Burden of Peripheral Artery Disease on Mortality and Incident Cardiovascular Events: The Multi-Ethnic Study of Atherosclerosis.
2020
Using one value for an individual's ankle brachial index (ABI) may inadequately quantify the risk for mortality and cardiovascular (CVD) events. Using data from the Multi-Ethnic Study of Atherosclerosis (2000-2015), 6,527 racial/ethnically diverse adults (62+/-10 years) free of known CVD had ABI assessment of their bilateral dorsalis pedis/posterior tibial arteries (4-vessels total) and followed for total mortality, incident CVD events/mortality. Individuals were classified into 0, 1, 2, 3 or 4 -vessel PAD (ABI =0.9). There were 1,202 (18%) deaths, 656 (10%) incident CVD events, and 282 (4.3%) CVD deaths. 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, increasing number of vessels with PAD was associated with higher risk of mortality (p-trend <0.001), CVD events (p-trend=0.002) and CVD mortality (p-trend=0.001). Compared to individuals with 0-vessel disease, HRs for mortality were 1.29 (95% CI, 1.06-1.59) for 1-, 1.45 (1.14-1.86) for 2-, 1.58 (1.13-2.21) for 3-, and 2.15 (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 four leg arteries in clinical practice and research.
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