Microvascular Disease, Peripheral Artery Disease, and Amputation

The mechanism of adverse limb events associated with peripheral artery disease remains incompletely understood. We investigated whether microvascular disease is associated with amputation in a large cohort of veterans to determine whether microvascular disease diagnosed in any location increases the...

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Veröffentlicht in:Circulation (New York, N.Y.) Jg. 140; H. 6; S. 449
Hauptverfasser: Beckman, Joshua A, Duncan, Meredith S, Damrauer, Scott M, Wells, Quinn S, Barnett, Joey V, Wasserman, David H, Bedimo, Roger J, Butt, Adeel A, Marconi, Vincent C, Sico, Jason J, Tindle, Hilary A, Bonaca, Marc P, Aday, Aaron W, Freiberg, Matthew S
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States 06.08.2019
Schlagworte:
Adult
Aged
Amputation - statistics & numerical data
Comorbidity
Diabetes Complications - epidemiology
Disease Susceptibility
Extremities - blood supply
Female
Follow-Up Studies
Humans
Ischemia - etiology
Ischemia - surgery
Kidney Diseases - epidemiology
Male
Microcirculation
Middle Aged
Peripheral Arterial Disease - complications
Peripheral Arterial Disease - physiopathology
Peripheral Arterial Disease - surgery
Peripheral Nervous System Diseases - epidemiology
Prevalence
Procedures and Techniques Utilization
Proportional Hazards Models
Prospective Studies
Retinal Diseases - epidemiology
Risk Factors
Veterans - statistics & numerical data
amputation
risk factors
veterans
peripheral artery disease
cardiovascular diseases
ISSN:1524-4539, 1524-4539
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Zusammenfassung:The mechanism of adverse limb events associated with peripheral artery disease remains incompletely understood. We investigated whether microvascular disease is associated with amputation in a large cohort of veterans to determine whether microvascular disease diagnosed in any location increases the risk of amputation alone and in concert with peripheral artery disease. Participants in the Veterans Aging Cohort Study were recruited from April 1, 2003 through December 31, 2014. We excluded participants with known prior lower limb amputation. Using time-updated Cox proportional hazards regression, we analyzed the effect of prevalent microvascular disease (retinopathy, neuropathy, and nephropathy) and peripheral artery disease status on the risk of incident amputation events after adjusting for demographics and cardiovascular risk factors. Among 125 674 veterans without evidence of prior amputation at baseline, the rate of incident amputation over a median of 9.3 years of follow-up was 1.16 per 1000 person-years, yielding a total of 1185 amputations. In time-updated multivariable-adjusted analyses, compared with those without peripheral artery disease or microvascular disease, microvascular disease alone was associated with a 3.7-fold (95% CI, 3.0-4.6) increased risk of amputation; peripheral artery disease alone conferred a 13.9-fold (95% CI, 11.3-17.1) elevated risk of amputation; and the combination of peripheral artery disease and microvascular disease was associated with a 22.7-fold (95% CI, 18.3-28.1) increased risk of amputation. Independent of traditional risk factors, the presence of microvascular disease increases the risk of amputation alone and synergistically increases risk in patients with peripheral artery disease. Further research is needed to understand the mechanisms by which this occurs.
Bibliographie:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
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ISSN:1524-4539
1524-4539
DOI:10.1161/CIRCULATIONAHA.119.040672