Smoking, Type 2 diabetes, hypertension, and hypercholesterolemia are significantly associated with the risk for clinically significant peripheral artery disease (PAD) in men, with each additional factor doubling the risk, conclude US and Dutch researchers.
"All of the 4 risk factors appeared to confer increased risk within short periods following recognition and, in the case of smoking, associated risk remained elevated even 20 years after cessation," observes Michel Joosten, from Harvard Medical School, in Boston, Massachusetts, USA, and colleagues.
"At the same time, the joint effect of multiple risk factors combined was independent and graded, with no evidence that these risk factors became less important among those already at high risk."
The team examined data from the prospective Health Professionals Follow-up Study of US male healthcare professionals aged 40 to 75 years at baseline in 1986. Information was available for 44,985 participants without cardiovascular disease at baseline, yielding 961,333 person-years of follow up over a median of 24.2 years.
The results, published in the Journal of the American Medical Association, reveal that the age-adjusted incidence of PAD per 100,000 person‑years was 33 cases for ever smoking, 43 for hypertension, 21 for hypercholesterolemia, and 67 for diabetes.
Furthermore, the age-adjusted incidence rate of PAD per 100,000 person-years was nine cases for no risk factors, 23 for one risk factor, 47 for two risk factors, 92 for three risk factors, and 186 for four risk factors. The absolute and age-adjusted incidence of PAD for men with all four risk factors was 3.5 per 1000 person-years and 1.9 per 1000 person-years, respectively.
The multivariable-adjusted hazard ratio (HR) for each additional risk factor was 2.06 compared with having no risk factors, while men who had no risk factors had a HR for PAD of 0.23 compared with other men.
Current smoking was associated with a substantially increased risk for PAD compared with never smoking, at a HR of 12.89, and duration of smoking was also significantly associated with PAD. Even men who had quit smoking over 20 years ago had an increased risk for PAD compared with never smokers, at a HR of 1.39.
The population attributable risk associated with the four risk factors was 75%. In 96% of cases, at least one of the four risk factors was present at diagnosis.
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