Peripheral Artery Disease and Subsequent Risk of Infectious Disease in Older Individuals: The ARIC Study

Overview

Journal Mayo Clin Proc

Specialty General Medicine

Date 2022 Oct 9

PMID 36210200

Authors

Yejin Mok

Junichi Ishigami

Pamela L Lutsey

Hirofumi Tanaka

Michelle L Meyer

Gerardo Heiss

Kunihiro Matsushita

Affiliations

Soon will be listed here.

Abstract

Objective: To quantify the association of peripheral artery disease (PAD) with infection risk because PAD has been understudied despite recognition of atherosclerotic cardiovascular disease as a risk factor for infection.

Methods: Among 5082 participants of the Atherosclerosis Risk in Communities study (aged 71 to 90 years during 2011-2013), we assessed the association of PAD status, based on clinical history and ankle-brachial index (ABI), with infection-related hospitalization (through December 2019) using multivariable Cox regression. We also cross-classified participants by PAD and coronary heart disease (CHD)/stroke status at baseline, with implications for polyvascular disease.

Results: During the median follow-up of 6.5 years, there were 1677 infection-related hospitalizations. Peripheral artery disease (clinical history or ABI ≤0.90) was independently associated with the risk of overall infection (adjusted hazard ratio [HR], 1.66 [95% CI, 1.42 to 1.94] vs ABI of 1.11 to 1.20), as was borderline low ABI of 0.91 to 1.00 (adjusted HR, 1.75 [95% CI, 1.47 to 2.07]). Results were consistent across major types of infection (ie, cellulitis, bloodstream infection, pneumonia, and urinary tract infection). For overall infection, PAD plus CHD/stroke had the highest HR of hospitalized infection (1.9), and PAD alone and CHD/stroke alone showed similar HRs of 1.6. For subtypes of infection, PAD alone had the highest HR of approximately 2 for bloodstream infection; PAD alone and PAD plus CHD/stroke had a similar risk of urinary tract infection with HR of approximately 1.7.

Conclusion: Peripheral artery disease and borderline low ABI were robustly associated with infection-related hospitalization of older adults. The contribution of PAD to infection risk was comparable to that of CHD/stroke, warranting clinical attention to PAD for the prevention of infectious diseases.

Citing Articles

Implementing Oral Antibiotics for Bone and Joint Infections: Lessons Learned and Opportunities for Improvement.

Hawkins M, Thottacherry E, Juthani P, Aronson J, Chang A, Amanatullah D Open Forum Infect Dis. 2024; 11(12):ofae683.

PMID: 39660026 PMC: 11629981. DOI: 10.1093/ofid/ofae683.

Subsequent risk of cancer among adults with peripheral artery disease in the community: The atherosclerosis risk in communities (ARIC) study.

Nohara S, Mok Y, Vant Hof J, Salameh M, Joshu C, Platz E Int J Cardiol. 2024; 418():132577.

PMID: 39306296 PMC: 11578760. DOI: 10.1016/j.ijcard.2024.132577.

Triglyceride-glucose index and the risk of stroke in American adults: findings from the atherosclerosis risk in communities study.

Wang X, Liu Q, Wang T, Tian W, Chen X, Zhang J Diabetol Metab Syndr. 2023; 15(1):187.

PMID: 37723527 PMC: 10507886. DOI: 10.1186/s13098-023-01161-3.

Evaluation of the Risk Factors for Cellulitis among Patients with Peripheral Artery Disease.

Wang B, Yang S, Ting K, Wang Y, Chou M, Yeh C Medicina (Kaunas). 2023; 59(5).

PMID: 37241165 PMC: 10224094. DOI: 10.3390/medicina59050933.

References

. The Atherosclerosis Risk in Communities (ARIC) Study: design and objectives. The ARIC investigators. Am J Epidemiol. 1989; 129(4):687-702. View

Pencina M, DAgostino R . Overall C as a measure of discrimination in survival analysis: model specific population value and confidence interval estimation. Stat Med. 2004; 23(13):2109-23. DOI: 10.1002/sim.1802. View

Korhonen P, Aarnio P . Borderline peripheral arterial disease. Int J Angiol. 2012; 17(4):175-7. PMC: 2728920. DOI: 10.1055/s-0031-1278304. View

Dryden M, Baguneid M, Eckmann C, Corman S, Stephens J, Solem C . Pathophysiology and burden of infection in patients with diabetes mellitus and peripheral vascular disease: focus on skin and soft-tissue infections. Clin Microbiol Infect. 2015; 21 Suppl 2:S27-32. DOI: 10.1016/j.cmi.2015.03.024. View

