University of Birmingham Institute of Cardiovascular Sciences, City Hospital, Dudley Road, Birmingham B18 7QH, UK.
Department of Experimental Medicine, Sapienza-University of Rome, Rome, Italy.
Europace. 2017 Sep 1;19(9):1439-1448. doi: 10.1093/europace/euw169.
Peripheral arterial disease (PAD) is highly prevalent in general population. Data on the prevalence of symptomatic PAD in patients with atrial fibrillation (AF) are limited, and the impact of PAD on adverse outcomes in AF patients is controversial. Our aims were: (i) to define the prevalence of symptomatic PAD in European AF patients and describe its associated clinical risk factors and (ii) to establish the relationship of PAD to adverse events in AF, especially all-cause death.
Atrial fibrillation patients enrolled in the EORP-AF Pilot study with data about PAD status were included in this analysis. Event rates were determined at 1-year follow-up. Peripheral arterial disease was recorded in 328 (11%) patients. Age (P < 0.0001), hypertension (P = 0.0059), diabetes mellitus (P = 0.0001), chronic heart failure (P < 0.0001), previous stroke/transient ischaemic attack (P = 0.0060), and antiplatelet drug treatment (P = 0.0001) were associated with the presence of PAD, while female gender was inversely associated (P = 0.0002). Peripheral arterial disease patients had higher absolute rates of both cardiovascular (CV) and all-cause death (both P < 0.0001). On Kaplan-Meier analysis, risk of all-cause death was higher in PAD patients compared with those without PAD (P < 0.0001), but PAD did not emerge as an independent risk factor for mortality on Cox regression analysis. A lower risk of all-cause death was associated with the prescription of statins (P = 0.0019), angiotensin-converting enzyme inhibitors (P = 0.0008), and calcium-channel blockers (P = 0.0071).
Peripheral arterial disease is prevalent in 11% of AF patients and related to various atherosclerotic risk factors. Even if PAD is associated with higher risk of all-cause death on univariate analysis, this risk was significantly lowered and was no longer evident after adjusting for the use of CV prevention drugs.
外周动脉疾病（PAD）在普通人群中患病率很高。关于心房颤动（AF）患者中症状性 PAD 的患病率数据有限，PAD 对 AF 患者不良结局的影响存在争议。我们的目的是：（i）定义欧洲 AF 患者中症状性 PAD 的患病率，并描述其相关的临床危险因素；（ii）确定 PAD 与 AF 不良事件的关系，特别是全因死亡。
纳入了 EORP-AF Pilot 研究中具有 PAD 状态数据的 AF 患者。在 1 年随访时确定事件发生率。328 例（11%）患者记录有 PAD。年龄（P < 0.0001）、高血压（P = 0.0059）、糖尿病（P = 0.0001）、慢性心力衰竭（P < 0.0001）、既往卒中/短暂性脑缺血发作（P = 0.0060）和抗血小板药物治疗（P = 0.0001）与 PAD 的存在相关，而女性性别则与之相反（P = 0.0002）。PAD 患者的心血管（CV）和全因死亡的绝对发生率均较高（均 P < 0.0001）。在 Kaplan-Meier 分析中，PAD 患者的全因死亡风险高于无 PAD 患者（P < 0.0001），但 Cox 回归分析显示 PAD 并非死亡的独立危险因素。他汀类药物（P = 0.0019）、血管紧张素转换酶抑制剂（P = 0.0008）和钙通道阻滞剂（P = 0.0071）的使用与全因死亡风险降低相关。
11%的 AF 患者存在 PAD，与多种动脉粥样硬化危险因素相关。即使 PAD 在单因素分析中与全因死亡风险增加相关，但在调整 CV 预防药物使用后，这种风险显著降低，且不再明显。
