temporal changes in characteristics of patients with ... presentations/nayak.pdf · temporal...
TRANSCRIPT
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.
Disclosure•Funded by NHLBI
• I have no actual or potential conflict of interest to this presentation
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
Specific AimsTo determine temporal trends in clinical characteristics of people with peripheral artery disease from 1998-2012.
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
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
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
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
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%
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%
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%
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
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
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
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
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
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
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
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
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
Thank You!