Patient Age at Diagnosis of Peripheral Artery Disease and Its Impact on Cardiovascular and Limb Outcomes

      Peripheral artery disease (PAD) prevalence increases with age, but the relation between age at PAD diagnosis and outcomes is unclear. We investigated the cardiovascular and limb outcomes of patients diagnosed with PAD at different ages. We studied patients with PAD aged ≥18 years who were diagnosed between 1996 and 2020 at Mayo Clinic. Patients were grouped by diagnosis age (<50, 50 to 59, 60 to 69, ≥70 years) and ankle brachial index (ABI): low ABI (<1.0) or elevated ABI (>1.4). Primary outcomes were cardiovascular events (CVEs; myocardial infarction or ischemic stroke) and limb events (LEs; critical limb ischemia or amputation). Competing risk analysis was performed to calculate adjusted hazard ratios. The cohort included 22,073 patients with PAD (low ABI: 77.1%; elevated ABI: 22.9%). CVEs were observed in 8.2% of patients and LEs in 15.6%. The highest CVE risk was observed in patients diagnosed with PAD before age 50 (compared with patients diagnosed after age 70; hazard ratio 2.33 [95% confidence interval 1.95 to 2.78]). CVE risk decreased with older age at diagnosis. Although younger groups demonstrated higher LE risk, there was no clear association with diagnosis age. These patterns of risk were seen both in low and elevated ABI subgroups but in greater magnitude with elevated ABI. Younger patients diagnosed with PAD face increased risk of myocardial infarction and ischemic stroke compared with patients diagnosed at an older age. CVE risk notably exceeds LE risk. In conclusion, younger age at PAD diagnosis may be an important risk factor, which warrants more aggressive interventions focused on CVE prevention.
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        • Selvin E
        • Erlinger TP.
        Prevalence of and risk factors for peripheral arterial disease in the United States: results from the National Health and Nutrition Examination Survey, 1999–2000.
        Circulation. 2004; 110: 738-743
        • Savji N
        • Rockman CB
        • Skolnick AH
        • Guo Y
        • Adelman MA
        • Riles T
        • Berger JS.
        Association Between advanced age and vascular disease in different arterial territories: a population database of Over 3.6 million subjects.
        J Am Coll Cardiol. 2013; 61: 1736-1743
        • Fowkes FGR
        • Rudan D
        • Rudan I
        • Aboyans V
        • Denenberg JO
        • McDermott MM
        • Norman PE
        • Sampson UKA
        • Williams LJ
        • Mensah GA
        • Criqui MH.
        Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis.
        Lancet. 2013; 382: 1329-1340
        • Weitz JI
        • Byrne J
        • Clagett GP
        • Farkouh ME
        • Porter JM
        • Sackett DL
        • Strandness DE
        • Taylor LM.
        Diagnosis and treatment of chronic arterial insufficiency of the lower extremities: a critical review.
        Circulation. 1996; 94: 3026-3049
        • Doraiswamy VA
        • Giri J
        Mohler 3rd E. Premature peripheral arterial disease - difficult diagnosis in very early presentation.
        Int J Angiol. 2009; 18: 45-47
        • Harris LM
        • Peer R
        • Curl GR
        • Pillai L
        • Upson J
        • Ricotta JJ.
        Long-term follow-up of patients with early atherosclerosis.
        J Vasc Surg. 1996; 23: 576-581
        • Levy PJ.
        Premature lower extremity atherosclerosis: clinical aspects.
        Am J Med Sci. 2002; 323: 11-16
        • Diehm C
        • Lange S
        • Darius H
        • Pittrow D
        • von Stritzky B
        • Tepohl G
        • Haberl RL
        • Allenberg JR
        • Dasch B
        • Trampisch HJ.
        Association of low ankle brachial index with high mortality in primary care.
        Eur Heart J. 2006; 27: 1743-1749
        • Anand SS
        • Caron F
        • Eikelboom JW
        • Bosch J
        • Dyal L
        • Aboyans V
        • Abola MT
        • Branch KRH
        • Keltai K
        • Bhatt DL
        • Verhamme P
        • Fox KAA
        • Cook-Bruns N
        • Lanius V
        • Connolly SJ
        • Yusuf S.
        Major adverse limb events and mortality in patients With peripheral artery disease: the COMPASS trial.
        J Am Coll Cardiol. 2018; 71: 2306-2315
        • Agarwal S
        • Sud K
        • Shishehbor MH.
        Nationwide trends of hospital admission and outcomes Among critical limb ischemia patients: from 2003-2011.
        J Am Coll Cardiol. 2016; 67: 1901-1913
        • Barretto S
        • Ballman KV
        • Rooke TW
        • Kullo IJ.
        Early-onset peripheral arterial occlusive disease: clinical features and determinants of disease severity and location.
        Vasc Med. 2003; 8: 95-100
        • Valentine RJ
        • MacGillivray DC
        • DeNobile JW
        • Snyder DA
        • Rich NM.
        Intermittent claudication caused by atherosclerosis in patients aged forty years and younger.
        Surgery. 1990; 107: 560-565
        • Nam SC
        • Han SH
        • Lim SH
        • Hong YS
        • Won JH
        • Bae JI
        • Jo J
        Factors affecting the validity of ankle-brachial index in the diagnosis of peripheral arterial obstructive disease.
        Angiology. 2010; 61: 392-396
        • Sutton-Tyrrell K
        • Venkitachalam L
        • Kanaya AM
        • Boudreau R
        • Harris T
        • Thompson T
        • Mackey RH
        • Visser M
        • Vaidean GD
        • Newman AB.
        Relationship of ankle blood pressures to cardiovascular events in older adults.
        Stroke. 2008; 39: 863-869
        • Resnick HE
        • Lindsay RS
        • McDermott MM
        • Devereux RB
        • Jones KL
        • Fabsitz RR
        • Howard BV.
        Relationship of high and low ankle brachial index to all-cause and cardiovascular disease mortality: the Strong Heart Study.
        Circulation. 2004; 109: 733-739
        • Arain FA
        • Ye Z
        • Bailey KR
        • Chen Q
        • Liu G
        • Leibson CL
        • Kullo IJ.
        Survival in patients with poorly compressible leg arteries.
        J Am Coll Cardiol. 2012; 59: 400-407