Vaartjes I, de Borst G J, Reitsma J B, de Bruin A, Moll F L, Grobbee D E, Bots M L
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
BMC Cardiovasc Disord. 2009 Aug 28;9:43. doi: 10.1186/1471-2261-9-43.
As the population ages, peripheral arterial disease (PAD) in the lower extremities will become a larger public health problem. Awareness in patients as well clinicians of the high risk of morbidity and mortality is important but seems currently low. Insights in absolute mortality risks following admission for PAD in the lower extremities can be useful to improve awareness as they are easy to interpret.
A nationwide cohort of 4,158 patients with an initial admission for PAD in the lower extremities was identified through linkage of the national hospital and population register in 1997 and 2000.
Over 60% of 4,158 patients were men. 28 days, 1 year and 5 year mortality risk were 2.4%, 10.3% and 31.0% for men and 3.5%, 10.4% and 27.4% for women. Coronary heart disease and stroke were frequent cause of death. Five years mortality risk was higher for men compared to women (HR 1.36, 95% CI 1.21-1.53).
In conclusion, our findings demonstrate that, 5 year mortality risk is high, especially in men and comparable to that of patients admitted for acute myocardial infarction or ischemic stroke. Though, in general population the awareness of the severity of PAD in the lower extremities is significantly lower than that for any other cardiovascular disease and it seems that cardiovascular risk factor management for prevention in PAD patients is very modest.
随着人口老龄化，下肢外周动脉疾病（PAD）将成为一个更为严重的公共卫生问题。提高患者及临床医生对其高发病和死亡风险的认识非常重要，但目前这方面的意识似乎较低。了解下肢PAD入院后的绝对死亡风险有助于提高认识，因为这些风险易于解读。
通过1997年和2000年全国医院与人口登记册的关联，确定了一个全国性队列，其中4158例患者首次因下肢PAD入院。
4158例患者中超过60%为男性。男性28天、1年和5年的死亡风险分别为2.4%、10.3%和31.0%，女性分别为3.5%、10.4%和27.4%。冠心病和中风是常见的死亡原因。男性5年死亡风险高于女性（风险比1.36，95%置信区间1.21 - 1.53）。
总之，我们的研究结果表明，5年死亡风险很高，尤其是男性，与急性心肌梗死或缺血性中风入院患者的风险相当。然而，在普通人群中，对下肢PAD严重性的认识明显低于对任何其他心血管疾病的认识，而且PAD患者预防心血管危险因素的管理似乎非常有限。
