ABSTRACT
BACKGROUND AND PURPOSE: Asymptomatic peripheral arterial disease (PAD) is very common in the elderly and can be detected in 15-20% of patients above 55 years. The aim of this study was to determine PAD prevalence and risk factors within the population of the overall INVADE project (INtervention project of cerebroVAscular diseases and Dementia in the District of Ebersberg [Bavaria]), a prospective non-randomized analysis. PATIENTS AND METHODS: A total of 3,909 participants were included in the INVADE project. An ankle-brachial index (ABI) measurement was available in 3 891 subjects. An additional 40 patients were excluded because their ABI was >1,5. The analysis was thus based on 3,851 participants. The mean age was 70.1 years (95% confidence interval: 69,8 - 70,3). There were 2 285 (59.3%) women. The changes of the different classical vascular and risk factors as well as various laboratory parameters, including high sensitivity C-reactive protein (hs-CRP) were recorded and analysed by the paired t-test or the Fisher's exact test. Independent predictors were calculated by multiple logistic regression analysis. RESULTS: The prevalence of PDA was 18.6%. In 75% of the PAD patients the diagnosis had been unknown before study onset. Those with PAD were significant younger (69.6 vs. 72.2 years; p<0.0001), had significant lower hsCRP values (3,8 mg/l vs. 4.9 mg/l; p=0.002) and a lower vascular risk profile. After two years of intervention an improvement of vascular risk factors and reduction in necessary treatment, such as antihypertensives and platelet inhibitors, was documented. Independent risk factors for PAD development, in addition to the baseline ABI, were age, years of smoking (packs per day) and hsCRP. CONCLUSION: The INVADE project confirms the high prevalence of PAD in an elderly population. These data underline the importance of measuring hsCRP for diagnosing and following PAD development.
Subject(s)
Peripheral Vascular Diseases/epidemiology , Age Factors , Aged , Antihypertensive Agents/therapeutic use , C-Reactive Protein/analysis , Cohort Studies , Female , Germany/epidemiology , Humans , Logistic Models , Male , Peripheral Vascular Diseases/diagnosis , Peripheral Vascular Diseases/drug therapy , Platelet Aggregation Inhibitors/therapeutic use , Prevalence , Prospective Studies , Risk Factors , Smoking/adverse effectsABSTRACT
BACKGROUND: The so-called INVADE project examines the efficacy of consistent diagnosis and treatment of cerebrovascular risk factors on the incidence of stroke. METHODS: This analysis compares known cardiovascular risk factors (elevated blood pressure, dipositas, hyperlipidemia, diabetes mellitus, and smoking) and respective medication of 2930 patients with respect to cerebrovascular disease, peripheral arterial disease (PAD), and coronary heart disease (CHD) between baseline and follow-up examination after 2 years of intervention. RESULTS: Using the ankle-brachial index (ABI), 381 patients (13%) with asymptomatic PAD were identified. Comparison between baseline and follow-up examination revealed significant reductions in the following risk factors. Cerebrovascular disease: elevated blood pressure -12.8%, dipositas -4.2%, and LDL -8.1%. For PAD the results were: elevated blood pressure -7.2%, smoking -1.2%, elevated cholesterol -6.4%, dipositas -3.2%, and LDL -7.4%. For CHD the results were: elevated blood pressure -11.3%, elevated cholesterol -13.0%, and LDL -14.9%. CONCLUSION: By the use of ABI, previously undiagnosed asymptomatic PAD was identified in 13% of all patients. Two-year intervention on the primary care level yielded significant reduction of known vascular risk factors.
Subject(s)
Coronary Disease/epidemiology , Coronary Disease/prevention & control , Peripheral Vascular Diseases/epidemiology , Peripheral Vascular Diseases/prevention & control , Risk Assessment/methods , Stroke/epidemiology , Stroke/prevention & control , Comorbidity , Female , Germany/epidemiology , Humans , Incidence , Male , Physical Examination/methods , Primary Health Care/methods , Primary Prevention/statistics & numerical data , Risk Factors , Treatment OutcomeABSTRACT
BACKGROUND: The INVADE project (Intervention project of cerebrovascular diseases and dementia in the district of Ebersberg) analyzes the effect of risk factor evaluation and modification on the incidence of stroke and dementia. Here we evaluated the changes of risk factors after two years in the INVADE population, particularly in participants with diabetes mellitus and coronary heart disease (CHD). PATIENTS AND METHODS: Baseline data of 3909 participants were available. In addition to common risk factors and new risk indicators, various social demographic data and life style parameters were analyzed. A guideline-based therapy was proposed for each participant based on an individual risk profile. The differences between baseline and the 2-year follow-up data were analyzed using the paired t-test and the McNemar test. RESULTS: Complete follow-up data were available in 3185 participants (1288 men; mean age 69.5 years). For the overall project population the reduction of traditional risk factors was effective, particularly in subjects with hypertension or diabetes. The prevalence of hypertension was 76 %, including 19 % newly diagnosed subjects. In this subgroup, the systolic blood pressure could be reduced by 4.7 mmHg. 20.3 % of the participants showed a diabetes mellitus, blood glucose level decreased about 8 %. Additionally an improvement in hypertension therapy and lipid levels was seen. Comparable results were achieved in the CHD subgroup. Additionally, in the overall study population treatment with antihypertensives and statins increased significantly. DISCUSSION: Even after two years, the INVADE project was able to reduce vascular risk factors particularly in high risk patients with diabetes and CHD. Based on these findings, the primary aim of the project, the reduction of stroke and dementia incidence, can be achieved.
