ATLANTA — Asking patients two brief questions about self-reported peripheral artery disease, as a supplement to the standard Framingham cardiovascular risk assessment, results in reclassification of a substantial proportion of patients as being at high rather than intermediate risk, Dr. Maya J. Salameh reported at the annual meeting of the American College of Cardiology.
The two yes/no questions are: Do you get pain in the back of your legs when you walk? Have you been told you have vascular disease in the legs?
Participants in the Northern Manhattan Study who answered yes to one or both questions went on to have a higher incidence of major vascular events, compared with patients in the same Framingham risk score category who answered in the negative, said Dr. Salameh of Columbia University, New York.
Among 3,083 participants with no baseline history of major vascular events, the prevalence of self-reported peripheral artery disease (PAD) as defined by an affirmative answer to one or both of the questions on the intake questionnaire was 15%.
During a mean follow-up of 5.5 years, there were 397 major vascular events, defined as MI, ischemic stroke, or vascular death. Among individuals with a low Framingham risk score, meaning their calculated 10-year risk of a cardiovascular event was less than 10%, the actual 5-year cumulative rate of major vascular events was 4.1% in participants without self-reported PAD and a nearly identical 4.2% in those with self-reported PAD.
But 5-year vascular event rates were higher in those individuals with an intermediate Framingham risk score who had self-reported PAD than in those who didn't (11.7% vs. 8.7%). And the disparity in event rates between those with and without self-reported PAD was even greater in those in the high-risk Framingham category (29.1% vs. 17.1%), which is reserved for those whose Framingham score places them at an estimated 10-year risk in excess of 20%.
Extrapolating from the Northern Manhattan Study 5-year results, the estimated 10-year vascular event rates in individuals without self-reported PAD who were in the low-, intermediate-, and high-risk Framingham categories at baseline were 8.2%, 17.4%, and 34.2%, respectively, which is consistent with how the risk score is supposed to operate.
Patients with self-reported PAD, however, were another story. Their extrapolated 10-year vascular event rates were 8.4%, 23.4%, and 58.2% for individuals in the low-, intermediate-, and high-risk Framingham categories. The 10-year major vascular event rate of 23.4% in the intermediate-risk group means those individuals actually belong in the high-risk Framingham category, Dr. Salameh said.
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