Joosten MM, Pai JK, Bertoia ML, Rimm EB, Spiegelman D, Mittleman MA, Mukamal KJ, et al.
JAMA. Date of publication 2012 Oct 24;volume 308(16):1660-7.
1. JAMA. 2012 Oct 24;308(16):1660-7. doi: 10.1001/jama.2012.13415.
Associations between conventional cardiovascular risk factors and risk of
peripheral artery disease in men.
Joosten MM(1), Pai JK, Bertoia ML, Rimm EB, Spiegelman D, Mittleman MA, Mukamal
KJ.
Author information:
(1)Division of General Medicine and Primary Care, Department of Medicine, Beth
Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts,
USA. hpmmj@channing.harvard.edu
CONTEXT: Previous studies have examined the associations of individual clinical
risk factors with risk of peripheral artery disease (PAD), but the combined
effects of these risk factors are largely unknown.
OBJECTIVE: To estimate the degree to which the 4 conventional cardiovascular risk
factors of smoking, hypertension, hypercholesterolemia, and type 2 diabetes are
associated with the risk of PAD among men.
DESIGN, SETTING, AND PARTICIPANTS: Prospective study of 44,985 men in the United
States without a history of cardiovascular disease at baseline in 1986;
participants in the Health Professionals Follow-up Study were followed up for 25
years until January 2011. The presence of risk factors was updated biennially
during follow-up.
MAIN OUTCOME MEASURE: Clinically significant PAD defined 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.
RESULTS: During a median follow-up of 24.2 years (interquartile range, 20.8-24.7
years), there were 537 cases of incident PAD. Each risk factor was significantly
and independently associated with a higher risk of PAD after adjustment for the
other 3 risk factors and confounders. The age-adjusted incidence rates were 9
(95% CI, 6-14) cases/100,000 person-years (n = 19 incident cases) for 0 risk
factors, 23 (95% CI, 18-28) cases/100,000 person-years (n = 99 incident cases)
for 1 risk factor, 47 (95% CI, 39-56) cases/100,000 person-years (n = 176
incident cases) for 2 risk factors, 92 (95% CI, 76-111) cases/100,000
person-years (n = 180 incident cases) for 3 risk factors, and 186 (95% CI,
141-246) cases/100,000 person-years (n = 63 incident cases) for 4 risk factors.
The multivariable-adjusted hazard ratio for each additional risk factor was 2.06
(95% CI, 1.88-2.26). Men without any of the 4 risk factors had a hazard ratio of
PAD of 0.23 (95% CI, 0.14-0.36) compared with all other men in the cohort. In 96%
of PAD cases (95% CI, 94%-98%), at least 1 of the 4 risk factors was present at
the time of PAD diagnosis. The population-attributable risk associated with these
4 risk factors was 75% (95% CI, 64%-87%). The absolute incidence of PAD among men
with all 4 risk factors was 3.5/1000 person-years.
CONCLUSION: Among men in this cohort, smoking, hypertension,
hypercholesterolemia, and type 2 diabetes account for the majority of risk
associated with development of clinically significant PAD.
DOI: 10.1001/jama.2012.13415
PMCID: PMC3733106
PMID: 23093164 [Indexed for MEDLINE]
