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Four risk factors strongly predictive of PAD in men
Smoking, hypertension, hypercholesterolemia and type 2 diabetes account for the majority of risk associated with the development of clinically significant peripheral arterial disease in men, according to study findings recently published in TheJournal of the American Medical Association.
“All of the four risk factors appeared to confer increased risk within short periods following recognition and, in the case of smoking, associated risk remained elevated even 20 years after cessation,” researchers wrote. “At the same time, the joint effect of multiple risk factors combined was independent and graded, with no evidence that these risk factors became less important among those already at high risk.”
The prospective study included men (n=44,985) in the United States who did not have a history of CVD at baseline in 1986. Researchers followed participants for 25 years until January 2011 and updated the presence of risk factors biennially during follow-up. They defined clinically significant PAD as limb amputation or revascularization, angiogram reporting vascular obstruction of 50% or greater, ankle brachial index of less than 0.90 or physician-diagnosed PAD.
During follow-up (median, 24.2 years), 537 cases of incident PAD were reported. Each of the four conventional risk factors examined in the study — smoking, hypertension, hypercholesterolemia and type 2 diabetes — were significantly and independently associated with a higher risk for PAD after adjustment for confounders and the three other risk factors.
The age-adjusted incidence rates were the following:
- Zero risk factors: nine cases per 100,000 person-years (n=19 incident cases);
- One risk factor: 23 cases per 100,000 person-years (n=99 incident cases);
- Two risk factors: 47 cases per 100,000 person-years (n=176 incident cases);
- Three risk factors: 92 cases per 100,000 person-years (n=180 incident cases);
- Four risk factors: 186 cases per 100,000 person-years (n=63 incident cases).
Researchers also reported that the multivariable-adjusted HR for each additional risk factor was 2.06 (95% CI, 1.88-2.26). In addition, the HR for men without any of the four risk factors was 0.23 (95% CI, 0.14-0.36) vs. all other men in the cohort. At least one of the four risk factors was present at the time of diagnosis for 96% of PAD cases.
Disclosure: The researchers report no relevant financial disclosures.