Excess 1-year cardiovascular risk in elderly primary care patients with a low ankle-brachial index (ABI) and high homocysteine level

被引:40
作者
Lange, S
Trampisch, HJ
Haberl, R
Darius, H
Pittrow, D
Schuster, A
von Stritzky, B
Tepohl, G
Allenberg, JR
Diehm, C
机构
[1] Ruhr Univ Bochum, Dept Med Informat Biometry & Epidemiol, D-44801 Bochum, Germany
[2] Municipal Hosp Munich Harlaching, Dept Neurol, Munich, Germany
[3] Vivantes Berlin Neukolln Med Ctr, Dept Med 1, Berlin, Germany
[4] Tech Univ Dresden, Fac Med, Dept Clin Pharmacol, Dresden, Germany
[5] 3P Consulting, Pocking, Germany
[6] Sanofi Synthelabo GmbH, Dept Med, Berlin, Germany
[7] Internist Vasc Med, Munich, Germany
[8] Heidelberg Univ, Dept Vasc Surg, D-6900 Heidelberg, Germany
[9] Heidelberg Univ, Klinikum Karlsbad Langensteinbach, Affiliated Teaching Hosp, Dept Internal Med Vasc Med, D-6900 Heidelberg, Germany
关键词
peripheral vascular disease; homocysteine; cardiovascular diseases; atherosclerosis; risk factors;
D O I
10.1016/j.atherosclerosis.2004.09.003
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Previous studies in selected patient samples suggested a high risk for total mortality and cardiovascular (CV) morbidity associated not only with symptomatic, but also with asymptomatic peripheral arterial disease (PAD). Our aim was to assess the I-year risk of death and CV morbidity associated with PAD in primary care. Furthermore, we quantified the strength of association between low ankle-brachial index (ABI, as indicator for PAD), plasma homocysteine (HC) levels, and various accepted PAD risk factors, and death and outcomes. In a prospective cohort study, 6880 unselected patients greater than or equal to65 years were followed up by 344 primary care physicians in Germany. At I year, all-cause mortality was 2.8% in patients with PAD and 0.9% in patients without PAD (odds ratio [OR] adjusted for age and gender: 2.7 [95% confidence interval: 1.7; 4.2]; multivariate adjusted OR: 2.0 [1.3; 3.3]). Mortality due to CV events was 1.6 versus 0.4% (OR: 3.7 [2.0; 6.9], adjusted OR: 2.5 [1.3; 4.9]). Patients with PAD and high HC values (greater than or equal tofourth quintile) had a markedly increased risk of premature death: OR versus no PAD/low HC level (<first quintile): 9.8 [3.2, 29.9], adjusted OR 6.6 [2.1, 20.9]. Patients with a low ABI have a substantially increased risk of (short-term) all-cause mortality. The combination of a low ABI and high HC level is particularly useful for identifying patients at excess risk. (C) 2004 Published by Elsevier Ireland Ltd.
引用
收藏
页码:351 / 357
页数:7
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