽

Pierre Marie Preux ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Risk ◽

Cardiovascular Risk Factors ◽

Peripheral Artery Disease ◽

Ankle Brachial Index ◽

Arab Countries ◽

Multivariate Logistic Regression Model ◽

Peripheral Artery ◽

High Prevalence ◽

Artery Disease

Summary: Background: Peripheral artery disease (PAD) is one of the most common manifestations of atherosclerosis affecting more than 200 million people globally but little is known about its epidemiology in Middle East populations, particularly in Arab countries. The present study was undertaken to assess the prevalence of PAD in the general population aged 40 years and more in Gaza-Palestine, and to determine the prevalence of its associated risk factors. Patients and methods: The study design was a cross-sectional with a stratified proportional sampling, involving the five governorates in Gaza Strip. We selected 1490 individuals aged age ≥ 40 years living in the area for more than 3 years. The questionnaire on lifestyle and cardiovascular risk factors was applied and the ankle-brachial index (ABI) was measured by Doppler examination in both legs in all participants. PAD was defined as an ABI ≤ 0.90. We excluded 92 participants (6 %) because of missing ABI or ABI > 1.40. Results: One-half of the 1398 participants had at least two associated cardiovascular risk factors, one-third were on aspirin and 15 % on statins. Overall, we found PAD in 191 (13.7 %) cases. This prevalence increased with age, and 18.7 % of adults older than 65 years had PAD. The prevalence was higher in females than in males (respectively 15.6 % vs 11.6 % p = 0.031). In the multivariate logistic regression model, significant associated factors with PAD in males were CAD (OR: 3.5; 95 % CI: 1.4–8.6), hypertension (OR: 2.8; 95 % CI: 1.3–6.1), and current smoking (OR: 2.7; 95 % CI: 1.1–6.6). In women, hypertension remains the main associated risk factor. Conclusions: Our study highlights the high prevalence of PAD in the Gazan community, mostly related to the high prevalence of cardiovascular risk factors and other cardiovascular conditions.

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Abstract 14374: Peripheral Artery Disease and Gait Speed in Women With and at Risk for HIV

Circulation ◽

10.1161/circ.142.suppl_3.14374 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Emily R Cedarbaum ◽

Yifei Ma ◽

Rebecca Scherzer ◽

Adaora A Adimora ◽

Marcas Bamman ◽

...

Keyword(s):

Risk Factors ◽

At Risk ◽

Peripheral Artery Disease ◽

Gait Speed ◽

Disease Risk ◽

Univariate Analysis ◽

Ankle Brachial Index ◽

Peripheral Artery ◽

Early Assessment ◽

Artery Disease

Introduction: Peripheral artery disease (PAD) is associated with decreased physical function and increased mortality in the general population. PAD is common in women with and at risk for HIV infection, but its association with functional decline is unclear. We examined the contribution of PAD to gait speed in the Women’s Interagency HIV Study, controlling for traditional cardiovascular risk factors and HIV-related factors. Methods: 1,839 participants (72% HIV+) with measured ankle-brachial index (ABI) and 4-meter gait speed were included in analysis. ABI scores were categorized as: <0.7, moderate-severe PAD; 0.7-<0.9, mild PAD; 0.9-<1.0, borderline PAD; 1.0-<1.1, low-normal; 1.1-1.4, normal. Longitudinal regression models with repeated measures were used to examine the association of PAD category with log-transformed gait speed after controlling for demographic, behavioral, and cardiovascular disease risk factors, and HIV and HCV status. Coefficients represented percentage differences. Results: Median age was 50 years, >70% were Black. Figure 1 shows median gait speed by PAD group. In univariate analysis, compared to normal ABI, each category of PAD severity was associated with slower gait speed: 6% slower for low-normal (95% confidence interval [CI]:4%, 9%), 10% for borderline (95% CI:6%, 13%), 14% for mild (95% CI:9%, 18%), and 16% for moderate-severe (95% CI:5%, 25%). In multivariate analysis, PAD severity remained associated with 6% (95% CI:4%, 9%), 10% (95%CI:7%, 14%), 12% (95%CI:8%, 17%), and 11% (95%CI: -1%, 22%) slower gait speed, respectively. HIV/HCV coinfection reduced gait speed by 9% (95%CI:4%, 14%). Among HIV+ women, neither CD4 count nor HIV viral load was associated with gait speed. Conclusions: In middle-aged women with and at risk for HIV, greater PAD severity is associated with progressively slower gait speed. ABI measurement may be a simple and clinically useful tool for early assessment of functional declines.

