Author + information
- Received June 19, 2006
- Revision received August 21, 2006
- Accepted September 29, 2006
- Published online April 10, 2007.
- Victor Aboyans, MD, PhD⁎,†,1,⁎ (, )
- Michael H. Criqui, MD, MPH⁎,‡,
- Mary McGrae McDermott, MD§,
- Matthew A. Allison, MD, MPH⁎,
- Julie O. Denenberg, MA⁎,
- Ramin Shadman, BA‡ and
- Arnost Fronek, MD, PhD‖
- ↵⁎Reprint requests and correspondence:
Dr. Victor Aboyans, Department of Family and Preventive Medicine, University of California-San Diego, 9500 Gilman Drive, La Jolla, California 92093-0607.
Objectives This study sought to assess the prognosis of subclavian stenosis (SS) as a potential marker of total and cardiovascular disease (CVD) mortality.
Background Subclavian stenosis, diagnosed by a brachial systolic pressure difference (BSPD) ≥15 mm Hg, is associated with an increased prevalence of CVD risk factors. However, the association between SS and mortality is unknown. We hypothesized that a BSPD ≥15 mm Hg would predict an increased risk of CVD events.
Methods We analyzed baseline and longitudinal data from 3 cohorts. Two were recruited from noninvasive vascular laboratories, and the third was a community-dwelling cohort. Multivariate survival models were used to test for an independent association of SS with total and CVD mortality.
Results Baseline and follow-up data (mean 9.8 years) were complete in 1,778 participants. Subclavian stenosis was found in 157 (8.8%) subjects. Adjusted for age, gender, ethnicity, and cohort of origin, the presence of SS was significantly associated with increased total and CVD mortality (respectively, hazard ratio [HR] 1.42, p < 0.005; and HR 1.50, p = 0.05). This association persisted after adjustments for CVD risk factors (smoking pack-years, hypertension, diabetes, total/high-density lipoprotein cholesterol ratio, and body mass index) as well as lipid-lowering and antiplatelet therapies (HR 1.40, p < 0.01; and HR 1.57, p < 0.05 for total and CVD mortality, respectively). When any history of CVD or an ankle-brachial index <0.90 were added to the model, SS remained an independent predictor for total mortality (HR 1.34, p = 0.02), with a similar trend for CVD mortality (HR 1.43, p = 0.09).
Conclusions The presence of SS, easily diagnosed by comparing systolic pressures in the left and right arm, predicts total and CVD mortality independent of both CVD risk factors and existent CVD at baseline.
↵1 Dr. Aboyans is the recipient of the 2004 annual grant of the French Society of Vascular Medicine.
This study was supported by NIH grants HL 22255 and HL 000946 (cohort A); grants R01-HL58099 and R01-HL64739 from the National Heart Lung and Blood Institute and grant RR-00048 from the National Center for Research Resources, National Institutes of Health (cohort B); and NIH grants HL 42973 as well as NCRR GCRC program grant M01 RR 00827 and AHA grant-in-aid 0050002N (cohort C). Michael Jaff, DO, FACC, acted as the Guest Editor for this article.
- Received June 19, 2006.
- Revision received August 21, 2006.
- Accepted September 29, 2006.
- American College of Cardiology Foundation