Mortality and Vascular Morbidity in Older Adults With Asymptomatic Versus Symptomatic Peripheral Artery Disease

Diehm, Curt; Allenberg, J.-R.; Pittrow, David; Mahn, Matthias; Tepohl, Gerhart; Haberl, R.; Darius, Harald; Burghaus, Ina; Trampisch, Hans–Joachim

doi:10.1161/circulationaha.109.865600

Cited by 499 publications

(301 citation statements)

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“…It should be noted that in terms of cardiovascular risk, population-based studies as well as our study were unequivocal, confirming that a low ABI is an independent predictor of future cardiovascular events [8,20]. …”

Section: Discussionsupporting

confidence: 82%

“…We have recently reported a substantially increased risk of all-cause and cardiovascular mortality after 3-year and 5-year follow-ups associated with a low ABI in this cohort [7,20]. The present analysis indicates that such PAD patients also carry a substantially elevated risk for ischemic stroke, which is about doubled compared to individuals without PAD.…”

Section: Discussionsupporting

confidence: 48%

“…In the Cardiovascular Health Study (5,888 Medicare patients ≥65 years), the unadjusted relative risk (RR) associated with a low ABI was 1.9 (95% CI 1.4–2.7), and the adjusted RR was 1.1 (95% CI 0.7–1.7) [20,29]. In the Honolulu Heart Program (2,767 men aged 71–93 years of Japanese ancestry), the unadjusted RR was 2.1 (95% CI 1.3–3.5), and the adjusted RR was 2.0 (95% CI 1.1–3.5) [30].…”

Section: Discussionmentioning

confidence: 99%

“…The methods and design of the German Epidemiological Trial on Ankle-Brachial Index (getABI) have been described elsewhere in greater detail [19,20]. Briefly, the study is an open, noninterventional prospective cohort study that is monitored.…”

Section: Methodsmentioning

confidence: 99%

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Peripheral Arterial Disease as an Independent Predictor for Excess Stroke Morbidity and Mortality in Primary-Care Patients: 5-Year Results of the getABI Study

Meves

Diehm²,

Berger³

et al. 2010

Cerebrovasc Dis

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Background:There is controversial evidence with regard to the significance of peripheral arterial disease (PAD) as an indicator for future stroke risk. We aimed to quantify the risk increase for mortality and morbidity associated with PAD. Methods:In an open, prospective, noninterventional cohort study in the primary care setting, a total of 6,880 unselected patients ≧65 years were categorized according to the presence or absence of PAD and followed up for vascular events or deaths over 5 years. PAD was defined as ankle-brachial index (ABI) <0.9 or history of previous peripheral revascularization and/or limb amputation and/or intermittent claudication. Associations between known cardiovascular risk factors including PAD and cerebrovascular mortality/events were analyzed in a multivariate Cox regression model. Results:During the 5-year follow-up [29,915 patient-years (PY)], 183 patients had a stroke (incidence per 1,000 PY: 6.1 cases). In patients with PAD (n = 1,429) compared to those without PAD (n = 5,392), the incidence of all stroke types standardized per 1,000 PY, with the exception of hemorrhagic stroke, was about doubled (for fatal stroke tripled). The corresponding adjusted hazard ratios were 1.6 (95% confidence interval, CI, 1.1–2.2) for total stroke, 1.7 (95% CI 1.2–2.5) for ischemic stroke, 0.7 (95% CI 0.2–2.2) for hemorrhagic stroke, 2.5 (95% CI 1.2–5.2) for fatal stroke and 1.4 (95% CI 0.9–2.1) for nonfatal stroke. Lower ABI categories were associated with higher stroke rates. Besides high age, previous stroke and diabetes mellitus, PAD was a significant independent predictor for ischemic stroke. Conclusions:The risk of stroke is substantially increased in PAD patients, and PAD is a strong independent predictor for stroke.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionsupporting

confidence: 48%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Peripheral Arterial Disease as an Independent Predictor for Excess Stroke Morbidity and Mortality in Primary-Care Patients: 5-Year Results of the getABI Study

Meves

Diehm²,

Berger³

et al. 2010

Cerebrovasc Dis

Self Cite

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“…It is the systemic nature of the atherosclerotic disease process which increases cardiovascular morbidity and mortality rates in people with PAD (Diehm et al, 2009).…”

Section: Associated Cardiovascular Riskmentioning

confidence: 99%

Can a nurse-led intervention program for people with peripheral arterial disease lead to sustained improvement in functional capacity and quality of life?