Schneeweiss S, Robicsek A, Scranton R, Zuckerman D, Solomon D . Veteran's affairs hospital discharge databases coded serious bacterial infections accurately. J Clin Epidemiol. 2007; 60(4):397-409. DOI: 10.1016/j.jclinepi.2006.07.011. View

Daryapeyma A, Ostlund O, Wahlgren C . Healthcare-associated infections after lower extremity revascularization. Eur J Vasc Endovasc Surg. 2014; 48(1):72-7. DOI: 10.1016/j.ejvs.2014.02.003. View

Almirall J, Bolibar I, Serra-Prat M, Roig J, Hospital I, Carandell E . New evidence of risk factors for community-acquired pneumonia: a population-based study. Eur Respir J. 2008; 31(6):1274-84. DOI: 10.1183/09031936.00095807. View

Ciszewski A, Bilinska Z, Brydak L, Kepka C, Kruk M, Romanowska M . Influenza vaccination in secondary prevention from coronary ischaemic events in coronary artery disease: FLUCAD study. Eur Heart J. 2008; 29(11):1350-8. DOI: 10.1093/eurheartj/ehm581. View

Perk J, De Backer G, Gohlke H, Graham I, Reiner Z, Verschuren W . European Guidelines on cardiovascular disease prevention in clinical practice (version 2012): The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted.... Atherosclerosis. 2012; 223(1):1-68. DOI: 10.1016/j.atherosclerosis.2012.05.007. View

10.

McDermott M, Liu K, Criqui M, Ruth K, Goff D, Saad M . Ankle-brachial index and subclinical cardiac and carotid disease: the multi-ethnic study of atherosclerosis. Am J Epidemiol. 2005; 162(1):33-41. DOI: 10.1093/aje/kwi167. View

11.

van Hoek A, Andrews N, Waight P, Stowe J, Gates P, George R . The effect of underlying clinical conditions on the risk of developing invasive pneumococcal disease in England. J Infect. 2012; 65(1):17-24. DOI: 10.1016/j.jinf.2012.02.017. View

12.

Allison M, Hiatt W, Hirsch A, Coll J, Criqui M . A high ankle-brachial index is associated with increased cardiovascular disease morbidity and lower quality of life. J Am Coll Cardiol. 2008; 51(13):1292-8. DOI: 10.1016/j.jacc.2007.11.064. View

13.

Black C, Yue X, Ball S, Donahue S, Izrael D, de Perio M . Influenza vaccination coverage among health care personnel--United States, 2013-14 influenza season. MMWR Morb Mortal Wkly Rep. 2014; 63(37):805-11. PMC: 5779456. View

14.

Melvin J, Smith J, Kruse R, Vogel T . Risk Factors for 30-Day Hospital Re-Admission with an Infectious Complication after Lower-Extremity Vascular Procedures. Surg Infect (Larchmt). 2017; 18(3):319-326. PMC: 5796593. DOI: 10.1089/sur.2016.234. View

15.

Bodewes T, Soden P, Ultee K, Zettervall S, Pothof A, Deery S . Risk factors for 30-day unplanned readmission following infrainguinal endovascular interventions. J Vasc Surg. 2017; 65(2):484-494.e3. PMC: 5293151. DOI: 10.1016/j.jvs.2016.08.093. View

16.

Smith Jr S, Benjamin E, Bonow R, Braun L, Creager M, Franklin B . AHA/ACCF Secondary Prevention and Risk Reduction Therapy for Patients with Coronary and other Atherosclerotic Vascular Disease: 2011 update: a guideline from the American Heart Association and American College of Cardiology Foundation. Circulation. 2011; 124(22):2458-73. DOI: 10.1161/CIR.0b013e318235eb4d. View

17.

Murray G, Butcher I, Heald C, Lee R, Chambless L, Folsom A . Ankle brachial index combined with Framingham Risk Score to predict cardiovascular events and mortality: a meta-analysis. JAMA. 2008; 300(2):197-208. PMC: 2932628. DOI: 10.1001/jama.300.2.197. View

18.

Grohskopf L, Sokolow L, Broder K, Olsen S, Karron R, Jernigan D . Prevention and Control of Seasonal Influenza with Vaccines. MMWR Recomm Rep. 2016; 65(5):1-54. DOI: 10.15585/mmwr.rr6505a1. View

19.

Shah B, Hux J . Quantifying the risk of infectious diseases for people with diabetes. Diabetes Care. 2003; 26(2):510-3. DOI: 10.2337/diacare.26.2.510. View

20.

Koivula I, Sten M, Makela P . Risk factors for pneumonia in the elderly. Am J Med. 1994; 96(4):313-20. DOI: 10.1016/0002-9343(94)90060-4. View