Microvascular disease elevates risk for amputation
Regardless of where it resided in the body and whether it was concomitant with peripheral artery disease, microvascular disease was associated with elevated risk for amputation, researchers reported.
“This study advances the idea that microvascular disease is a system-wide disorder rather than only affecting one part of the body,” Joshua A. Beckman, MD, professor of medicine and director of vascular medicine at Vanderbilt University Medical Center, said in a press release. “PAD (in the legs) has long been considered a sign that a patient likely also has narrowed arteries leading to the heart or brain. If a patient has PAD, they have a higher risk of other cardiovascular diseases, such as heart attacks and strokes. Our study suggests that microvascular disease in any part of the body, such as the eyes, kidneys or feet, may be linked to decreased blood vessel function in other parts of the body, putting patients at risk for potential lower-limb amputations.”
Beckman and colleagues analyzed 125,674 participants from the Veterans Aging Cohort Study to determine the effect of prevalent microvascular disease — including retinopathy, neuropathy and nephropathy — and PAD on amputation.
During median follow-up of 9.3 years, the rate of incident amputation was 1.16 per 1,000 patient-years, according to the researchers.
After adjustment for demographics and CV risk factors, compared with those without microvascular disease or PAD, those with microvascular disease had elevated risk for amputation (HR = 3.7; 95% CI, 3-4.6), as did those with PAD (HR = 13.9; 95% CI, 11.3-17.1) and those with both microvascular disease and PAD (HR = 22.7; 95% CI. 18.3-28.1).
“Patients with both microvascular disease and PAD have the highest risk of lower-limb amputation and need maximal medical therapies to reduce their risk,” Beckman said in the release. – by Erik Swain
Disclosure s : Beckman reports he consults for Amgen, Antidote Pharmaceutical, AstraZeneca, Boehringer Ingelheim, Bristol-Myers Squibb, Merck and Sanofi, and serves on the data safety monitoring committee for Bayer and Novartis. The other authors report no relevant financial disclosures.