Vascular Surgery

Aim: The risk factors for peripheral artery disease (PAD) are more common in Indigenous than non-Indigenous Australians. However, the presentation and outcome of PAD in Indigenous Australians has not been previously investigated. The aim of this prospective cohort study was to compare the presenting characteristics and clinical outcome of Indigenous and non-Indigenous Australians with PAD. Methods: PAD patients were prospectively recruited since 2003 from an outpatient vascular clinic in Townsville, Australia. Presenting symptoms and risk factors in Indigenous and nonIndigenous patients were compared using Pearson’s χ2 test and Mann Whitney U test. Kaplan Meier survival analysis and Cox proportional hazard analysis compared the incidence of myocardial infarction (MI), stroke or death (major cardiovascular events) among Indigenous and non-Indigenous patients. Results: 401 PAD patients were recruited, of which 16 were Indigenous and 385 were non-Indigenous Australians. Indigenous Australians were younger at entry (median age 63.3 [54.767.8] vs. 69.6 [63.3-75.4]), more commonly current smokers (56.3% vs. 31.4%), and more frequently had insulin treated diabetes (18.8% vs. 5.2%). During a median follow-up of 2.5 years, five and 45 combined events (MI, stroke or death) were recorded amongst Indigenous and non-Indigenous Australians, respectively. Indigenous Australians were at a 4-fold greater risk of major cardiovascular events (adjusted hazard ratio 4.03 [95% confidence intervals 1.17-13.87], p=0.027) compared to nonIndigenous Australians.    Conclusions: These findings suggest that Indigenous Australians 

with PAD present at a younger age have higher rates of smoking and insulin-treated diabetes, and poorer clinical outcomes compared to non-Indigenous Australians