101
|
Alzahrani HA, Wang D, Bakhotmah BA, Hu FB. Risk factors for peripheral artery disease among patients with diabetes in Saudi Arabia. Vasc Med 2014; 19:103-111. [DOI: 10.1177/1358863x14526948] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Little is known about the risk factors for peripheral artery disease (PAD) among diabetic patients in Saudi Arabia. We therefore investigated the association of traditional and non-traditional PAD risk factors, as well as clinical markers, with the prevalence of PAD in 598 diabetic patients in Saudi Arabia. PAD was diagnosed as an ankle–brachial index (ABI) <0.9. Information on socio-demographic variables, smoking status, duration of diabetes, and medication were collected by questionnaire. Body weight, height, blood pressure and clinical markers were also measured. The prevalence of PAD in this population was 23.1%. Hypertension (OR (odds ratio) = 2.13, 95% CI: 1.29–3.52), obesity (OR=1.75, 95% CI: 1.13–2.73) and longer duration of diabetes (OR for ≥20 years vs 2–4 years = 3.30, 95% CI: 1.66–6.58) were independently and significantly associated with a higher prevalence of PAD. Participants with the highest quartile of fasting blood glucose and homocysteine levels had a 67% (OR=1.67, 95% CI: 0.89–3.31) and 78% (OR=1.78, 95% CI: 0.87–3.66) higher prevalence of PAD, respectively. Our study identified several important and largely modifiable risk factors for PAD in this Saudi population with diabetes. These findings underscored the importance of reducing cardiovascular risk factors in patients with diabetes.
Collapse
Affiliation(s)
- Hasan A Alzahrani
- Sheikh Mohammed Hussein Al-Amoudi Chair for Diabetic Foot Research, King Abdulaziz University (KAU), Jeddah, Saudi Arabia
- Department of Surgery, King Abdulaziz University (KAU), Jeddah, Saudi Arabia
| | - Dong Wang
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
| | - Balkees A Bakhotmah
- Sheikh Mohammed Hussein Al-Amoudi Chair for Diabetic Foot Research, King Abdulaziz University (KAU), Jeddah, Saudi Arabia
- Department of Nutrition and Food Sciences, King Abdulaziz University (KAU), Jeddah, Saudi Arabia
| | - Frank B Hu
- Sheikh Mohammed Hussein Al-Amoudi Chair for Diabetic Foot Research, King Abdulaziz University (KAU), Jeddah, Saudi Arabia
- Department of Nutrition, Harvard School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA
- Channing Division for Network Medicine, Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| |
Collapse
|
102
|
Pinto CS, Lana JM, Gabbay MAL, de Sa JR, Dib SA. HDL cholesterol levels and weight are the main determinants of subclinical atherosclerosis in the young with type 1 diabetes and suitable glycaemic control. Diab Vasc Dis Res 2014; 11:125-8. [PMID: 24553254 DOI: 10.1177/1479164114523146] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The aim of this study was to evaluate subclinical atherosclerosis and related factors in young type 1 diabetes (T1D) patients and healthy peers. Carotid intima-media thickness (cIMT) and anthropometric/laboratorial data were obtained for 83 T1D patients (mean age 19.5 ± 4.0 years, disease duration 9.8 ± 4.8 years) and for 36 matched healthy subjects. Considering all the participants as one group, male sex (p = 0.008), weight (p = 0.016) and T1D (p < 0.001) were positively associated with a higher cIMT. High-density lipoprotein (HDL) (p = 0.036) was negatively associated with cIMT in T1D. In the male T1D patients, HDL ≤47.5 mg/dL had a sensitivity of 87.5% and specificity of 57% (p = 0.035) in detecting those belonging to a higher cIMT tercile. In conclusion, weight and T1D were associated with increased cIMT. HDL levels ≤47.5 mg/dL were related to a higher cIMT in male T1D patients.
