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Risk factor profile, management and prognosis of patients with peripheral arterial disease with or without coronary artery disease: results of the prospective German REACH registry cohort

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Abstract

Aims

Peripheral arterial disease (PAD) and coronary artery disease (CAD) are manifestations of the same underlying condition, atherothrombosis. We compared patients with PAD only with those having PAD and concomitant documented CAD in terms of characteristics, risk factors, treatment and prognosis.

Methods and results

This is a subgroup analysis of the German cohort of the Reduction of Atherothrombosis for Continued Health (REACH) Registry. It includes 483 patients with PAD only, and 479 patients with PAD plus CAD. Patients with concomitant cerebrovascular disease were excluded. Symptomatic PAD was defined as intermittent claudication (IC), confirmed by ankle brachial index <0.9, or PAD-related intervention. Patients in the total cohort were predominantly elderly (mean age 67.3 ± 8.9 years), males (72.3%), current or previous smokers (80.18%), and had often abdominal obesity (49.6%). Atherosclerotic risk factors and comorbidities were highly prevalent. Patients with PAD + CAD compared to those with PAD only were significantly more intensively treated with regards to antihrombotic agents (97.1% vs. 88.8%), statins (80.2% vs. 51.6%), or ACE inhibitors/ARB (75.6% vs. 61.1%). After two-year follow-up, no significant differences between subgroups were noted for total mortality (4.6% vs. 5.5%), cardiovascular mortality (3.7% vs. 3.9%), non-fatal myocardial infarction (1.9% vs. 2.7%) but for non-fatal stroke (4.4% vs. 2.0%, P < 0.05).

Conclusion

Peripheral arterial disease patients carry a high burden of risk factors and co-morbidities, and are at high risk of death and cardiovascular events. If documented CAD is absent, PAD patients are undertreated. Thus, in PAD patients, secondary cardiovascular prevention with stringent treatment of risk factors to the same extent as in CAD patients is mandatory, in line with current guidelines.

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Acknowledgments

The REACH registry is funded by Sanofi-Aventis and BMS. All manuscripts in this registry are prepared by independent authors, who are not governed by the funding sponsors, and are reviewed by an academic publications committee before submission. The funding sponsors have the opportunity to review manuscript submissions, but do not have authority to change any aspect of a manuscript. We thank the German centres for their valuable contribution to the registry.

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Authors and Affiliations

  1. Herzzentrum Ludwigshafen, Bremserstrasse 79, 67063, Ludwigshafen, Germany

    Uwe Zeymer

  2. Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen, Germany

    Uwe Zeymer & Tobias Limbourg

  3. Medical Department II, Grosshadern University, Munich, Germany

    Klaus G. Parhofer

  4. Medical Faculty, Institute for Clinical Pharmacology, Technical University of Dresden, Dresden, Germany

    David Pittrow

  5. Medical Department, Bristol Myers Squibb, Munich, Germany

    Christiane Binz

  6. Medical Department, Sanofi-Aventis, Berlin, Germany

    Markus Schwertfeger

  7. Department of Neurology, Klinikum Minden, Minden, Germany

    Joachim Röther

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  1. Uwe Zeymer
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Correspondence to Uwe Zeymer.

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Zeymer, U., Parhofer, K.G., Pittrow, D. et al. Risk factor profile, management and prognosis of patients with peripheral arterial disease with or without coronary artery disease: results of the prospective German REACH registry cohort. Clin Res Cardiol 98, 249–256 (2009). https://doi.org/10.1007/s00392-009-0754-1

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