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      Polyvascular disease, pulse pressure and mortality : The Ludwigshafen Risk and Cardiovascular Health (LURIC) study

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          Abstract

          Summary: Background: Peripheral arterial disease (PAD), coronary artery disease (CAD) and carotid stenosis (CS) are robust predictors of mortality. The value of individual vascular beds in polyvascular disease (PVD) to predict mortality in patients with atherosclerotic burden is not clear. Therefore, we have examined the predictive value of PAD, CAD and CS in patients at intermediate to high risk of cardiovascular (CV) disease. Patients and methods: In our retrospective observational study we analyzed baseline data from the Ludwigshafen Risk and Cardiovascular Health (LURIC) study, a monocentric cohort study of 3316 patients referred to coronary angiography. Results: As the number of atherosclerotic vascular beds increased, the hazard ratios (HRs) for both all-cause mortality and CV mortality significantly increased in a multivariate analysis after adjusting for age, sex, body mass index, diabetes mellitus and estimated glomerular filtration rate, with HRs of 1.36 (95%CI: 1.11–1.68), 2.56 (95%CI: 2.01–3.26), 2.84 (95%CI: 1.93–4.17) and 1.56 (95%CI: 1.19–2.06), 2.70 (95%CI: 1.97–3.72), 3.50 (95%CI: 2.19–5.62), respectively. The combination of PAD with either CAD or CS was associated with higher HRs for all-cause (HR 2.81 and 7.53, respectively) and CV (HRs 2.80 and 6.03, respectively) mortality compared with the combination of CAD and CS (HRs 1.94 and 2.43, respectively). The presence of PVD was associated with higher age, systolic blood pressure, pulse pressure (PP; a marker of vascular stiffness), former smoking and inversely with lower eGFR. Conclusions: We show that as the number of atherosclerotic vascular beds increases, all-cause and CV mortality rates increase in parallel. Simultaneous prevalence of PAD is associated with significantly higher all-cause and CV mortality rates compared with CS coexistence. Furthermore, increasing atherosclerotic load may contribute to vascular stiffness and impaired renal function.

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          Most cited references21

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          ESVM Guideline on peripheral arterial disease

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            2019 ESC/EAS Guidelines for the management of dyslipidaemias: Lipid modification to reduce cardiovascular risk

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              2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS)

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                Author and article information

                Contributors
                Journal
                vas
                VASA
                European Journal of Vascular Medicine
                Hogrefe AG, Bern
                0301-1526
                1664-2872
                May 23, 2022
                Affiliations
                [ 1 ]Fifth Department of Medicine, Faculty of Medicine of the University of Heidelberg, University Medical Center Mannheim UMM, Mannheim, Germany
                [ 2 ]SYNLAB MVZ Humangenetik Mannheim, Germany
                [ 3 ]First Department of Medicine, Faculty of Medicine of the University of Heidelberg, University Medical Center Mannheim UMM, Mannheim, Germany
                [ 4 ]Center for Preventive Medicine and Digital Health Baden-Württemberg (CPDBW), Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
                [ 5 ]Department of Internal Medicine II, University Hospital Giessen and Marburg, Justus-Liebig-University Giessen, Germany
                [ 6 ]Clinical Institute of Medical and Chemical Laboratory Diagnostics, Medical University of Graz, Austria
                [ 7 ]Synlab Academy, SYNLAB Holding Deutschland GmbH, Mannheim and Augsburg, Germany
                [ 8 ]Division of Vascular Surgery, Department of Surgery, Faculty of Medicine of the University of Heidelberg, University Medical Center Mannheim UMM, Mannheim, Germany
                [ 9 ]European Center for Angioscience ECAS, Faculty of Medicine of the University of Heidelberg, Mannheim, Germany
                [ a ]The authors contributed equally as senior authors.
                Author notes
                Dr. Babak Yazdani, University Medical Center Mannheim UMM, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany babak.yazdani@ 123456umm.de
                Author information
                https://orcid.org/0000-0001-9222-8958
                https://orcid.org/0000-0001-6162-6304
                Article
                vas_a001011_-1_1
                10.1024/0301-1526/a001011
                c4c45b27-563a-4e03-ba3f-66b0e3bcfd6f
                Copyright @ 2022
                History
                : November 21, 2021
                : May 4, 2022
                Funding
                Funding The work of G.E.D. was supported by the European Union’s Horizon 2020 research and innovation programme under ERA-Net Cofund action N o 727565 (OCTOPUS project) and the German Ministry of Education and Research (grant number 01EA1801A). The funding sources were not involved in the study design; collection, analysis and interpretation of data; writing of the report; or the decision to submit the article for publication.
                Categories
                Original communication

                Medicine
                Atherosclerotic burden,pulse pressure,cardiovascular mortality,coronary artery disease,carotid stenosis,lower extremity peripheral artery disease,polyvascular disease

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