Section of Vascular Surgery, Department of Clinical Science and Education, Karolinska Institutet at Södersjukhuset, Stockholm, Sweden.
Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
Eur J Vasc Endovasc Surg. 2018 Apr;55(4):529-536. doi: 10.1016/j.ejvs.2018.01.019. Epub 2018 Feb 23.
The aim was to determine long-term mortality rates and the underlying cause of death for subjects with different peripheral arterial disease (PAD) stages in a population based setting.
A randomly selected population sample of 5080 subjects was enrolled in the study in 2004-2005. Participants completed health state questionnaires and underwent ankle brachial index (ABI) measurements for classification into PAD severity stages and reference subjects. A follow-up was conducted by the end of 2015 using data from Swedish governmental national registers for cause of death, which was then compared with PAD stage determined at baseline in 2005.
The 10 year all cause mortality was 27% for reference cases, 56% for asymptomatic PAD (APAD), 63% for intermittent claudication (IC), and 75% for severe limb ischaemia (SLI). Among all PAD subjects, cardiovascular (CV) causes were the most common main cause of death (45%) and a CV event was present as either the main or one of the three most common contributing causes of death in 64% of the cases. The age adjusted hazard ratios for a main cause of death by a CV event were 1.9 (95% CI 1.5-2.3) for APAD, 2.6 (95% CI 2.1-3.4) for IC, and 3.5 (95% CI 2.3-5.2) for SLI.
PAD subjects, including the APAD subjects, are still at high risk of CV death. The mortality risks are more than doubled in symptomatic PAD patients compared with reference subjects and increase by severity of PAD stage. Awareness and improved risk reduction management of PAD are still warranted.
本研究旨在确定在人群中不同外周动脉疾病（PAD）阶段患者的长期死亡率和死亡原因。
在 2004-2005 年，本研究从一个随机选择的人群样本中招募了 5080 名受试者。参与者完成了健康状况问卷，并进行了踝肱指数（ABI）测量，以确定 PAD 严重程度分期和参考受试者。通过瑞典政府全国登记册获取截至 2015 年底的死亡原因随访数据，并与 2005 年基线时确定的 PAD 分期进行比较。
参考病例的 10 年全因死亡率为 27%，无症状 PAD（APAD）为 56%，间歇性跛行（IC）为 63%，严重肢体缺血（SLI）为 75%。在所有 PAD 患者中，心血管（CV）疾病是最常见的主要死亡原因（45%），64%的病例中 CV 事件是主要或三个最常见死亡原因之一。经年龄调整后，CV 事件导致主要死亡原因的风险比（HR）为 APAD 1.9（95%CI 1.5-2.3），IC 为 2.6（95%CI 2.1-3.4），SLI 为 3.5（95%CI 2.3-5.2）。
包括无症状 PAD 患者在内的 PAD 患者仍然存在较高的 CV 死亡风险。与参考受试者相比，有症状 PAD 患者的死亡率风险增加了一倍以上，且随着 PAD 严重程度分期的增加而增加。仍然需要提高对 PAD 的认识并改善风险降低管理。
