Excess 1-year cardiovascular risk in elderly primary care patients with a low ankle-brachial index (ABI) and high homocysteine level

@article{citeulike:898581, abstract = {Previous studies in selected patient samples suggested a high risk for total mortality and cardiovascular (CV) morbidity associated not only with symptomatic, but also with asymptomatic peripheral arterial disease (PAD). Our aim was to assess the 1-year risk of death and CV morbidity associated with PAD in primary care. Furthermore, we quantified the strength of association between low ankle-brachial index (ABI, as indicator for PAD), plasma homocysteine (HC) levels, and various accepted PAD risk factors, and death and outcomes. In a prospective cohort study, 6880 unselected patients >=65 years were followed up by 344 primary care physicians in Germany. At 1 year, all-cause mortality was 2.8\% in patients with PAD and 0.9\% in patients without PAD (odds ratio [OR] adjusted for age and gender: 2.7 [95\% confidence interval: 1.7; 4.2]; multivariate adjusted OR: 2.0 [1.3; 3.3]). Mortality due to CV events was 1.6 versus 0.4\% (OR: 3.7 [2.0; 6.9], adjusted OR: 2.5 [1.3; 4.9]). Patients with PAD and high HC values (>=fourth quintile) had a markedly increased risk of premature death: OR versus no PAD/low HC level (<first quintile): 9.8 [3.2, 29.9], adjusted OR 6.6 [2.1, 20.9]. Patients with a low ABI have a substantially increased risk of (short-term) all-cause mortality. The combination of a low ABI and high HC level is particularly useful for identifying patients at excess risk.}, author = {Lange, Stefan and Trampisch, Hans J. and Haberl, Roman and Darius, Harald and Pittrow, David and Schuster, Alexander and von Stritzky, Berndt and Tepohl, Gerhart and Allenberg, Jens R. and Diehm, Curt }, citeulike-article-id = {898581}, doi = {http://dx.doi.org/10.1016/j.atherosclerosis.2004.09.003}, journal = {Atherosclerosis}, keywords = {homocisteina, itb, riesgo}, month = {February}, number = {2}, pages = {351--357}, posted-at = {2006-10-16 00:26:06}, priority = {2}, title = {Excess 1-year cardiovascular risk in elderly primary care patients with a low ankle-brachial index (ABI) and high homocysteine level}, url = {http://dx.doi.org/10.1016/j.atherosclerosis.2004.09.003}, volume = {178}, year = {2005} }

TY - JOUR ID - citeulike:898581 L3 - citeulike-article-id:898581 TI - Excess 1-year cardiovascular risk in elderly primary care patients with a low ankle-brachial index (ABI) and high homocysteine level JF - Atherosclerosis VL - 178 IS - 2 SP - 351 EP - 357 N2 - Previous studies in selected patient samples suggested a high risk for total mortality and cardiovascular (CV) morbidity associated not only with symptomatic, but also with asymptomatic peripheral arterial disease (PAD). Our aim was to assess the 1-year risk of death and CV morbidity associated with PAD in primary care. Furthermore, we quantified the strength of association between low ankle-brachial index (ABI, as indicator for PAD), plasma homocysteine (HC) levels, and various accepted PAD risk factors, and death and outcomes. In a prospective cohort study, 6880 unselected patients >=65 years were followed up by 344 primary care physicians in Germany. At 1 year, all-cause mortality was 2.8% in patients with PAD and 0.9% in patients without PAD (odds ratio [OR] adjusted for age and gender: 2.7 [95% confidence interval: 1.7; 4.2]; multivariate adjusted OR: 2.0 [1.3; 3.3]). Mortality due to CV events was 1.6 versus 0.4% (OR: 3.7 [2.0; 6.9], adjusted OR: 2.5 [1.3; 4.9]). Patients with PAD and high HC values (>=fourth quintile) had a markedly increased risk of premature death: OR versus no PAD/low HC level (<first quintile): 9.8 [3.2, 29.9], adjusted OR 6.6 [2.1, 20.9]. Patients with a low ABI have a substantially increased risk of (short-term) all-cause mortality. The combination of a low ABI and high HC level is particularly useful for identifying patients at excess risk. KW - homocisteina KW - itb KW - riesgo AU - Lange, Stefan AU - Trampisch, Hans AU - Haberl, Roman AU - Darius, Harald AU - Pittrow, David AU - Schuster, Alexander AU - von Stritzky, Berndt AU - Tepohl, Gerhart AU - Allenberg, Jens AU - Diehm, Curt PY - 2005/02// UR - http://dx.doi.org/10.1016/j.atherosclerosis.2004.09.003 ER -