McLennan¹

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Peripheral arterial disease (PAD) is a manifestation of systemic atherosclerosis which causes significant morbidity and mortality affecting between 14% and 29% of individuals >70 years of age . Multiple studies have demonstrated an improvement in walking distance in people suffering from symptomatic PAD through exercise therapy. While most studies have examined the results of exercise and risk factor modification programs over a short-term this study sought to identify not only whether a nurse-led intervention program can improve functional capacity and quality of life, but if improvements could be sustained over a longer follow-up term. After a mean follow up time of 52 months, the NLIP group had sustained a 14% mortality rate. This is in keeping with the 5-year predicted mortality found amongst PAD sufferers. 3The results from this study suggest that a nurse-led intervention program for people with PAD can have sustained improvement in pain free walking distance and emotional well-being. Further research is required to identify whether earlier intervention may lead to a reduction in mortality rates in PAD population.4

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Peripheral Artery Disease

Beckman

2013

Atlas of Clinical Vascular Medicine

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H ow best to approach a patient with peripheral arterial disease (PAD) can be an intimidating and confusing task. There are few disease processes as variable in location, presentation, and severity as those seen in the vasculopath. There are many etiologies to be considered simultaneously. Ironically, it is the variability of PAD that provides an opportunity to extract a comprehensive and tightly integrated history and physical examination that is nearly unparalleled in medicine. Similarly, there are few disease processes that offer the opportunity to impact so many aspects of the patient, literally from head to toe. This article, part of a series on PAD, focuses on the initial assessment and evaluation of the PAD, with pathophysiology, genetics, and treatment addressed in accompanying articles. HistoryEach patient with PAD is unique (Table 1). Even though the pathophysiology, risk factors, location, and eventual treatment options for a patient often prove routine, the manner in which the patient presents is anything but predictable. 1 We have all had the experience of taking a well-structured history (Table 2) from a textbook patient, presented to an attending physician or a colleague, and then watched and listened in disbelief as the confirmatory history is nothing at all similar to what was heard 15 minutes earlier. Unfortunately, patients do not often read the textbook. As demonstrated by McDermott and colleagues, 2 the discomfort caused by PAD is more often atypical than typical. Descriptions such as "tired," "giving way," "sore," and "hurts" are offered more often than "cramp." This forces the healthcare provider to meticulously clarify the location, quality, and circumstances of the discomfort. It is not unusual that a patient reports ≥2 types and locations of discomfort. Careful consideration for pain from both orthopedic and neurogenic sources must be taken. Each symptom should be individually addressed and clarified. These symptoms must be taken in context with the lifestyle of each patient. Defining how the symptoms have an impact on vocation, activities of daily living, and social activities should be done with each evaluation. Comorbidities and risk factors for PAD are discussed elsewhere in this series and should be elicited from the patient when not already clear. The physical examination should focus on the clues gleaned from the history. Specific scenarios are discussed at the end of this article.

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Mortality and Vascular Morbidity in Older Adults With Asymptomatic Versus Symptomatic Peripheral Artery Disease

Cited by 499 publications

References 32 publications

Peripheral Arterial Disease as an Independent Predictor for Excess Stroke Morbidity and Mortality in Primary-Care Patients: 5-Year Results of the getABI Study

Peripheral Arterial Disease as an Independent Predictor for Excess Stroke Morbidity and Mortality in Primary-Care Patients: 5-Year Results of the getABI Study

Can a nurse-led intervention program for people with peripheral arterial disease lead to sustained improvement in functional capacity and quality of life?

Peripheral Artery Disease

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