A 15-fold increase in rates of mortality due to cardiovascular disease and coronary heart disease among subjects with large-vessel peripheral arterial disease !!! do you believe?

Peripheral arterial disease (PAD) is a widespread vascular disorder that has been addressed for over a century and continues to affect a large portion of the modernized world. Both symptomatic and asymptomatic PAD affects 4.3% of the U.S. population aged ≥40 years of age1 and is recognized as a chronic atherosclerotic progression of lower-extremity arterial obstruction, which eventually leads to limb-threatening ischemia. PAD is functionally defined as an occlusive disease that generates a resting ankle–brachial index (ABI) of ≤0.90,2 although an ABI of between 0.9 and 1 is considered borderline and may introduce diagnostic subjectivity. PAD is strongly associated with terminal coronary artery disease for patients both with and without a significant cardiovascular history.3 As defined by a history of cardiovascular events or interventions (abdominal aortic aneurysms, transient ischemic attacks, stroke, carotid endarterectomy, history of angina, myocardial infarction, coronary angioplasty, and/or coronary artery bypass graft surgery), general cardiovascular disease has been associated with 70% of patients with PAD, rendering its diagnosis a significant indication for pan-vascular risk.4 Thus, the timely detection of PAD permits treatment of the diseased limb and preemptive management of cardiovascular risks.5 Preliminary PAD screenings have evolved into routine, noninvasive vascular laboratory studies, which reduce the risks, time, and costs associated with angiography. 

In a 10 years followup study published in Annals of vascular surgery in 1992 it was found that  - Twenty-one of the 34 men (61.8 percent) and 11 of the 33 women (33.3 percent) with large-vessel peripheral arterial disease died during follow-up, as compared with 31 of the 183 men (16.9 percent) and 26 of the 225 women (11.6 percent) without evidence of peripheral arterial disease. After multivariate adjustment for age, sex, and other risk factors for cardiovascular disease, the relative risk of dying among subjects with large-vessel peripheral arterial disease as compared with those with no evidence of such disease was 3.1 (95 percent confidence interval, 1.9 to 4.9) for deaths from all causes, 5.9 (95 percent confidence interval, 3.0 to 11.4) for all deaths from cardiovascular disease, and 6.6 (95 percent confidence interval, 2.9 to 14.9) for deaths from coronary heart disease. The relative risk of death from causes other than cardiovascular disease was not significantly increased among the subjects with large-vessel peripheral arterial disease. After the exclusion of subjects who had a history of cardiovascular disease at base line, the relative risks among those with large-vessel peripheral arterial disease remained significantly elevated. Additional analyses revealed a 15-fold increase in rates of mortality due to cardiovascular disease and coronary heart disease among subjects with large-vessel peripheral arterial disease that was both severe and symptomatic.

1. 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
2. Norgren L, Hiatt WR, Dormandy JA, et al. Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). J Vasc Surg. 2007;45(Suppl. S):S5–67
3. Criqui MH, Langer RD, Fronek A, et al. Mortality over a period of 10 years in patients with peripheral arterial disease. N Engl J Med. 1992;326:381–386
4. Hirsch AT, Criqui MH, Treat-Jacobson D, et al. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA. 2001;286:1317–1324
5. Verhaeghe R. Prophylactic antiplatelet therapy in peripheral arterial disease. Drugs. 1991;42((Suppl. 5)):51–57