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Associations Between Conventional Cardiovascular Risk Factors and Risk of Peripheral Artery Disease in Men


Previous studies have examined the associations of individual clinical risk factors with risk of peripheral artery disease (PAD), but the combined effects of these risk factors are largely unknown. As a result, a study published in the Journal of the American Medical Association (2012;308:1660-1667) was performed to estimate the degree to which the 4 conventional cardiovascular risk factors of smoking, hypertension, hypercholesterolemia, and type 2 diabetes are associated with the risk of PAD among men.


The investigation was a prospective study of 44,985 men in the US without a history of cardiovascular disease at baseline in 1986. These participants in the Health Professionals Follow-up Study were followed up for 25 years until January 2011. The presence of risk factors was updated biennially during follow-up.


The main outcome measure was clinically significant PAD defined as limb amputation or revascularization, angiogram reporting vascular obstruction of 50% or greater, ankle-brachial index of less than 0.90, or physician-diagnosed PAD.


Results showed that during a median follow-up of 24.2 years, there were 537 cases of incident PAD. Each risk factor was significantly and independently associated with a higher risk of PAD after adjustment for the other 3 risk factors and confounders. The age-adjusted incidence rates were:

  1. 9 for 0 risk factors
  2. 23 for 1 risk factor
  3. 47 for 2 risk factors
  4. 92 for 3 risk factors, and
  5. 186 for 4 risk factors.


According to the authors, among men in this cohort, smoking, hypertension, hypercholesterolemia, and type 2 diabetes account for the majority of risk associated with development of clinically significant PAD.


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