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

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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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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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Background
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Method
Retracted
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Method
Predictors of health care use among patients with or at high risk of atherothrombotic disease: Two-year follow-up data
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“In the most recent and largest study to date regarding appropriate vascular protection in PAD, prescribing rates were below 40% for statins, ACE inhibitor or ARB, and ASA (considered individually), despite the evidence suggesting that most patients with PAD would benefit from these therapies.(13) The study reported he…”
Influential
ASCVD Risk and Statin Use in PAD
Bonaca, M. P., & Hess, C. N. (2020) · Journal of the American College of Cardiology · doi:10.1016/j.jacc.2020.06.009 · Cited by 5
miRNA‐6236 Regulation of Postischemic Skeletal Muscle Angiogenesis
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Background
Area Deprivation Index is not predictive of worse outcomes after open lower extremity revascularization
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“9,10 However, patients with PAD are often found to be under prescribed these medications, 11 particularly when compared to other manifestations of CVD, such as ischaemic heart disease (IHD), and for women with PAD.”
Background
Effect of ramipril on walking times and quality of life among patients with peripheral artery disease and intermittent claudication: A randomized controlled trial. Journal of the American Medical Association 2013; 309: 453–460
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Peripheral artery disease patients may benefit more from aggressive secondary prevention than aneurysm patients to improve survival
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Hyperthyroidism and vascular cell adhesion molecule-1 are associated with a low ankle-brachial index
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Self-citation
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“Patients with PAD also have a poorer prognosis compared to other individuals with ASCVD, including CAD [18].”
Role of Lipids and Lipid Management Therapy Among Patients With Peripheral Artery Disease: A Reappraisal of the Current Evidence and Future Directions
Walker, M., Riggs, K. A., Rohatgi, A. K., Beckman, J. A., Addo, T. A., Girotra, S. R., Bonaca, M. P., Armstrong, E. J., & Kumbhani, D. J. (2025) · Journal of the American Heart Association · doi:10.1161/jaha.124.039734 · Cited by 4
“25 In this study, dyslipidemia was among several other independent risk factors for disease progression (age, diabetes, and cigarette smoking).”
Self-citation
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Mobile health technologies to improve walking distance in people with intermittent claudication
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Association between atherogenic index of plasma and peripheral arterial disease
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Triagem pré-participação em exercício físico em pacientes com doença arterial periférica
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Background
Evidence-Experience Gap and Future Perspective on the Treatment of Peripheral Artery Disease
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Self-citation
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Background
Assessment of Feasibility and Patency of below the Knee Atherectomy Using the 1.5 mm Phoenix Catheter—A Retrospective Study
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“Lower extremity peripheral arterial disease (LEAD) is a chronic stenotic or occlusive disease of arteries of the lower extremities that is usually a result of atherosclerosis [1].”
Background
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“Our finding that increasing age and duration of diabetes are associated with a higher likelihood of PAD is consistent with previous reports [3,37].”
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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 › Cardiology and Cardiovascular Medicine › 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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