A1 Refereed original research article in a scientific journal
Sex-Specific Risks of Major Cardiovascular and Limb Events in Patients With Symptomatic Peripheral Artery Disease
Authors: Axel Haine, Sarah Kavanagh, Jeffrey S. Berger, Connie N. Hess, Lars Norgren, F. Gerry R. Fowkes, Brian G. Katona, Kenneth W. Mahaffey, Juuso I. Blomster, Manesh R. Patel, W. Schuyler Jones, Frank W. Rockhold, William R. Hiatt, Iris Baumgartner; International Steering Commitee and Investigators of the EUCLID Trial
Publisher: ELSEVIER SCIENCE INC
Publication year: 2020
Journal: Journal of the American College of Cardiology
Journal name in source: JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Journal acronym: J AM COLL CARDIOL
Volume: 75
Issue: 6
First page : 608
Last page: 617
Number of pages: 10
ISSN: 0735-1097
eISSN: 1558-3597
DOI: https://doi.org/10.1016/j.jacc.2019.11.057(external)
Web address : https://www.sciencedirect.com/science/article/pii/S0735109719387303?via%3Dihub(external)
BACKGROUND Patients with peripheral artery disease (PAD) have a higher risk of major adverse cardiovascular events (MACE) compared with those without PAD.OBJECTIVES The aim of this post hoc analysis was to evaluate sex-specific differences in MACE and limb events in the EUCLID (Examining Use of Ticagrelor in PAD) trial.METHODS Cox proportional hazards models were used to compare time-to-event outcomes stratified by sex. Covariates were introduced after adjusted model selection.RESULTS EUCLID enrolled 13,885 patients with PAD (28% women [n = 3,888]). PAD severity and medical treatment were comparable between sexes, whereas prior tower extremity revascularization was reported less frequently in women (54.8% vs. 57.3%; p = 0.006). Women were older (mean +/- SD age: 67.8 +/- 8.9 vs. 66.1 +/- 8.2 years; p < 0.001) and more likely to have diabetes mellitus (p = 0.004), hypertension, hyperlipidemia, and chronic kidney disease (all p < 0.001). Over a mean follow-up of 30 months, women had a lower risk of MACE (9.5% vs. 11.2%; adjusted hazard ratio: 0.77; 95% confidence interval: 0.68 to 0.88; p < 0.001) and all-cause-mortality (7.6% vs. 9.7%; adjusted hazard ratio: 0.61; 95% confidence interval: 0.53 to 0.71; p < 0.001). In contrast, risk for major adverse limb events (2.6% vs. 3.0%) and hospitalization for acute limb ischemia (1.6% vs. 1.7%) were not different by sex.CONCLUSIONS Although women with PAD are at tower risk for MACE and all-cause mortality, risk for limb events was similar between sexes over a mean follow-up of 30 months. Understanding sex-specific differences and dissociation between baseline cardiovascular risk and subsequent cardiovascular events requires further investigation. (A Study Comparing Cardiovascular Effects of Ticagrelor and Clopidogrel in Patients With Peripheral Artery Disease [EUCLID]; NCT01732821)