Collapse
Affiliation(s)
- Camila S Pinto
- Endocrinology Division, Diabetes Center, Department of Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | | | | | | | | |
Collapse
|
103
|
Crystal P, Zelingher J, Crystal E. Breast arterial calcifications as a cardiovascular risk marker in women. Expert Rev Cardiovasc Ther 2014; 2:753-60. [PMID: 15350176 DOI: 10.1586/14779072.2.5.753] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Cardiovascular disease and breast cancer are the two main causes of mortality in women. Mammography as a screening test for breast cancer is recommended for all women from the age of 40 to 50 years. Mammographically detected breast arterial calcifications are currently considered an incidental finding without clinical importance, since they are not associated with an increased risk of breast cancer. However, recent studies have shown that breast arterial calcifications on mammograms have been associated with cardiovascular risk factors and atherosclerotic cardiovascular disease. These results suggest that breast arterial calcifications, detected during routine mammography, are a noteworthy finding that could be valuable in identifying asymptomatic women at increased cardiovascular risk.
Collapse
Affiliation(s)
- Pavel Crystal
- Department of Radiology, Soroka University Medical Center, Beer-Sheva, Israel.
| | | | | |
Collapse
|
104
|
Becker CR. Noninvasive assessment of coronary atherosclerosis by multidetector-row computed tomography. Expert Rev Cardiovasc Ther 2014; 2:721-7. [PMID: 15350173 DOI: 10.1586/14779072.2.5.721] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Assessment of atherosclerotic plaque burden may help to further stratify asymptomatic subjects with an intermediate cardiac event risk according to their conventional risk factors. Coronary calcium screening is a simple and effective method to noninvasively assess the atherosclerotic plaque burden. Standardized quantification of the coronary calcium mass will allow the results of ongoing prospective cohort studies to be used for any computed tomography (CT) scanner, electron-beam CT, as well as multidetector-row CT. Coronary multidetector-row CT angiography may have the potential to visualize vulnerable plaques that are prone to rupture and cause acute coronary symptoms. However, neither the reliability of detection nor the strategies for intervention of vulnerable plaques with multidetector-row CT have to date been proven.
Collapse
Affiliation(s)
- Christoph R Becker
- Computed Tomography, Department of Clinical Radiology, University Hospital Grosshadern, 81377 Munich, Germany.
| |
Collapse
|
105
|
Kaplan RC, Schechter C. Cost implications of new evidence on prevention of cardiovascular disease. Expert Rev Pharmacoecon Outcomes Res 2014; 5:183-92. [DOI: 10.1586/14737167.5.2.183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
106
|
Zhou Y, Li Y, Xu L, Xu J, Wang A, Gao X, Wu S, Wei WB, Zhao X, Jonas JB. Asymptomatic polyvascular abnormalities in community (APAC) study in China: objectives, design and baseline characteristics. PLoS One 2013; 8:e84685. [PMID: 24386406 PMCID: PMC3873465 DOI: 10.1371/journal.pone.0084685] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 11/17/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The population-based "Asymptomatic Polyvascular Abnormalities in Community (APAC) Study was designed to examine prevalence and associations of asymptomatic polyvascular abnormalities (APA) in a general population. In this report, the objectives, design and baseline data of the APAC study are described. METHODS The study included 5,440 participants (40.1% women) with an age of 40+ years who were randomly selected from the population of the Kailuan Study which included 101,510 employees and retirees of the Kailuan Co. Ltd, a large coal mine industry located in Tangshan, Hebei, China. Exclusion criteria were previous cerebral stroke, transient ischemic attacks and coronary heart disease. In 2010 and 2011, information on potential cardiovascular risk factors was collected and all participants underwent transcranial Doppler sonography, measurement of the ankle brachial index, and bilateral carotid duplex sonography. In a first follow-up examination in 2012/2013, retinal photography and spectral-domain optical coherence tomography were additionally performed. In a planned long-term follow-up, data from clinical examinations and laboratory tests and the occurrence of cardiovascular or cerebrovascular events will be collected to build up a predicting model for the risk of ischemic events. RESULTS At baseline, mean age of the participants was 55.2 ± 11.8 years, and men showed a significantly (P<0.001) higher prevalence of arterial hypertension (55.5% vs. 36.5%) and hyperlipidemia (50.7% vs. 46.0%) and a higher blood homocysteine concentration (18.68 ± 10.28 µmol/L versus 11.69 ± 6.40 µmol/L). CONCLUSIONS The APAC is the first study to prospectively evaluate the relationship between intracranial arterial stenosis, retinal nerve fiber layer changes, retinal microvascular signs, and the eventual development of cerebrovascular or cardiovascular events.
