Incident physical disability in people with lower extremity peripheral arterial disease: The role of cardiovascular disease

被引:21
作者
Brach, Jennifer S. [1 ]
Solomon, Cam [4 ]
Naydeck, Barbara L. [5 ]
Sutton-Tyrrell, Kim [2 ]
Enright, Paul L. [6 ]
Jenny, Nancy Swords [7 ]
Chaves, Paulo M. [8 ,9 ]
Newman, Anne B. [2 ,3 ]
机构
[1] Univ Pittsburgh, Dept Phys Therapy, Sch Hlth & Rehabil Sci, Pittsburgh, PA 15260 USA
[2] Univ Pittsburgh, Grad Sch Publ Hlth, Dept Epidemiol, Pittsburgh, PA 15260 USA
[3] Univ Pittsburgh, Sch Med, Dept Med, Div Geriatr Med, Pittsburgh, PA 15260 USA
[4] Univ Washington, Collaborat Hlth Studies Coordinating Ctr, Seattle, WA 98195 USA
[5] Regence Blue Cross Blue Shield, Portland, OR USA
[6] Univ Arizona, Coll Publ Hlth, Tucson, AZ USA
[7] Univ Vermont, Dept Pathol, Burlington, VT 05405 USA
[8] Johns Hopkins Univ, Dept Epidemiol, Baltimore, MD USA
[9] Johns Hopkins Univ, Dept Med, Baltimore, MD USA
关键词
peripheral arterial disease; disability; cardiovascular disease;
D O I
10.1111/j.1532-5415.2008.01719.x
中图分类号
R592 [老年病学]; C [社会科学总论];
学科分类号
03 ; 0303 ; 100203 ;
摘要
OBJECTIVES: To evaluate the risk of incident physical disability and the decline in gait speed over a 6-year follow-up associated with a low ankle-arm index (AAI) in older adults. DESIGN: Observational cohort study. SETTING: Forsyth County, North Carolina; Sacramento County, California; Washington County, Maryland; and Allegheny County, Pennsylvania. PARTICIPANTS: Four thousand seven hundred five older adults, 58% women and 17.6% black, participating in the Cardiovascular Health Study. MEASUREMENTS: AAI was measured in 1992/93 (baseline). Self-reported mobility, activity of daily living (ADL), and instrumental activity of daily living (IADL) disability and gait speed were recorded at baseline and at 1-year intervals over 6 years of follow-up. Mobility disability was defined as any difficulty walking half a mile and ADL and IADL disability was defined as any difficulty with 11 specific ADL and IADL tasks. Individuals with mobility, ADL, or IADL disability at baseline were excluded from the respective incident disability analyses. RESULTS: Lower baseline AAI values were associated with increased risk of mobility disability and ADL/IADL disability. Clinical cardiovascular disease (CVD), diabetes mellitus, and interim CVD events partially explained these associations for mobility disability and clinical CVD and diabetes mellitus partially explained these associations for ADL and IADL disability. Individuals with an AAI less than 0.9 had on average a mean decrease in gait speed of 0.02 m/s per year, or a decline of 0.12 m/s over the 6-year follow-up. Prevalent CVD partly explained this decrease but interim CVD events did not further attenuate it. CONCLUSION: Low AAI serves as marker of future disability risk. Reduction of disability risk in patients with a low AAI should consider cardiovascular comorbidity and the prevention of additional disabling CVD events.
引用
收藏
页码:1037 / 1044
页数:8
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