Duke University School of Medicine, Durham, NC, USA.
Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
Vasc Med. 2022 Aug;27(4):323-332. doi: 10.1177/1358863X221084360. Epub 2022 Apr 7.
Peripheral artery disease (PAD) is associated with modifiable atherosclerotic risk factors like hypertension, diabetes, hyperlipidemia, and smoking. However, the effect of risk factor control on outcomes and disparities in achieving control is less well understood.
All patients in an integrated, regional health system with PAD-related encounters, fee-for-service Medicare, and clinical risk factor control data were identified. Component risk factors were dichotomized into controlled and uncontrolled categories (control defined as low-density lipoprotein < 100 mg/dL, hemoglobin A1c < 7.0%, SBP < 140 mmHg, and current nonsmoker) and composite categories (none, 1, ⩾ 2 uncontrolled RFs) created. The primary outcome was major adverse vascular events (MAVE, a composite of all-cause mortality, myocardial infarction, stroke, and lower-extremity revascularization and amputation).
The cohort included 781 patients with PAD, average age 72.5 ± 9.8 years, of whom 30.1% were Black, and 19.1% were Medicaid dual-enrolled. In this cohort, 260 (33.3%) had no uncontrolled risk factors and 200 (25.6%) had two or more uncontrolled risk factors. Patients with the poorest risk factor control were more likely to be Black ( < 0.001), Medicaid dual-enrolled ( < 0.001), and have chronic limb-threatening ischemia ( = 0.009). Significant differences in MAVE by degree of risk factor control were observed at 30 days (none uncontrolled: 5.8%, 1 uncontrolled: 11.5%, ⩾ 2 uncontrolled: 13.6%; = 0.01) but not at 1 year ( = 0.08). risk factor control was not associated with outcomes at 1 year after adjustment for patient and PAD-specific characteristics.
risk factor control is poor among patients with PAD. Significant disparities in achieving optimal risk factor control represent a potential target for reducing inequities in outcomes.
外周动脉疾病（PAD）与可改变的动脉粥样硬化风险因素有关，如高血压、糖尿病、血脂异常和吸烟。然而，风险因素控制对结果的影响以及在实现控制方面的差异尚不清楚。
确定了一个综合的、区域性卫生系统中患有 PAD 相关疾病、按服务收费的医疗保险和临床风险因素控制数据的所有患者。将组成风险因素分为控制和未控制两类（控制定义为低密度脂蛋白<100mg/dL、糖化血红蛋白<7.0%、SBP<140mmHg 和当前非吸烟者），并创建了复合类别（无、1、≥2 个未控制的 RF）。主要结局是主要不良血管事件（MAVE，包括全因死亡率、心肌梗死、卒中和下肢血运重建和截肢的复合结局）。
该队列包括 781 名 PAD 患者，平均年龄 72.5±9.8 岁，其中 30.1%为黑人，19.1%为医疗保险双重参保者。在该队列中，260 名（33.3%）患者没有未控制的风险因素，200 名（25.6%）患者有两个或更多未控制的风险因素。风险因素控制最差的患者更有可能是黑人（<0.001）、医疗保险双重参保者（<0.001）和患有慢性肢体威胁性缺血（=0.009）。在 30 天时，观察到风险因素控制程度与 MAVE 显著相关（无未控制因素：5.8%，1 个未控制因素：11.5%，≥2 个未控制因素：13.6%；=0.01），但在 1 年时无显著相关性（=0.08）。在调整患者和 PAD 特定特征后，风险因素控制与 1 年后的结局无关。
PAD 患者的风险因素控制较差。在实现最佳风险因素控制方面存在显著差异，这代表了减少结果不平等的潜在目标。
