Long Term Risk for Peripheral Arterial Disease Patients is Higher Among Men

Abstract

Introduction: The introduction of modern cardiovascular risk preventive therapy and new endovascular treatment options may have influenced the long term mortality and morbidity in patients with peripheral arterial disease (PAD). The aim of this study was to determine long-term survival and incidence of leg revascularizations in subjects with PAD with special focus on gender differences. Methods: A cohort study was started 2004 by randomly selecting 8000 subjects, aged 59–89 years, from the population. A total of 5080 subjects participated and underwent ankle brachial index measurements (ABI). Data was also collected for risk factors and concomitant diseases. The cohort was re-examined 2015 covering data from national governmental registries on survival and surgical interventions for PAD. Results: The point-prevalence of PAD in 2004 was 11 % (95% CI, 9–13) for subjects having only asymptomatic PAD (APAD), 7% (6.5 –7) for intermittent claudication (IC) and 1.2 % (1 –1.5) for those with severe limb ischemia(SLI). Among the 4926 subjects who were available for follow up at 10 years the mortality rates were 50% for APAD, 59% for IC and 72% for SLI. Subjects without PAD had a rate of 24%. Mortality was higher among men (age adjusted 35.9% 95% CI: 34.2–37.6) than women (26.1% 95% CI: 24.7–27.6) likewise in PAD subjects with diabetes mellitus (68% vs. 52% without, p < 0.001). Factors significantly related to increased mortality were for men and women, respectively; SLI (HR 1.87 and 1.87), congestive heart failure (HR 1.69 vs. 2.44), renal failure (HR 1.4. vs. 2.2) and diabetes (HR 1.51 vs. 1.65). Fifty one subjects underwent revascularization because of chronic leg ischemia in the cohort during the ten years. In the reference group the rate was 0.4%, while it was 1.9 % of APAD subjects, 5.8 % of the IC and 6.2% of the SLI group. Conclusion: The mortality is still high in patients with PAD, and half of patients with APAD are dead within 10 years which is comparable with IC patients. The mortality is higher in men than in women. In a population based cohort like this, very few patients were revascularized, and surprisingly few patients with IC and SLI are offered vascular surgery. Overall, more focus on mortality in PAD is needed and there is still a need for information about vascular surgery to GP's offices and awareness among PAD subjects.