• Posted July 23, 2024

Younger May Not Fare Better When It Comes to Leg Artery Disease

Middle-aged folks don’t necessarily fare better than seniors following urgent surgery to unclog arteries and restore blood flow to their legs, a new study warns.

Adults in their 50s with peripheral artery disease (PAD) appear more likely to require a leg amputation within years after emergency surgery to unblock their arteries, compared with people in their 80s. However, older people with PAD have a higher risk of death than younger patients whether or not they have the surgery, results show.

“Our primary finding is different from the traditional belief that older people were at an increased risk of major amputation. Our study, interestingly, shows the opposite relationship,” said lead researcher Qiuju Li, a research fellow in medical statistics at the London School of Hygiene and Tropical Medicine.

Peripheral artery disease occurs when arteries leading away from the heart narrow due to cholesterol deposits, researchers said in background notes. This most commonly affects the legs.

People with PAD suffer from painful muscle cramps in their hips, thighs, calves or feet when they’re ambulating, and the pain doesn’t subside with rest, researchers said.

About 10 million to 12 million Americans 40 and older have PAD, according to the American Heart Association and the American College of Cardiology. Risk factors include diabetes, elevated cholesterol, high blood pressure and smoking.

For this study, published in the journal Circulation, researchers analyzed data from nearly 95,000 British adults older than 50 who underwent surgery to restore blood flow to their legs between 2013 and 2020.

About two-thirds of the people had the surgery done as an elective procedure, while the rest had it performed during an emergency hospital admission.

The overall risk of a leg amputation was low for both middle-aged adults and seniors -- nearly 11% for those 50 to 54 versus nearly 7% in those 80 to 84.

However, middle-age people who needed emergency surgery to reopen their arteries had a much higher risk of losing their leg.

The risk of leg amputation following emergency surgery for people ages 50 to 54 was 18% at one year and nearly 29% at five years, compared to 12% and 17% for people ages 80 to 84.

On the other hand, those in their 80s were more likely to die whether or not the surgery led to an amputation, compared to those in their 50s.

For people in their 80s, the risk of death without a leg amputation was 49% within five years of an elective surgery and 59% following emergency surgery, compared with 13% and 17% for those in their 50s, results show.

The risk of death following a leg amputation was 39% at three months and 30% at one year of surgery  for people in their 80s, compared with 20% and 15% for those in their 50s.

“The findings also highlight how the association between the illness trajectories and patient characteristics is not straightforward,” Li said in a journal news release. 

“While being older at the time they had blood flow-restoring surgery was associated with a marked increase in the risk of death, the risk of major amputation after that surgery was lower among older patients rather than younger patients,” Li added.

Guidelines issued earlier this year by the AHA, the ACC and nine other medical societies highlighted the importance of early diagnosis and treatment of PAD, to prevent amputations and other heart-related complications caused by the condition, researchers noted.

“This study shows that for patients with severe peripheral arterial disease, there is not one simple answer that can explain each patient’s condition,” said guidelines co-vice chair Dr. Philip Goodney, section chief of vascular surgery at Dartmouth Health in New Hampshire.

“For example, patients with severe disease who present at young ages have poor outcomes, irrespective of how they might be treated,” Goodney added. “This may be the result of severe disease or difficult circumstances for treatment.”

More information

The Yale School of Medicine has more about peripheral artery disease.

SOURCE: American Heart Association, news release, July 22, 2024