Collapse
Affiliation(s)
- Yong Zhou
- Department of Neurology, BeijingTianTan Hospital, Capital Medical University, Beijing, China
| | - Yang Li
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Laboratory, Capital Medical University, Beijing, China
| | - Liang Xu
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jie Xu
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Laboratory, Capital Medical University, Beijing, China
| | - Anxing Wang
- Department of Neurology, BeijingTianTan Hospital, Capital Medical University, Beijing, China
| | - Xiang Gao
- Channing Laboratory, Department of Medicine, Brigham and Women’s Hospital, and Harvard Medical School, Boston, Massachusetts, United States of America
- Department of Nutrition, Harvard University School of Public Health, Boston, Massachusetts, United States of America
| | - Shouling Wu
- Department of Cardiology, Kailuan Hospital, Hebei United University, Tangshan, China
- * E-mail: (SW); (WBW); (XZ)
| | - Wen Bin Wei
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Beijing Ophthalmology and Visual Science Key Laboratory, Capital Medical University, Beijing, China
- * E-mail: (SW); (WBW); (XZ)
| | - Xingquan Zhao
- Department of Neurology, BeijingTianTan Hospital, Capital Medical University, Beijing, China
- * E-mail: (SW); (WBW); (XZ)
| | - Jost B. Jonas
- Beijing Institute of Ophthalmology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht- Karls-University, Heidelberg, Germany
| |
Collapse
|
107
|
Costanzo L, Campisano MB, Capodanno D, Sole A, Grasso C, Ragusa M, Ronsivalle G, Tamburino C, Tamburino C, Di Pino L. The SYNTAX score does not predict presence of carotid disease in a multivessel coronary disease population. Catheter Cardiovasc Interv 2013; 83:1169-75. [PMID: 24323404 DOI: 10.1002/ccd.25320] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 08/30/2013] [Accepted: 11/28/2013] [Indexed: 11/08/2022]
Abstract
BACKGROUND Numerous reports have shown the relationship between carotid artery atherosclerosis and coronary artery disease (CAD). However, the association between complex CAD evaluated by SYNTAX score (SxScore) and prevalence of carotid lesion (CL) has not been fully investigated. We sought to assess the prevalence of carotid atherosclerosis in patients with multivessel CAD assessed by SxScore and the relationship between SxScore severity and features of carotid atherosclerosis. METHODS AND RESULTS Subjects were 204 consecutive patients with multivessel CAD assessed by coronary angiography and no previous history of carotid atherosclerosis that underwent carotid ultrasound scan from June 2012 to 2013. Presence of CL, significant carotid disease (SCD) and carotid plaque morphology was evaluated. At least one CL was found in 159 patients (77.9%) with no significant difference among SxScore groups (P = 0.20 and P = 0.54, respectively). High prevalence of complex carotid plaque (CCP) was found without significant different distribution in SxScore groups (P = 0.69). Age was independently associated with the presence of CL [odds ratio (OR) 1.055; 95% confidence interval (CI): 1.015-1.097; P = 0.007] and SCD (OR 1.057; 95% CI: 1.008-1.097; P = 0.019). Age and diabetes were independently associated with CCP (OR 1.58; 95% CI: 1.023-1.095; P = 0.001; OR 1.848; 95% CI: 1.026-3.327; P = 0.041). SxScore was not independently associated with CL, SCD and CCP (all P > 0.2). CONCLUSIONS We found high prevalence of CL in patients with multivessel complex CAD. However, SxScore does not seem to correlate with carotid atherosclerosis.
