Outcome of symptomatic leg ischaemia: Four year morbidity and mortality in Vadstena, Sweden

Objective: To quantify cardiovascular morbidity and mortality including the incidence of vascular surgery and amputations, among individuals with symptomatic leg ischaemia. Design: Prospective cohort study. Material: Inhabitants 50-89 years of age (n = 2784) of Vadstena community, Ostergotland, Sweden, with 4 years of follow-up. 107 subjects with symptomatic leg ischaemia (SLI), selected by a postal questionnaire and ankle pressure measurements, and an age and sex matched control group of 214 individuals. Chief outcome measures: Cardiovascular morbidity and mortality all cause mortality, surgical procedures for leg ischaemia, major amputations, ankle brachial pressure index. Main results: Age and sex adjusted all-cause mortality risk in the SLI-group was increased by 1.9. This was most prominent among men in their sixties and women in their seventies. Cardiovascular mortality was increased by 1.9 (95% confidence interval 1.1-3.3). Relative risks for acute myocardial infarction and cerebrovascular events were 2.4 (1.1-5.1) and 1.7 (0.9-3.2), respectively The increase in age and sex adjusted incidence of primary reconstructive surgery during the first year after initial examination was 67-fold compared to the total population of Vadstena 50-89 years old, and 18-fold for the whole observation period, while the increase in risk for major amputation during the observation period was 12-fold. Median ankle brachial index improved significantly during follow-up among the individuals alive and not subjected to vascular surgery. Conclusions: Among the SLI-subjects identified in a general population, the overall risk for cardiovascular morbidity and mortality over 4 years was significantly increased compared to normals.