Among patients with PAD, those with HF at higher risk for poor outcomes
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Patients with peripheral artery disease and HF have higher rates of CAD and elevated risk for adverse CV events and mortality compared with patients with PAD but no HF, researchers reported.
“The presence of PAD has been associated with increased morbidity and mortality in patients with HF,” Marc D. Samsky, MD, cardiologist in the Duke Clinical Research Institute at Duke University School of Medicine in Durham, North Carolina, and colleagues wrote. “However, the association of chronic HF with clinical and safety outcomes in patients with atherosclerotic vascular disease, particularly PAD, remains undefined.”
The researchers conducted a post hoc analysis of the EUCLID trial, a double-blind, multicenter, randomized controlled trial that compared the safety and efficacy of ticagrelor (Brilinta, AstraZeneca) 90 mg twice daily with clopidogrel 75 mg once daily to prevent major adverse CV events in patients with symptomatic PAD. Of the EUCLID cohort, 1,928 patients (mean age, 66 years; 27% women) with a history of HF and 11,955 patients (mean age, 66 years; 28% women) without a history of HF were included in the analysis.
Researchers determined the association of HF with outcomes and identified risk factors associated with HF development during follow-up.
Those with HF were more than twice as likely to have CAD compared with those without HF (53.6% vs. 25.1%; P < .001). In addition, patients with PAD and HF were at significantly increased risk for major adverse CV events (HR = 1.31; 95% CI, 1.13-1.51) and all-cause mortality (HR = 1.39; 95% CI, 1.19-1.63), but had significantly fewer bleeding events (HR = 0.65; 95% CI, 0.45-0.96) compared with patients with PAD but no HF.
Researchers also identified age 66 years or older (HR per 5 years = 1.29; 95% CI, 1.18-1.4), diabetes (HR = 1.85; 95% CI, 1.41-2.43) and weight less than 76 kg (HR = 1.12; 95% CI, 1.07-1.16) as characteristics associated with HF development.
“These data possibly support the need for aggressive treatment of recurrent atherosclerotic disease in patients with PAD, especially those with HF,” the researchers wrote.
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