Secondary Prevention and Mortality in Peripheral Artery Disease: National Health and Nutrition Examination Study, 1999 to 2004

Pande, Reena L.; Perlstein, Todd S.; Beckman, Joshua A.; Creager, Mark A.

doi:10.1161/circulationaha.110.003954

Cited by 406Peripheral Artery Disease ManagementLipoproteins and Cardiovascular HealthVascular Procedures and Complications

Secondary Prevention and Mortality in Peripheral Artery Disease: National Health and Nutrition Examination Study, 1999 to 2004

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Pande, Reena L., Perlstein, Todd S., Beckman, Joshua A., Creager, Mark A.·2011·Circulation

DOI 10.1161/circulationaha.110.003954PMC PMC3139992

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Abstract

Background—: Whether individuals with peripheral artery disease (PAD) identified by screening ankle-brachial index benefit from preventive therapies to reduce cardiovascular risk is unknown. We aimed to determine the number of US adults with PAD who are not receiving preventive therapies and whether treatment is associated with reduced mortality in PAD subjects without known cardiovascular disease. Methods and Results—: We analyzed data from the National Health and Nutrition Examination Survey (NHANES) 1999 to 2004 with mortality follow-up through December 31, 2006. We defined PAD as an ankle-brachial index ≤0.90. Of 7458 eligible participants ≥40 years, weighted PAD prevalence was 5.9±0.3% (mean±SE), corresponding to ≈7.1 million US adults with PAD. Statin use was reported in only 30.5±2.5%, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use in 24.9±1.9%, and aspirin use in 35.8±2.9%, corresponding to 5.0 million adults with PAD not taking statins, 5.4 million not taking angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and 4.5 million not receiving aspirin. After adjustment for age, sex, and race/ethnicity, PAD was associated with all-cause mortality (hazard ratio, 2.4; 95% confidence interval, 1.9 to 2.9; P <0.0001). Even after exclusion of individuals with known cardiovascular disease, subjects with PAD had higher mortality rates (16.1±2.1%) than subjects without PAD or cardiovascular disease (4.1±0.3%), with an adjusted hazard ratio of 1.9 (95% confidence interval, 1.3 to 2.8; P =0.001). Among PAD subjects without cardiovascular disease, use of multiple preventive therapies was associated with 65% lower all-cause mortality (hazard ratio, 0.35; 95% confidence interval, 0.20 to 0.86; P =0.02). Conclusions—: Millions of US adults with PAD are not receiving secondary prevention therapies. Treatment with multiple therapies is associated with reduced all-cause mortality.

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Secondary Prevention and Mortality in Peripheral Artery Disease: National Health and Nutrition Examination Study, 1999 to 2004
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Authors: Pande, R. L., Perlstein, T. S., Beckman, J. A., & Creager, M. A.
Affiliations: Brigham and Women's Hospital (US)
ORCID: Pande, Reena L.
Beckman, Joshua A.
Creager, Mark A.
Venue: Circulation
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2011-07-05
Volume: 124
Issue: 1
Pages: 17-23
ISSN: 0009-7322 (ISSN-L)
1524-4539
DOI: 10.1161/circulationaha.110.003954
PMC: PMC3139992
OpenAlex: W2082336558
Semantic Scholar: 91f0b40eb962eac5bce27896ae06727a10351d5f
Cited by: 406
References: 30
Citations by year: 2026: 13 · 2025: 13 · 2024: 28 · 2023: 31 · 2022: 24 · 2021: 39 · 2020: 33 · 2019: 26 · 2018: 35 · 2017: 26 · 2016: 38 · 2015: 25 · 2014: 21 · 2013: 19 · 2012: 35
FWCI: 24.58
Type: journal article
Language: en
Open access: green
www.ncbi.nlm.nih.gov
Locations: Circulation (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Heart, Lung, and Blood Institute (K12HL083786, R01HL075771)
Topics: Health Sciences › Medicine › Surgery › Peripheral Artery Disease Management
Health Sciences › Medicine › Surgery › Lipoproteins and Cardiovascular Health
Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Vascular Procedures and Complications
Keywords: peripheral arterial disease, secondary prevention, all-cause mortality, ankle-brachial index, statin use, ACE inhibitors, angiotensin receptor blockers, aspirin, cardiovascular risk reduction, untreated patients
MeSH terms: Aged, Angiotensin-Converting Enzyme Inhibitors, Aspirin, Cardiovascular Diseases, Female, Humans, Male, Nutrition Surveys, Retrospective Studies, Risk Factors, United States, Prevalence, Secondary Prevention, Angiotensin II Type 2 Receptor Blockers, Peripheral Arterial Disease

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Secondary Prevention and Mortality in Peripheral Artery Disease: National Health and Nutrition Examination Study, 1999 to 2004

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