Self-Reported Peripheral Arterial Disease Predicts Future Vascular Events in a Community-Based Cohort

  • Maya J. Salameh
  • Tatjana Rundek
  • Bernadette Boden-Albala
  • Zhezhen Jin
  • Elizabeth V. Ratchford
  • Marco R. Di Tullio
  • Shunichi Homma
  • Ralph L. Sacco
Original Article

Abstract

Background

Lower extremity peripheral arterial disease (PAD) is highly prevalent and strongly associated with cardiovascular morbidity and mortality. The ankle-brachial index used to screen for PAD is not routinely performed in primary care settings.

Objective

To determine if self-reported PAD is an independent predictor of combined vascular events (myocardial infarction, ischemic stroke, and vascular death).

Design

Ongoing population-based prospective cohort (the Northern Manhattan Study). Subjects enrolled between July 1993 and June 2001 with a mean follow-up time of 7.1 years.

Patients

Subjects (n = 2,977), aged 40 years or older and free of prior stroke or myocardial infarction, were classified as having self-reported PAD if they answered affirmatively to one of two questions regarding exercise-induced leg pain or a prior diagnosis of PAD.

Main Outcome Measures

Combined vascular outcome defined as incident myocardial infarction, incident ischemic stroke, or vascular death.

Results

The mean age of the cohort was 68.9 ± 10.4 years; 64% were women; 54% Hispanic, 25% African-American, 21% Caucasian; 15% reported having PAD. After a mean follow-up of 7.1 years, self-reported PAD was significantly predictive of combined events (n = 484) in the univariate model (HR 1.5, 95% CI, 1.2–1.9) and after adjustment for traditional cardiovascular risk factors (HR 1.3, 95% CI, 1.0–1.7).

Conclusion

Self-reported PAD is an independent risk factor for future vascular events in this predominantly non-white cohort. The addition of two simple PAD questions to the routine medical history in general medicine settings could identify high-risk patients who would benefit from further vascular evaluation and risk factor modification.

KEY WORDS

peripheral arterial disease claudication vascular events myocardial infarction ischemic stroke 

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Copyright information

© Society of General Internal Medicine 2008

Authors and Affiliations

  • Maya J. Salameh
    • 1
  • Tatjana Rundek
    • 2
  • Bernadette Boden-Albala
    • 3
  • Zhezhen Jin
    • 4
  • Elizabeth V. Ratchford
    • 5
  • Marco R. Di Tullio
    • 1
  • Shunichi Homma
    • 1
  • Ralph L. Sacco
    • 6
  1. 1.Department of MedicineColumbia University College of Physicians and SurgeonsNew YorkUSA
  2. 2.Department of NeurologyUniversity of Miami, Miller School of MedicineMiamiUSA
  3. 3.Department of NeurologyColumbia University College of Physicians and Surgeons and Division of Socio-Medical Science, Columbia University Mailman School of Public HealthNew YorkUSA
  4. 4.Department of BiostatisticsColumbia University Mailman School of Public HealthNew YorkUSA
  5. 5.Department of MedicineJohns Hopkins University Medical CenterBaltimoreUSA
  6. 6.Department of Neurology, Epidemiology, and Human GeneticsUniversity of Miami, Miller School of MedicineMiamiUSA

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