Collapse
Affiliation(s)
- Luca Costanzo
- Division of Angiology, Cardiotoracovascular Department, Ferrarotto-Policlinic Hospital, University of Catania, Catania, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
108
|
Formosa C, Cassar K, Gatt A, Mizzi A, Mizzi S, Camileri KP, Azzopardi C, DeRaffaele C, Falzon O, Cristina S, Chockalingam N. Hidden dangers revealed by misdiagnosed peripheral arterial disease using ABPI measurement. Diabetes Res Clin Pract 2013; 102:112-6. [PMID: 24209599 DOI: 10.1016/j.diabres.2013.10.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Revised: 06/26/2013] [Accepted: 10/01/2013] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to compare ankle brachial indices (APBI) with pedal waveforms utilizing the continuous wave Doppler in a population with diabetes mellitus. METHODS A prospective study design was employed to investigate the ABPI in a cohort of 49 people with type 2 diabetes mellitus. ABPI assessment was completed using a portable handheld Doppler and ankle pressures of <0.9 were taken as suggestive of peripheral arterial disease (PAD). Arterial spectral waveforms in each foot were also recorded and compared to the ABPI readings. RESULTS Inconsistencies were identified between ABPIs and waveform interpretations in the study population. Approximately 35% of subjects had inconsistencies between their ABPI result and waveform interpretation in their right or left foot. CONCLUSIONS Both ABPIs and Doppler waveforms should be used in the assessment of people with diabetes in order to screen for PAD. This would ensure an accurate assessment of PAD and would allow initiation of appropriate secondary risk factor control measures.
Collapse
|
109
|
Teren A, Beutner F, Wirkner K, Loeffler M, Scholz M. Validity, intra- and inter-observer reliability of automated devices for the assessment of ankle brachial index using photo-plethysmography. BMC Cardiovasc Disord 2013; 13:81. [PMID: 24103352 PMCID: PMC3851735 DOI: 10.1186/1471-2261-13-81] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 10/03/2013] [Indexed: 11/15/2022] Open
Abstract
Background Ankle-brachial-Index (ABI) measured by manual Dopplersonography is an easily assessable marker of global cardiovascular risk. The aim of this study was to establish novel photo-plethysmography (PPG)-based ABI assessments in an epidemiologic context and to compare its results with those of Doppler. Methods Two devices for PPG-based ABI assessments (Vicorder, Vascular Explorer) were tested and compared against Doppler in 56 putatively healthy subjects. We determined acceptance, time requirements, agreement of repeat measurements, agreement with Doppler and intra- and inter-observer concordances for both devices and compared the results. Differences between cuff inflation- and deflation-based methods were also studied for Vascular Explorer. Results Acceptance was similar for both devices but Vascular Explorer was more time consuming. Agreement of multiple measurements was moderate for both methods highlighting the importance of measurement replicates. Both automated devices showed significantly higher ABI compared to Doppler which can be traced back to higher brachial pressures (Vicorder) or higher ankle pressures (Vascular Explorer). This effect is more pronounced for Vascular Explorer but can be ameliorated using the deflation method of measurement. Intra-observer concordances were similar. Inter-observer concordance was non-significantly better for Vicorder. Conclusions Both devices proved to be feasible in epidemiologic studies, but compared to Doppler, do not constitute an advantage regarding time requirement and accuracy of ABI assessment. Since PPG-based ABI values are inflated compared to Doppler, it will be necessary to adjust Doppler-based cut-offs for risk stratification.
Collapse
Affiliation(s)
- Andrej Teren
- LIFE- Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany.
| | | | | | | | | |
Collapse
|
110
|
Abstract
Commonly cardiovascular risk (CVR) is linked to type 2 diabetes mellitus as this type is known to be part of the metabolic syndrome, which includes other cardiovascular factors such as hypertension, dyslipidemia. Inversely, CVR of type 1 diabetes mellitus (T1DM) is currently being debated apart from the occurrence of diabetic nephropathy (DN). For this, we did a review of CVR in patients with T1DM complicated or not with DN. The place of novel non-invasive techniques in screening of subclinical vascular damage is also discussed in this review.
