Mlacak Blaz, Blinc Ales, Pohar Maja, Stare Janez
Health Centre Metlika, Metlika, Slovenia.
Croat Med J. 2006 Apr;47(2):327-34.
To test how the presence of peripheral arterial disease predicted mortality of middle-aged and elderly residents of Metlika county, a rural area in southeastern Slovenia.
In 1987, we interviewed and examined a representative cohort of 646 subjects aged 45-80 years at inclusion without overt coronary or cerebrovascular disease, for cardiovascular risk factors and measured the ankle-brachial pressure index (ABPI). Peripheral arterial disease was defined as ABPI<0.90. The subjects were followed up 15 years or until death. All-cause mortality and cardiovascular mortality were assessed and compared between subjects with and without peripheral arterial disease in a multivariate model.
There were 580 subjects with normal ABPI and 66 subjects with peripheral arterial disease, among which 49 were asymptomatic and 17 had intermittent claudication. Because subjects with peripheral arterial disease were on average 10 years older than those without peripheral arterial disease, the mere presence of peripheral arterial disease was not an independent predictor of mortality. However, there was a significant interaction of peripheral arterial disease with age, with a more pronounced adverse prognostic effect of peripheral arterial disease in younger than in older age groups. For a 55-year-old subject with peripheral arterial disease, the hazard ratio of dying from any cause in the follow-up period was 2.44 (95% confidence interval [CI], 1.15-4.96) in comparison to an age-matched subject without peripheral arterial disease, but at 75 years of age, the hazard ratio decreased to only 0.71 (95% CI, 0.46-1.09). For cardiovascular mortality, the hazard ratio in the presence of peripheral arterial disease was 6.05 (95% CI, 1.87-16.27) at 55 years and 0.92 (95% CI, 0.54-1.52) at 75 years. Among patients with peripheral arterial disease, each decrement of ABPI at inclusion by 0.10 significantly increased the cardiovascular mortality after 15 years by 30% (P = 0.038).
Peripheral arterial disease, even asymptomatic, is an important predictor of adverse cardiovascular prognosis in relatively young patients. Reduced ABPI is a strong, independent predictor of cardiovascular mortality in all patients with peripheral arterial disease.
检验外周动脉疾病的存在如何预测斯洛文尼亚东南部农村地区梅特利卡县中年及老年居民的死亡率。
1987年，我们对纳入研究时年龄在45 - 80岁、无明显冠心病或脑血管疾病的6百46名受试者组成的代表性队列进行了访谈和检查，以了解心血管危险因素，并测量了踝臂压力指数（ABPI）。外周动脉疾病定义为ABPI<0.90。对受试者进行了15年的随访或直至死亡。在多变量模型中评估并比较了有和没有外周动脉疾病的受试者的全因死亡率和心血管死亡率。
ABPI正常的受试者有580名，外周动脉疾病患者有66名，其中49名无症状，17名有间歇性跛行。由于外周动脉疾病患者的平均年龄比无外周动脉疾病的患者大10岁，因此外周动脉疾病的单纯存在并非死亡率的独立预测因素。然而，外周动脉疾病与年龄之间存在显著的相互作用，外周动脉疾病在较年轻年龄组中的不良预后作用比在较年长年龄组中更为明显。对于一名55岁的外周动脉疾病患者，与年龄匹配的无外周动脉疾病的受试者相比，随访期间任何原因死亡的风险比为2.44（95%置信区间[CI]，1.15 - 4.96），但在75岁时，风险比降至仅0.71（95%CI，0.46 - 1.09）。对于心血管死亡率，外周动脉疾病患者在55岁时的风险比为6.05（95%CI，1.8
