Microvascular Disease May Be Linked to Higher Risk of Leg Amputations


July 8, 2019—The American Heart Association (AHA) announced the publication of a study demonstrating that microvascular disease is independently associated with a higher risk of leg amputation compared with people without the disease. The study was published online ahead of print by Joshua A. Beckman, MD, et al in the AHA's journal Circulation.

The study examined the amputation risk among people with microvascular disease or peripheral artery disease (PAD), as well as those who had both microvascular disease and PAD. The AHA Strategically Focused Research Network in Vascular Disease and the United States Department of Veterans Affairs funded the study. Investigators used data from the Veterans Aging Cohort study, which included more than 125,000 veterans who initially did not undergo amputations when the study began.

In the announcement, the AHA reported that over an average of 9 years:

  • Microvascular disease had a 3.7-fold increased risk of lower limb amputation and accounted for 18% of all amputations during the study.
  • PAD had a 13.9-fold increased risk of lower limb amputation and accounted for 22% of all amputations.
  • Microvascular disease and PAD had a 23-fold increase in the risk of lower limb amputation, which accounted for 45% of all amputations.

The AHA noted that although microvascular disease is commonly diagnosed as retinopathy or nephropathy, the authors believe those are markers of microvascular dysfunction throughout the body. In the announcement, Dr. Beckman stated, “This study advances the idea that microvascular disease is a system-wide disorder rather than only affecting one part of the body. PAD (in the legs) has long been considered a sign that a patient likely also has narrowed arteries leading to the heart or brain. If a patient has PAD, they have a higher risk of other cardiovascular diseases, such as heart attacks and strokes." Dr. Beckman is the lead author of the study and Professor of Medicine and Director of Vascular Medicine at Vanderbilt University Medical Center in Nashville, Tennessee.

Dr. Beckman continued, “Our study suggests that microvascular disease in any part of the body, such as the eyes, kidneys, or feet (neuropathy) may be linked to decreased blood vessel function in other parts of the body, putting patients at risk for potential lower limb amputations.”

Based on the findings, Dr. Beckman suggested that patients with microvascular disease require close observation and care of their feet to detect sores or injuries early to promote healing and reduce amputations. “Patients with both microvascular disease and PAD have the highest risk of lower-limb amputation and need maximal medical therapies to reduce their risk,” concluded Dr. Beckman in the AHA press release.


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