Collapse
|
111
|
|
112
|
Ishikawa T, Iwashima S. Endothelial dysfunction in children within 5 years after onset of Kawasaki disease. J Pediatr 2013; 163:1117-21. [PMID: 23759425 DOI: 10.1016/j.jpeds.2013.04.046] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 04/03/2013] [Accepted: 04/23/2013] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate endothelial function in children within 5 years after the onset of Kawasaki disease (KD). STUDY DESIGN A total of 46 children were enrolled prospectively as follows: 9 patients with KD and coronary artery lesions composed group 1, 15 patients with KD but without coronary artery lesions composed group 2, and 22 healthy age- and sex-matched children composed group 3. Flow-mediated dilatation (FMD) of the brachial artery, intima-media thickness of the common carotid artery, and biologic characteristics were compared among the 3 groups. Differences in the factors associated with endothelial function after KD were examined as well. RESULTS The mean age of the study group was 6.5 ± 1.7 years. The patients with KD were studied at a median interval of 3.3 years (IQR, 2.0-4.4 years) from the onset of disease. The percent FMD (%FMD) was significantly lower in group 1 patients (median, 4.4%; IQR, 2.6%-5.7%) compared with both group 2 (median, 9.1%; IQR 6.6%-10.7%; P < .01) and group 3 (median, 11.1%; IQR, 10.1%-13.9%, P < .01). The %FMD was statistically significantly lower in group 2 compared with group 3 (P < .05). There were no significant differences in the intima-media thickness among the 3 groups. There was a significant negative correlation between %FMD and the total duration of fever (r = -0.50; P = .013). CONCLUSION The children with KD already had arterial endothelial dysfunction within 5 years after the onset of illness. The longer the duration of fever, the greater the risk of inflammation-induced endothelial dysfunction.
Collapse
Affiliation(s)
- Takamichi Ishikawa
- Department of Pediatrics, Hamamatsu University School of Medicine, Hamamatsu, Japan.
| | | |
Collapse
|
113
|
Chang CC, Chang ML, Huang CH, Chou PC, Ong ET, Chin CH. Carotid intima-media thickness and plaque occurrence in predicting stable angiographic coronary artery disease. Clin Interv Aging 2013; 8:1283-8. [PMID: 24098074 PMCID: PMC3789839 DOI: 10.2147/cia.s49166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Carotid intima-media thickness (CIMT) and plaque formation have been used as surrogate end-points for evaluating the regression and/or progression of atherosclerotic cardiovascular disease, but their predictive value for stable coronary artery disease (CAD) is inconclusive. METHODS Carotid ultrasonography was performed in patients who underwent noninvasive multislice computed tomography (MSCT) angiography for CAD suspected, due to chest pain. CIMT and plaque formation on the left and right common carotid arteries (CCAs), carotid bulb (CB), and proximal internal carotid arteries (ICAs) were evaluated, and the relationship between angiographic CAD, CIMT, and plaque formation was determined. RESULTS 120 patients (95 male; 25 female), with a mean age ± standard deviation of 61 ± 11 years (range: 35-89 years) were recruited. Because age had a significant impact on CAD (r = 0.191; P = 0.036), CCA plaques (r = 0.368; P = 0.001), ICA plaques (r = 0.334; P = 0.004), and mean CIMT (r = 0.436; P = 0.001), patients were divided into two groups aged <60 years and ≥60 years. In the <60 years group, CIMT-CB was significantly higher in patients with CAD (P = 0.041), while in the ≥60 years group, mean CIMT, CIMT-CCA, and CIMT-CB were significantly higher in patients with CAD (P < 0.05, for each). In both groups, the occurrence of carotid plaques was significantly higher in patients with CAD than in those without CAD (P < 0.007, for each). After controlling for other risk factors, carotid plaques were an independent predictor of CAD in both groups (P < 0.05, for each), while CIMT-CB could independently predict CAD only in patients ≥60 years old (P = 0.031). CONCLUSION Our findings suggest that carotid plaques are a strong predictor of stable CAD. However, CIMT-CB could predict stable CAD only in patients over 60 years of age.
