Research
Print page Print page
Switch language
The Capital Region of Denmark - a part of Copenhagen University Hospital
Published

Polyvascular disease: A narrative review of current evidence and a consideration of the role of antithrombotic therapy

Research output: Contribution to journalReviewpeer-review

  1. Associations between body mass index trajectories in childhood and cardiovascular risk factors in adulthood

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Omega-3 fatty acids and risk of cardiovascular disease in Inuit: First prospective cohort study

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. AHRR hypomethylation as an epigenetic marker of smoking history predicts risk of myocardial infarction in former smokers

    Research output: Contribution to journalJournal articleResearchpeer-review

  4. Endothelial shear stress and vascular remodeling in bioresorbable scaffold and metallic stent

    Research output: Contribution to journalJournal articleResearchpeer-review

  1. Full-Volume Assessment of Abdominal Aortic Aneurysms by 3-D Ultrasound and Magnetic Tracking

    Research output: Contribution to journalJournal articleResearchpeer-review

  2. Vascular function in adults with cyanotic congenital heart disease

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. In Situ Vein Bypass Is Superior to Endovascular Treatment of Femoropopliteal Lesions in Chronic Limb-Threatening Ischemia

    Research output: Contribution to journalJournal articleResearchpeer-review

  • E Hope Weissler
  • W Schuyler Jones
  • Ileana Desormais
  • Sebastian Debus
  • Lucia Mazzolai
  • Christine Espinola-Klein
  • Sigrid Nikol
  • Mark Nehler
  • Henrik Sillesen
  • Victor Aboyans
  • Manesh R Patel
View graph of relations

BACKGROUND AND AIMS: Polyvascular disease (PVD) affects approximately 20% of patients with atherosclerosis and is a strong independent risk factor for ischemic outcomes. However, guidelines do not address screening or treatment for PVD, and there have been no PVD-specific trials. We reviewed subgroup analyses of large randomized controlled trials of more intense antithrombotic therapy to determine whether increased intensity of therapy improved ischemic outcomes in patients with PVD.

METHODS: MEDLINE, MEDLINE in-Process, EMBASE, and the Cochrane Library were queried for randomized controlled trials larger than 5000 patients evaluating secondary prevention therapies in patients with coronary artery disease or lower extremity peripheral artery disease.

RESULTS: Thirteen trials were included ranging in size from 7243 to 27,395 patients. In 9 trials (CHARISMA, TRA 2°P-TIMI 50, PEGASUS-TIMI 54, VOYAGER PAD, TRACER, EUCLID, TRILOGY ACS, PLATO, and COMPASS), patients in the PVD subgroup treated with increased-intensity antithrombotic therapy had similar or greater relative risk reductions for ischemic events in comparison with the general trial cohorts. In four trials (DAPT, THEMIS, APPRAISE-2, and ATLAS ACS 2 TIMI 51), the PVD subgroup had an increased hazard of ischemic events with increased-intensity therapy compared with the general trial cohorts.

CONCLUSIONS: More intense antithrombotic therapy in patients with PVD was associated with a similar relative risk reduction for ischemic events compared with patients without PVD. Therefore, patients with PVD benefit from a larger absolute risk reduction because of their higher baseline risk. Future trials in patients with atherosclerotic cardiovascular disease should intentionally include PVD patients to adequately assess treatment options for this under-studied, under-treated population.

Original languageEnglish
JournalAtherosclerosis
Volume315
Pages (from-to)10-17
Number of pages8
ISSN0021-9150
DOIs
Publication statusPublished - Dec 2020

ID: 62413496