外周动脉疾病的二级预防与死亡率：1999 至 2004 年全国健康和营养调查研究。
Secondary prevention and mortality in peripheral artery disease: National Health and Nutrition Examination Study, 1999 to 2004.
机构信息
Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115, USA.
出版信息
Circulation. 2011 Jul 5;124(1):17-23. doi: 10.1161/CIRCULATIONAHA.110.003954. Epub 2011 Jun 20.
BACKGROUND
Whether individuals with peripheral artery disease (PAD) identified by screening ankle-brachial index benefit from preventive therapies to reduce cardiovascular risk is unknown. We aimed to determine the number of US adults with PAD who are not receiving preventive therapies and whether treatment is associated with reduced mortality in PAD subjects without known cardiovascular disease.
METHODS AND RESULTS
We analyzed data from the National Health and Nutrition Examination Survey (NHANES) 1999 to 2004 with mortality follow-up through December 31, 2006. We defined PAD as an ankle-brachial index ≤0.90. Of 7458 eligible participants ≥40 years, weighted PAD prevalence was 5.9±0.3% (mean±SE), corresponding to ≈7.1 million US adults with PAD. Statin use was reported in only 30.5±2.5%, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use in 24.9±1.9%, and aspirin use in 35.8±2.9%, corresponding to 5.0 million adults with PAD not taking statins, 5.4 million not taking angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and 4.5 million not receiving aspirin. After adjustment for age, sex, and race/ethnicity, PAD was associated with all-cause mortality (hazard ratio, 2.4; 95% confidence interval, 1.9 to 2.9; P<0.0001). Even after exclusion of individuals with known cardiovascular disease, subjects with PAD had higher mortality rates (16.1±2.1%) than subjects without PAD or cardiovascular disease (4.1±0.3%), with an adjusted hazard ratio of 1.9 (95% confidence interval, 1.3 to 2.8; P=0.001). Among PAD subjects without cardiovascular disease, use of multiple preventive therapies was associated with 65% lower all-cause mortality (hazard ratio, 0.35; 95% confidence interval, 0.20 to 0.86; P=0.02).
CONCLUSIONS
Millions of US adults with PAD are not receiving secondary prevention therapies. Treatment with multiple therapies is associated with reduced all-cause mortality.
背景
通过踝臂指数筛查发现的外周动脉疾病（PAD）患者是否受益于预防治疗以降低心血管风险尚不清楚。我们旨在确定未接受预防治疗的美国 PAD 患者人数，以及在无已知心血管疾病的 PAD 患者中，治疗是否与死亡率降低相关。
方法和结果
我们分析了 1999 年至 2004 年全国健康和营养调查（NHANES）的数据，并随访至 2006 年 12 月 31 日。我们将 PAD 定义为踝臂指数≤0.90。在 7458 名≥40 岁的合格参与者中，加权 PAD 患病率为 5.9%±0.3%（平均值±SE），相当于约 710 万美国成年人患有 PAD。仅报告 30.5%±2.5%的患者使用他汀类药物，24.9%±1.9%的患者使用血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂，35.8%±2.9%的患者使用阿司匹林，相当于 500 万未服用他汀类药物的 PAD 患者，540 万未服用血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂的患者，以及 450 万未服用阿司匹林的患者。调整年龄、性别和种族/民族后，PAD 与全因死亡率相关（风险比，2.4；95%置信区间，1.9 至 2.9；P<0.0001）。即使排除已知患有心血管疾病的个体，PAD 患者的死亡率也高于无 PAD 或心血管疾病的患者（16.1%±2.1%比 4.1%±0.3%），调整后的风险比为 1.9（95%置信区间，1.3 至 2.8；P=0.001）。在无心血管疾病的 PAD 患者中，使用多种预防疗法与全因死亡率降低 65%相关（风险比，0.35；95%置信区间，0.20 至 0.86；P=0.02）。
结论
数以百万计的美国 PAD 患者未接受二级预防治疗。多种疗法的治疗与全因死亡率降低相关。
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