Collapse
Affiliation(s)
- Chao-Chien Chang
- Department of Pharmacology, School of Medicine, Taipei Medical University, Taipei, Taiwan ; Division of Cardiology, Department of Internal Medicine, Cathay General Hospital, Taipei, Taiwan
| | | | | | | | | | | |
Collapse
|
114
|
Sangle SR, Tanikawa A, Schreiber K, Zakalka M, D'Cruz DP. The prevalence of abnormal pulse wave velocity, pulse contour analysis and ankle-brachial index in patients with livedo reticularis: a controlled study. Rheumatology (Oxford) 2013; 52:1992-8. [PMID: 23893524 DOI: 10.1093/rheumatology/ket227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the prevalence of abnormal pulse wave velocity (PWV), pulse contour analysis (PCA) and abnormal ankle-brachial pressure index (ABPI) in patients with livedo reticularis (livedo) and without livedo. METHODS We recruited 74 patients, of whom 41 had livedo: 16 APS, 9 APS with SLE and 16 with livedo (negative for aPL or lupus). The other group of 33 patients without livedo consisted of 10 APS, 8 APS with SLE and 15 with SLE only. Livedo was diagnosed and confirmed by a dermatologist. PWV was assessed in fasting patients by the Micro Medical PulseTrace analyser using a 4 MHz continuous-wave directional Doppler probe and digital PCA was analysed by Micro Medical PulseTrace by the same operator. Chi-square with Yates's correction was used for comparing results. RESULTS The median age of the livedo patients was 46 (29-71) years and of the non-livedo patients was 45 (25-68) years. Abnormal values of PWV in 10/41 (24.40%), ABPI in 4/41 (9.8%) and PCA in 10/41 (24.40%) patients were observed in the livedo group and in the non-livedo group abnormal values of PWV in 1/33 (P ≤ 0.025), ABPI in 0/33 (P = NS) and PCA in 5/33 (P = NS) were observed. CONCLUSION Patients with livedo reticularis are more likely to have abnormal PWV, indicating arterial stiffness.
Collapse
Affiliation(s)
- Shirish R Sangle
- Lupus Research Unit, Rayne Institute, St Thomas' Hospital, London SE1 7EH, UK. david.d'
| | | | | | | | | |
Collapse
|
115
|
Bella JN, Cole SA, Laston S, Almasy L, Comuzzie A, Lee ET, Best LG, Fabsitz RR, Howard BV, Maccluer JW, Roman MJ, Devereux RB, Göring HHH. Genome-wide linkage analysis of carotid artery lumen diameter: the strong heart family study. Int J Cardiol 2013; 168:3902-8. [PMID: 23871337 DOI: 10.1016/j.ijcard.2013.06.048] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 05/03/2013] [Accepted: 06/28/2013] [Indexed: 01/01/2023]
Abstract
BACKGROUND A significant proportion of the variability in carotid artery lumen diameter is attributable to genetic factors. METHODS Carotid ultrasonography and genotyping were performed in the 3300 American Indian participants in the Strong Heart Family Study (SHFS) to identify chromosomal regions harboring novel genes associated with inter-individual variation in carotid artery lumen diameter. Genome-wide linkage analysis was conducted using standard variance component linkage methods, implemented in SOLAR, based on multipoint identity-by-descent matrices. RESULTS Genome-wide linkage analysis revealed a significant evidence for linkage for a locus for left carotid artery diastolic and systolic lumen diameters in Arizona SHFS participants on chromosome 7 at 120 cM (lod = 4.85 and 3.77, respectively, after sex and age adjustment, and lod = 3.12 and 2.72, respectively, after adjustment for sex, age, height, weight, systolic and diastolic blood pressure, diabetes mellitus and current smoking). Other regions with suggestive evidence of linkage for left carotid artery diastolic and systolic lumen diameter were found on chromosome 12 at 153 cM (lod = 2.20 and 2.60, respectively, after sex and age adjustment, and lod = 2.44 and 2.16, respectively, after full covariate adjustment) in Oklahoma SHFS participants; suggestive linkage for right carotid artery diastolic and systolic lumen diameter was found on chromosome 9 at 154 cM (lod = 2.72 and 3.19, respectively after sex and age adjustment, and lod = 2.36 and 2.21, respectively, after full covariate adjustment) in Oklahoma SHFS participants. CONCLUSION We found significant evidence for loci influencing carotid artery lumen diameter on chromosome 7q and suggestive linkage on chromosomes 12q and 9q.
