Vascular Medicine Outcomes Program, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn; Department of Psychiatry, Yale School of Medicine, New Haven, Conn.
Optum Health, Eden Prairie, Minn.
J Vasc Surg. 2022 Jun;75(6):2054-2064.e3. doi: 10.1016/j.jvs.2022.01.134. Epub 2022 Feb 16.
Contemporary estimates of undetected asymptomatic lower extremity peripheral artery disease (PAD) in the community and its association with adverse outcomes in the population are lacking. We investigated the long-term association between previously undetected PAD and subsequent all-cause mortality and major adverse cardiovascular events (MACE) for Medicare Advantage beneficiaries aged ≥65 years in a large metropolitan area characterized by concentrations of atherosclerotic risk factors and a more vulnerable socioeconomic risk profile.
Data were derived from the patients' electronic medical records and linked with claims outcomes data for 13,971 Medicare Advantage beneficiaries aged ≥65 years who had undergone PAD screening in 2016 as a part of their routine annual health assessment in the greater Las Vegas, Nevada, metropolitan area. PAD screening was performed with their primary care provider using volume plethysmography system methods. The association between PAD screening status and 1- and 3-year all-cause mortality and MACE rates was documented.
The cohort had a mean age of 75.3 ± 6.6 years, and 57.7% were women. Of the 13,768 patients, 4351 (31.6%) had had a positive PAD screening result. Almost 60% had had a lower socioeconomic income level, with 15.1% living under the poverty level. The risk estimates associated with a positive vs negative PAD screening result for both all-cause mortality and MACE were as follows: unadjusted hazard ratio (HR) for mortality, 2.17 (95% confidence interval [CI], 1.79-2.63) and unadjusted HR for MACE, 2.00 (95% CI, 1.15-3.49) at 1 year and unadjusted HR for mortality, 2.04 (95% CI, 1.84-2.26) and unadjusted HR for MACE, 1.67 (95% CI, 1.37-2.02) at 3 years. After multivariable adjustment, all associations persisted (P < .001), with HRs ranging from 1.41 to 1.69, except for that for 1-year MACE (similar risk estimate but P = .09).
A positive screening result for previously undetected lower extremity PAD was independently associated with short- and long-term increased risks of mortality and MACE for individuals aged ≥65 years living in a large, metropolitan area.
目前缺乏社区内未被发现的无症状下肢外周动脉疾病（PAD）的估计数据，以及其与人群中不良结局之间的关联。我们研究了在一个以动脉粥样硬化危险因素集中和社会经济风险状况更脆弱为特征的大都市区中，年龄在 65 岁及以上的医疗保险优势受益人的先前未被发现的 PAD 与随后的全因死亡率和主要不良心血管事件（MACE）之间的长期关联。
数据来自患者的电子病历，并与内华达州拉斯维加斯大都市区的 13971 名年龄在 65 岁及以上的医疗保险优势受益人的索赔结果数据相关联，这些患者在 2016 年进行了 PAD 筛查，作为其常规年度健康评估的一部分。PAD 筛查是由他们的初级保健提供者使用容积体积描记系统方法进行的。记录了 PAD 筛查状态与 1 年和 3 年全因死亡率和 MACE 发生率之间的关联。
该队列的平均年龄为 75.3±6.6 岁，57.7%为女性。在 13768 名患者中，4351 名（31.6%）有阳性 PAD 筛查结果。近 60%的人收入较低，其中 15.1%生活在贫困线以下。阳性 PAD 筛查结果与全因死亡率和 MACE 之间的风险估计如下：1 年时未调整的死亡率危险比（HR）为 2.17（95%置信区间[CI]，1.79-2.63），未调整的 MACE HR 为 2.00（95%CI，1.15-3.49），3 年时未调整的死亡率 HR 为 2.04（95%CI，1.84-2.26），未调整的 MACE HR 为 1.67（95%CI，1.37-2.02）。多变量调整后，所有关联均持续存在（P<.001），HR 范围为 1.41 至 1.69，除 1 年 MACE 外（相似的风险估计，但 P=0.09）。
在一个大型的都市区中，年龄在 65 岁及以上的个体先前未被发现的下肢 PAD 筛查结果呈阳性，与短期和长期内死亡率和 MACE 风险的增加独立相关。
