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Temporal Changes in Characteristics of Patients with Peripheral Artery Disease Relevant to Treating PAD Related Functional Impairment
Pooja Nayak BA, Jack M. Guralnik MD, PhD, Tamar S. Polonsky MD, Melina R Kibbe MD, Lu Tian ScD, Lihui Zhao PhD, Michael H. Criqui MD, MPH, Luigi Ferrucci MD, PhD, Lingyu Li, Mary M. McDermott, MD.
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Disclosure•Funded by NHLBI
• I have no actual or potential conflict of interest to this presentation
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Background•Peripheral Artery Disease (PAD) is common
•PAD will become more prevalent as the population ages
• Increased prevalence of diabetes and obesity in the United States and Worldwide
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Specific AimsTo determine temporal trends in clinical characteristics of people with peripheral artery disease from 1998-2012.
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WALCS I Study WALCS II Study
WALCS III Study BRAVO Study
October 1998-September 2000 N=419
October 2002-September 2004 N=242
October 2006-September 2008 N=100
October 2008-September 2010 N=291
October 2010-September 2012 N=172
Methods
N=1224
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Inclusion/Exclusion Criteria•Consistent inclusion/exclusion criteria across all studies •Ankle-Brachial Index <0.90 at baseline and age ≥ 55 years •Exclusion Criteria: •Dementia
•Wheelchair-bound
•Foot or leg amputations
•Non-English Speaking
•Major surgery in the past 3 months
•Oxygen with ambulation
•Severe knee osteoarthritis
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Identification of Baseline Characteristics•Patient self-report confirmed by PCP questionnaire and medical record review •BMI, diabetes, smoking history, myocardial infarction, angina, heart failure, stroke, cancer, knee arthritis, hip arthritis, leg symptoms, walking exercise, mobility
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ResultsTemporal Trends in Age, Sex, ABI from 1998-2012 in People with PAD.
1998 -2000 2002 –2004
2006 –2008
2008 –2010
2010 –2012
Trend P*
Number of participants
419 242 100 291 172 NA
Age (years) 72.9 (7.5) 74.4 (8.1) 72.0 (7.9) 70.9 (7.7) 69.6 (7.4) <.001
Female sex, N (%) 172 (41.1) 117 (48.3) 42 (42.0) 108 (37.1) 65 (37.8) 0.17
Ankle Brachial Index
0.65 (0.15) 0.65 (0.16) 0.64 (0.15) 0.64 (0.15) 0.65 (0.14) 0.71
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Trends in the Proportion of African Americans among People with PAD from 1998-2012
Perc
ent
0
12.5
25
37.5
50
1998-2000 2002-2004 2006-2008 2008-2010 2010-2012
p-trend <0.00116.2%
45.3%
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Trends in the Proportion of People with PAD with Body Mass Index (BMI) >25 and > 30 from 1998-2012
Perc
ent
0
20
40
60
80
1998-2000 2002-2004 2006-2008 2008-2010 2010-2012
BMI >25 kg/M2: p-trend <0.001
BMI >30 kg/M2: p-trend <0.001
66.1%
78.5%
23.6%
43.0%
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Trends in the Proportion of Diabetics among People with PAD from 1998-2012Pe
rcen
t
0
11.5
23
34.5
46
1998-2000 2002-2004 2006-2008 2008-2010 2010-2012
29.8% P-trend <0.001
40.7%
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Temporal Trends in Walking Exercise > 3 Times per Week in People with PAD from 1998-2012
Perc
ent
0
9
18
27
36
1998-2000 2002-2004 2006-2008 2008-2010 2010-2012
34.4%
23.3%P-trend=0.025
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Temporal Trends in the Number of Blocks Walked by People with PAD in the Last Week from 1998-2012
Num
ber
of B
lock
s W
alke
d
0
8.5
17
25.5
34
1998-2000 2002-2004 2006-2008 2008-2010 2010-2012
32.2
19.1P-trend <0.001
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Temporal Trends in Mobility Impairment from 1998-2012 in People with PADPe
rcen
t
0
7.5
15
22.5
30
1998-2000 2002-2004 2006-2008 2008-2010 2010-2012
17.9%
23.3%
P-trend=0.019
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Trends in the Proportion of People with PAD Experiencing Intermittent Claudication Versus Other or No Exertional Leg Symptoms from 1998-2012
10/1998 – 09/2000
10/2002 – 09/2004
10/2006 – 09/2008
10/2008 – 09/2010
10/2010 – 09/2012
Trend P*
Number of participants
419 242 100 291 172 NA
Intermittent claudication, N (%)
131 (31.3) 55 (22.8) 30 (30.0) 59 (20.3) 27 (15.7) <.001
Exertional leg symptoms other than classic claudication, N (%)
200 (47.7) 126 (52.3) 49 (49.0) 178 (61.2) 99 (57.6) 0.001
No exertional leg symptoms N (%)
88 (21.0) 60 (24.9) 21 (21.0) 54 (18.6) 46 (26.7) 0.79
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Summary of Trends• Increase in proportion of African American participants • Increase in mean BMI and diabetes •Decrease in physical activity with increase in mobility loss •Decline in classic symptoms of intermittent claudication
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Sensitivity Analyses•Excluding Veterans Administration participants: results not substantially changed
•Excluding for African American participants •Results not substantially changed
•No significant change over time:
•Proportion reporting exertional symptoms other than claudication
•Proportion reporting walking regularly for exercise
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Clinical Significance•Increased prevalence of obesity: • Greater functional impairment and rates of functional decline
•Increased prevalence of diabetes: •Multi-focal and distal atherosclerotic disease
•Less amenable to lower extremity revascularization
•Lower rates of walking exercise and greater mobility impairment •Higher prevalence of atypical leg symptoms: •More difficult to diagnose PAD patients
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Limitations•Results may not be generalizable to: •Patients outside Chicago
•Patients with undiagnosed PAD
•Most recent data in 2012 •Findings may be due to differences in patient mix
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Conclusions•Proportion of PAD patients with diabetes, obesity, and atypical leg symptoms increased •Mean physical activity decreased •Need interventions that increase activity and weight loss
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Thank You!