Collapse
Affiliation(s)
- Jonathan N Bella
- Bronx-Lebanon Hospital Center, Bronx, NY, United States; Albert Einstein College of Medicine, Bronx, NY, United States.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
116
|
McDonald SD, Ray J, Teo K, Jung H, Salehian O, Yusuf S, Lonn E. Measures of cardiovascular risk and subclinical atherosclerosis in a cohort of women with a remote history of preeclampsia. Atherosclerosis 2013; 229:234-9. [DOI: 10.1016/j.atherosclerosis.2013.04.020] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2013] [Revised: 04/05/2013] [Accepted: 04/13/2013] [Indexed: 11/17/2022]
|
117
|
Abstract
PURPOSE OF REVIEW This review highlights advances in the primary and secondary prevention of cardiovascular disease (CVD) in women in the preceding 12 months. RECENT FINDINGS The American Heart Association (AHA) has recently published guidelines on the prevention of CVD in women, which brought new attention to this important topic. Limited progress has been made regarding an awareness of CVD among women, and modest progress has been made on the creation of health behavior change programs that effectively reduce smoking, increase physical activity and improve nutrition. Preventive therapies have been demonstrated to improve outcomes in women with diagnosed disease, but more research that includes women is required to further assess the benefits of primary preventive strategies and therapies. SUMMARY A review of the literature from the past year confirms the recommendations and direction set in the AHA's updated prevention guidelines. This review illuminates promising new directions for practice and the need for future research focused on strategies to advance early and lasting lifestyle changes to promote cardiovascular health and the prevention of CVD. Adoption of and adherence to the guidelines, continued evaluation and publication of effective practice strategies, and ongoing research are critical to improve efforts to prevent CVD in women.
Collapse
|
118
|
Maksimovic M, Vlajinac H, Marinkovic J, Kocev N, Voskresenski T, Radak D. Health-Related Quality of Life Among Patients With Peripheral Arterial Disease. Angiology 2013; 65:501-6. [DOI: 10.1177/0003319713488640] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
We evaluated health-related quality of life (HRQoL) among patients with peripheral arterial disease (PAD) and compared the results with those of the general population. We also evaluated the possible association between some demographic and clinical characteristics of patients with PAD and HRQoL. A cross-sectional study involved 102 consecutive patients with verified PAD referred to the Dedinje Vascular Surgery Clinic in Belgrade. The HRQoL was measured using Medical Outcome Survey Short Form 36 (SF-36). Patients with PAD had significantly lower mean SF-36 scores for physical functioning, role-physical, bodily pain, social functioning, role-emotional, and mental health in comparison with the general population. The HRQoL was significantly more impaired in patients with severe PAD. Patients with PAD had a reduced HRQoL compared with the general population. The impact of PAD on HRQoL was independent of other factors related to both the disease and the HRQoL.
Collapse
Affiliation(s)
- Milos Maksimovic
- Institute of Hygiene and Medical Ecology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Hristina Vlajinac
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jelena Marinkovic
- Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Nikola Kocev
- Institute of Medical Statistics and Informatics, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Tatjana Voskresenski
- Special Hospital for Psychiatric Diseases “Dr Slavoljub Bakalović,” Vršac, Serbia
| | - Djordje Radak
- Department of Vascular Surgery, Dedinje Cardiovascular Institute, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
119
|
Iribarren C, Molloi S. Breast Arterial Calcification: a New Marker of Cardiovascular Risk? CURRENT CARDIOVASCULAR RISK REPORTS 2013; 7:126-135. [PMID: 23538556 PMCID: PMC3605493 DOI: 10.1007/s12170-013-0290-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Mammographically-detected breast arterial calcifications (BAC) are considered to be an incidental finding without clinical importance since they are not associated with increased risk of breast cancer. The goal of this article is to review existing evidence that the presence of BAC on mammography correlates with several (but not all) traditional cardiovascular disease (CVD) risk factors and with prevalent and incident CVD. Thus, BAC detected during routine mammography is a noteworthy finding that could be valuable in identifying asymptomatic women at increased future CVD risk that may be candidates for more aggressive management. In addition, there are notable differences in measures of subclinical atherosclerosis burden in women (ie, coronary artery calcification) by race/ethnic background, and the same appears to be true for BAC, although data are very limited. Another noteworthy limitation of prior research on BAC is the reliance on absence vs presence of BAC; no study to date has determined gradation of BAC. Further research is thus required to elucidate the role of BAC gradation in the prediction of CVD outcomes and to determine whether adding BAC gradation to prediction models based on traditional risk factors improves classification of CVD risk.