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Traditional and non-traditional risk factors for peripheral artery disease development/progression in patients with type 2 diabetes: the Rio de Janeiro type 2 diabetes cohort study

Cardiovascular Diabetology ◽

10.1186/s12933-021-01249-y ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Claudia R. L. Cardoso ◽

Juliana V. Melo ◽

Thainá R. M. Santos ◽

Nathalie C. Leite ◽

Gil F. Salles

Keyword(s):

Risk Factors ◽

Type 2 Diabetes ◽

Peripheral Artery Disease ◽

Microvascular Complications ◽

Ankle Brachial Index ◽

Peripheral Artery ◽

Prognostic Information ◽

Traditional Risk Factors ◽

Artery Disease

Abstract Background The prognostic importance of non-traditional risk factors for peripheral artery disease (PAD) development/progression is scarcely studied in diabetes. We investigated if carotid intima-media thickness (CIMT) and carotid-femoral pulse wave velocity (cf-PWV) added prognostic information beyond traditional cardiovascular risk markers for PAD outcomes. Methods Ankle-brachial index (ABI) was measured at baseline and after a median of 91 months of follow-up in 681 individuals with type 2 diabetes. Multivariate Cox regressions examined the associations between the candidate variables and the outcome. PAD development/progression was defined by a reduction in ABI ≥ 0.15 (to a level < 0.9) or limb revascularization procedures, lower-extremity amputations or death due to PAD. The improvement in risk discrimination was assessed by increases in C-statistics of the models. Results Seventy-seven patients developed/progressed PAD: 50 reduced ABI to < 0.9, seven had lower-limb revascularizations, and 20 had amputations or death. Age, male sex, diabetes duration, presence of microvascular complications (peripheral neuropathy and diabetic kidney disease), baseline HbA1c, 24-h systolic BP (SBP) and mean cumulative office SBP and LDL-cholesterol were associated with PAD development/progression in several models. CIMT and cf-PWV were additionally associated with PAD outcomes, and their inclusion further improved risk discrimination (with C-statistic increases between 0.025 and 0.030). The inclusion of ambulatory 24-h SBP, instead of office SBP, also improved PAD risk discrimination. Conclusions Increased CIMT and aortic stiffness are associated with greater risks of developing/progressing PAD, beyond traditional risk factors, in type 2 diabetes.

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Peripheral artery disease assessed by ankle-brachial index in patients with established cardiovascular disease or at least one risk factor for atherothrombosis - CAREFUL Study: A national, multi-center, cross-sectional observational study

BMC Cardiovascular Disorders ◽

10.1186/1471-2261-11-4 ◽

2011 ◽

Vol 11 (1) ◽

Cited By ~ 23

Author(s):

Ahmet K Bozkurt ◽

Ilker Tasci ◽

Omur Tabak ◽

Mehmet Gumus ◽

Yesim Kaplan

Keyword(s):

Cardiovascular Disease ◽

Risk Factor ◽

Observational Study ◽

Peripheral Artery Disease ◽

Ankle Brachial Index ◽

Careful Study ◽

Peripheral Artery ◽

Cross Sectional ◽

Artery Disease

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High ankle brachial index predicts high risk of cardiovascular events amongst people with peripheral artery disease

PLoS ONE ◽

10.1371/journal.pone.0242228 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0242228

Author(s):

Jonathan Golledge ◽

Joseph V. Moxon ◽

Sophie Rowbotham ◽

Jenna Pinchbeck ◽

Frank Quigley ◽

...

Keyword(s):

Risk Factors ◽

Peripheral Artery Disease ◽

Cardiovascular Events ◽

Ankle Brachial Index ◽

Cardiovascular Death ◽

Peripheral Artery ◽

Major Cardiovascular Events ◽

Increased Risk ◽

Traditional Risk Factors ◽

Artery Disease

Ankle-brachial pressure index (ABPI) is commonly measured in people referred to vascular specialists. This study aimed to assess the association of high ABPI (≥ 1.4) with cardiovascular events in people with peripheral artery disease (PAD). 1533 participants with PAD diagnosed by a vascular specialist were prospectively recruited from four out-patient clinics in Australia. ABPI was measured at recruitment and the occurrence of myocardial infarction (MI), stroke or cardiovascular death (major cardiovascular events; MACE) and any amputation were recorded over a median (inter-quartile range) follow-up of 3.3 (1.0–7.1) years. The association of high, compared to normal, low (0.5–0.9) or very low (<0.5), ABPI with clinical events was estimated using Cox proportional hazard analyses, adjusting for traditional risk factors and reported as hazard ratio with 95% confidence intervals. 596 (38.9%), 676 (44.1%), 157 (10.2%) and 104 (6.8%) participants had normal, low, very low and high ABPI, respectively. Participants with high ABPI had increased risk of MACE, MI and death by comparison to those with either normal ABPI [1.69 (1.07, 2.65), 1.93 (1.07, 3.46) and 1.67 (1.09, 2.56)] or either low or very low ABPI [1.51 (1.02, 2.23), 1.92 (1.16, 3.19) and 1.47 (1.02, 2.14)] after adjusting for other risk factors. Findings were similar in a sensitivity analysis excluding people with ABPI only measured in one leg (n = 120). Participants with high ABPI also had an increased risk of MACE and MI compared to those with very low ABPI alone. High ABPI is a strong indicator of excess risk of cardiovascular events amongst people with PAD.

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