Multiple metabolic comorbidities and their consequences among patients with peripheral arterial disease

Young Shin Park, Gi Wook Ryu, Mona Choi

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1 Citation (Scopus)


Older adults with peripheral arterial disease (PAD) have increased risks of major cardiovascular events and hospitalization. Metabolic comorbidities, such as hypertension, diabetes mellitus, and dyslipidemia, are common risk factors for these unfavorable health events. This study aimed to determine how multiple metabolic comorbidities affect the risk of adverse health outcomes in older adults with PAD. A retrospective cohort study was adopted using administrative claim data from the Health Insurance Review and Assessment Service Agency. The study sample included 3,122 older adults (≥ 65 years old) with at least one PAD diagnosis in an inpatient setting from 2011 to 2013 and who had at least one follow-up visit after hospitalization by 2018. The three metabolic comorbidities were defined as having at least two diagnostic claims or one prescription per year of anti-hypertensive, anti-diabetic, or anti-dyslipidemic medications for the corresponding diagnosis. The outcome variables included major adverse cardiovascular events (MACEs) and major adverse limb events (MALE). Kaplan-Meier survival curves demonstrated that PAD patients with more metabolic comorbidities had shorter MACE-free and MALE-free periods. Adjusted Cox proportional hazards analyses suggested significant additive effects of multiple metabolic comorbidities on increased risks of MACE and MALE among older adults with PAD. Lower socioeconomic status and non-metabolic comorbidities also increased the risk of MACE. Male sex, being young-old (65–74 years), and a higher proportion of inpatient claims increased the risk of MALE. The findings of this study suggest the need for a comprehensive care program for older adults with PAD and metabolic comorbidities. In addition, the healthcare utilization pattern should be considered when designing preventive care for older patients with comorbidities to manage PAD at an earlier stage.

Original languageEnglish
Article numbere0268201
JournalPloS one
Issue number5 May
Publication statusPublished - 2022 May

Bibliographical note

Funding Information:
This study was supported by the National Research Foundation (NRF) of Korea funded by the Ministry of Education (2020R1A6A1A03041989), the Ministry of Science and ICT (2019R1A2C1007185). And Dr. GI WOOK RYU received a scholarship from the Brain Korea 21 FOUR Project funded by the NRF of Korea. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. All authors thank Dr. Ki Jun Song for his important statistical consulting that guided and improved the methods of this manuscript.

Publisher Copyright:
Copyright: © 2022 Park et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

All Science Journal Classification (ASJC) codes

  • General


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