Microvascular disease increases the risk of lower limb amputation - a Western Danish cohort study

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BACKGROUND: Peripheral artery disease is the leading cause of non-traumatic lower limb amputation. Microvascular disease (MVD) increases the risk of lower limb amputation in patients with peripheral artery disease (PAD). We estimated risk of lower limb amputation associated with MVD and PAD in a Danish cohort.

METHODS: We included every resident without previous lower limb amputation in Western Denmark aged 50-75 years on January 1, 2012 and followed them for 7 years. Participants were stratified by MVD and PAD. We estimated adjusted hazard ratios of lower limb amputation using individuals with no MVD and no PAD as reference. We also provide a sex-specific analyses and estimated the population attributable fraction of male sex.

RESULTS: We included 933,597 individuals, of whom 16,741 had MVD only, 18,217 had PAD only, and 1,827 had MVD and PAD. Both MVD only (adjusted hazard ratio 3.36, 95% CI 2.98-3.73) and PAD only (adjusted hazard ratio 7.32, 95% CI 6.62-8.08) increased the risk of lower limb amputation separately. Individuals with MVD and PAD had the highest risk of amputation (adjusted hazard ratio 12.27, 95% CI 10.43-14.80). Men had increased absolute risk of amputation. Population attributable fraction associated with male sex was 31%.

CONCLUSIONS: MVD and PAD are independently associated with a 3-fold and 7-fold increase of amputation risk, respectively. Combined, they had an additive effect constituting a 12-fold amputation risk. The amputation risk was higher in men than women, and 3 in 10 amputations were attributed to male sex.

Original languageEnglish
JournalEuropean Journal of Clinical Investigation
Pages (from-to)e13812
ISSN0960-135X
DOIs
Publication statusE-pub ahead of print - 9 May 2022

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