Smoking, hypertension, hypercholesterolemia and type 2 diabetes accounted for the majority of risk associated with men developing peripheral arterial disease (PAD), a study found.
Researchers conducted a prospective study of nearly 45,000 men without a history of cardiovascular disease in 1986 from the Health Professionals Follow-up Study and followed them until January 2011 to unravel how these factors and combinations of factors influenced who developed PAD.
Results appeared in the Oct. 24/31 issue of the Journal of the American Medical Association.
During a median follow-up of nearly 25 years, there were 537 cases of PAD. Age-adjusted incidence rates were:
--No risk factors: 9 (95% confidence interval [CI], 6 to 14) cases/100,000 person-years (n=19),
--One risk factor: 23 (95% CI, 18 to 28) cases/100,000 person-years (n=99),
--Two risk factors: 47 (95% CI, 39 to 56) cases/100,000 person-years (n=176),
--Three risk factors: 92 (95% CI, 76 to 111) cases/100,000 person-years (n=180), and
--Four risk factors: 186 (95% CI, 141 to 246) cases/100,000 person-years (n=63).
Men without any risk factors had a hazard ratio of PAD of 0.23 (95% CI, 0.14 to 0.36) compared with all other men in the cohort. The multivariable-adjusted hazard ratio for each additional risk factor was 2.06 (95% CI, 1.88 to 2.26).
At least one of the four risk factors was present in 96% of PAD cases at diagnosis (95% CI, 94% to 98%). The absolute incidence of PAD among men with all four risk factors was 3.5/1,000 person-years.
"We found a somewhat lower increase in risk of PAD associated with hypercholesterolemia compared with the other 3 risk factors," the researchers wrote. "This may reflect the importance of effective treatment for hypercholesterolemia. While treatment for hypertension does not appear to fully reduce its associated risk for CHD, statin therapy treats hypercholesterolemia extremely effectively, essentially eliminating its associated risk."