Abstract 3009: Self-Reported Peripheral Arterial Disease Predicts Future Vascular Events in the Northern Manhattan Study
Background and Objective: Lower extremity peripheral arterial disease (PAD) is prevalent and strongly associated with cardiovascular morbidity and mortality. The ankle-brachial index, considered the most effective test for the detection of PAD, is not routinely performed for screening in the primary care setting. We sought to determine if self-reported PAD (srPAD) is an independent predictor of combined vascular events (myocardial infarction, ischemic stroke, or vascular death).
Methods: Subjects from the population-based Northern Manhattan Study (NOMAS) prospective cohort were analyzed. Those with either claudication symptoms or a self-reported prior history of PAD were classified as having srPAD. Claudication was defined as exercise-induced pain in the back of the legs relieved by rest. The Cox proportional hazard model was used to determine the association between srPAD and the incidence of combined vascular events.
Results: Among 3290 participants (mean age 69.1±10 years; 62.9% women; 52.4% Hispanic; 24.4% African-American; 20.9% Caucasian), the prevalence of srPAD was 15.5%, with no significant difference by race-ethnicity. After a mean follow-up of 5.5 years, 434 combined vascular events were detected (mean average annual risk of 2.4%), including 124 myocardial infarctions, 142 ischemic strokes, and 168 vascular deaths. Self-reported PAD was significantly predictive of combined events after adjustment for age, gender, race-ethnicity, diabetes, hypertension, hyperlipidemia, smoking, and education level. (HR 1.4, 95% CI, 1.1–1.8).
Conclusion: Self-reported PAD is independently associated with future vascular events in this predominantly non-white cohort. Self-reported PAD may not accurately reflect the presence of true PAD. However, it is an under-recognized risk factor for future vascular events and could serve as an effective first step in identifying high risk patients who would benefit from further vascular evaluation and aggressive risk factor modification.