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Table 9. PAD-Related Risk Amplifiers
Risk Factor Epidemiology
Data Supporting Amplified Risk
(MACE, MALE, or Both)
Polyvascular
disease
• Atherosclerosis
within ≥2
arterial beds:
coronary,
peripheral
artery, or
cerebrovascular
Up to 45%
of patients
with known
atherosclerotic
disease or
atherosclerotic
risk factors have
polyvascular
disease.
Among 879
patients with
PAD undergoing
lower extremity
angiography
before
revascularization,
52% had
underlying
CAD (abnormal
coronary
angiography or
stress test).
Patients with PAD and CAD had a higher risk of
all-cause death over 5 y (adjusted HR, 1.35 [95%
CI, 1.02–1.80]) compared with those with only
CAD.
In the EUCLID trial of 13,885 patients with
PAD, despite treatment with antiplatelet therapy,
MI occurred in 4.9% of the study participants
over a median follow-up of 30 mo.
In adults >60 y of age with a first ischemic stroke,
symptomatic PAD was independently associated
with increased risk of vascular events (HR, 2.76
[95% CI, 1.10–6.95]).
Polyvascular disease and diabetes have the
highest cardiovascular event rate (60%), with a
stepwise increase in MACE with each additional
atherosclerotic arterial bed, from 1.47 to 2.33 to
3.12 (trend, P=0.0001).
Higher rates of lower extremity revascularization,
but not ALI or major amputation, were seen with
polyvascular disease in the EUCLID trial.
e risk of MALE was reduced in patients with
polyvascular disease treated with aspirin and
rivaroxaban in stable, chronic PAD (COMPASS
trial) or aer lower extremity revascularization
(VOYAGER PAD trial).
Depression A diagnosis of
depression (ICD-
9) was identified
in 16% of patients
with PAD in a VA
population.
14.1% of patients
with PAD are
seen at specialty
clinics with
symptoms of
depression
(PHQ-8). Self-
perceived stress
(28.7%) and
anxiety (8.3%) are
also prevalent.
A Geriatric Depression Score ≥6 was associated
with increased MACE during longitudinal
follow-up (mean 2.7 y) in an observational study
that included 951 patients with PAD.
In a VA population, a comorbid diagnosis of
depression (ICD codes) among patients with
PAD was associated with a 13% higher rate of
amputation and a 17% higher mortality at a
median of 5.9 y follow-up.
A comorbid diagnosis of depression is associated
with a longer length of stay and higher rate of
30-d readmission among patients undergoing
major open vascular surgery or peripheral
endovascular procedures for PAD.
(cont'd)
