Article

Lower extremity peripheral artery disease (PAD) has been proposed as a
'coronary heart disease (CHD) risk equivalent'. We aimed to examine whether PAD
confers similar risk for mortality as incident myocardial infarction (MI) and
whether risk differs by gender. METHODS: Using nationwide Danish administrative
registries (2000-2008), we identified patients aged >/=40 years with incident PAD
(PAD only, n = 35,628), incident PAD with a history of MI (PAD + MI, n = 7029),
and incident MI alone (MI alone, n = 71,115). RESULTS: Patients with PAD only
tended to be younger, female, and have less comorbidity than the other groups.
During follow up (median 1051 d, IQR 384-1938), we found that MI-alone patients
had greater risk of adverse outcomes in the acute setting (first 90 d); however,
the PAD-only and PAD + MI groups had higher long-term mortality at 7 years than
those with MI alone (47.8 and 60.4 vs. 36.4%, respectively; p < 0.0001). After
adjustment, the PAD-only and PAD + MI groups had a higher long-term risk for
mortality [hazard ratio (HR) 1.47, 95% confidence interval (CI) 1.44-1.51; and HR
1.65, 95% CI 1.58-1.72, respectively], cardiovascular mortality (HR 1.30, 95% CI
1.26-1.34; and HR 1.71, 95% CI 1.62-1.80, respectively), and composite of death,
MI, and ischaemic stroke, 95% CI HR, 1.38, 95% CI 1.36-1.42; and HR 1.68, 95% CI
1.61-1.75, respectively). The greater long-term risks of PAD were seen for both
women and men. CONCLUSIONS: Both women and men with incident PAD have greater
long-term risks of total and cardiovascular mortality vs. those with incident MI.
PAD should be considered a CHD risk equivalent, warranting aggressive secondary
prevention.
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Langue : ANGLAIS