Abnormal vascular physiology in the lower extremities as a risk factor for ischemic stroke and mortality.
ankle brachial index
ischemic stroke
mortality
peripheral artery disease
poorly compressible arteries
Journal
Journal of osteopathic medicine
ISSN: 2702-3648
Titre abrégé: J Osteopath Med
Pays: Germany
ID NLM: 101776472
Informations de publication
Date de publication:
11 03 2021
11 03 2021
Historique:
received:
09
11
2020
accepted:
22
12
2020
pubmed:
11
3
2021
medline:
31
8
2021
entrez:
10
3
2021
Statut:
epublish
Résumé
Peripheral artery disease (PAD) is highly prevalent in the general population, affecting up to 25% of patients 55 years of age or older. There is a known association with acute ischemic stroke, but limited large cohort studies exist pertaining to the relationship between PAD severity and incident ischemic stroke. To evaluate the risk of incident ischemic stroke and mortality along the spectrum of low and elevated ankle brachial index (ABI) measurement. We performed a retrospective extraction of ABI data of all adult patients who underwent lower extremity physiology study for any indication from January 1, 1996 to June 30, 2018 in the Mayo Clinic health system. PAD was categorized into severe, moderate, mild, and borderline based on ABI measurements and poorly compressible arteries (PCA). These were compared with normal ABI measurements. Associations of PAD/PCA with new ischemic stroke events and all cause mortality were analyzed. Hazard ratios (HR) were calculated using multivariable Cox proportional regression with 95% confidence intervals. A total of 39,834 unique patients were included with a median follow up duration of 4.59 years. All abnormal ABI groups, except borderline PAD, were associated with increased risk of incident ischemic stroke after multivariate regression compared to normal ABI. A severity-dependent association was observed between PAD and ischemic stroke with moderate (HR, 1.22 [95% CI, 1.10-1.35]) and severe (HR, 1.19 [95% CI, 1.02-1.40]) categories conferring similar risk in comparison to normal ABI. Patients with PCA carried the greatest ischemic stroke risk (HR, 1.30 [95% CI, 1.15-1.46]). Similarly, abnormal ABI groups were associated with a significant risk for all cause mortality in a severity-dependent manner, with severe PAD conferring the greatest risk (HR, 3.07 [95% CI, 2.88-3.27]). This study adds to the growing body of evidence that both PAD and PCA are independent risk factors for incident ischemic stroke and all cause mortality. The association of PAD severity and PCA with risk of ischemic stroke may help clinicians with risk stratification and determining treatment intensity.
Identifiants
pubmed: 33691353
pii: jom-2020-0290
doi: 10.1515/jom-2020-0290
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
463-470Informations de copyright
© 2021 Shubhang K. Bhatt et al., published by De Gruyter, Berlin/Boston.
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