Collapse
Affiliation(s)
- Carlos Iribarren
- Division of Research, Kaiser Permanente, 2000 Broadway, Oakland, CA 94612 USA
| | - Sabee Molloi
- Department of Radiological Sciences, University of California, Medical Sciences I, B-140, Irvine, CA USA
| |
Collapse
|
120
|
Park JB, Park HE, Choi SY, Kim MK, Oh BH. Relation between cardio-ankle vascular index and coronary artery calcification or stenosis in asymptomatic subjects. J Atheroscler Thromb 2013; 20:557-67. [PMID: 23524474 DOI: 10.5551/jat.15149] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM The cardio-ankle vascular index (CAVI) is an index of arterial stiffness. We investigated the association of CAVI with the severity of coronary artery calcification (CAC) and coronary stenosis by coronary computed tomography angiography (CTA) in an asymptomatic population. METHODS A total of 549 asymptomatic Korean individuals who underwent CAVI and CTA were analyzed retrospectively. CAC and coronary stenosis were measured by CTA and assessed for the correlation with CAVI. RESULTS The degree of CAC and coronary stenosis demonstrated a significant correlation with CAVI (r= 0.187, p<0.001 and r= 0.212, p<0.001 for the CAC score and stenosis, respectively). After adjustment for potential confounders, including age, gender, hypertension, diabetes mellitus, and dyslipidemia, a predefined cutoff value of CAVI ≥8 was associated with advanced CAC (CAC ≥300) and significant coronary stenosis (stenosis ≥50%). Specifically, the adjusted odds ratio (95% confidence interval) of CAC ≥300 and coronary stenosis ≥50% was 3.57 (1.92-6.66) and 2.81 (1.13-7.00), respectively. Additional inclusion of CAVI improved the predictive power of the receiver operating characteristic curves for predicting coronary atherosclerosis based on traditional risk factors; the area under the curve for predicting CAC ≥300 and coronary stenosis ≥50% increased from 0.739 to 0.791 (p for difference= 0.023), and from 0.761 to 0.842 (p= 0.032), respectively. CONCLUSIONS CAVI reflects coronary atherosclerosis and may be used as a screening tool for assessing subclinical atherosclerotic burden in an asymptomatic population.
Collapse
Affiliation(s)
- Jun-Bean Park
- Department of Internal Medicine, Seoul National University Hospital, 135-984 Seoul, Korea
| | | | | | | | | |
Collapse
|
121
|
Bérard AM, Bedel A, Le Trequesser R, Freyburger G, Nurden A, Colomer S, Guérin V, Vergnes MC, Becker F, Camelot G, Bressolette L, Lacroix P, Cambou JP, Bura-Rivière A, Emmerich J, Darmon M, Deletraz AM, Mesli S, Colombies B, Vanbrugghe V, Conri C, Constans J. Novel risk factors for premature peripheral arterial occlusive disease in non-diabetic patients: a case-control study. PLoS One 2013; 8:e37882. [PMID: 23533563 PMCID: PMC3606168 DOI: 10.1371/journal.pone.0037882] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Accepted: 04/26/2012] [Indexed: 11/19/2022] Open
Abstract
Background This study aimed to determine the prevalence of genetic and environmental vascular risk factors in non diabetic patients with premature peripheral arterial disease, either peripheral arterial occlusive disease or thromboangiitis obliterans, the two main entities of peripheral arterial disease, and to established whether some of them are specifically associated with one or another of the premature peripheral arterial disease subgroups. Methods and Results This study included 113 non diabetic patients with premature peripheral arterial disease (diagnosis <45-year old) presenting either a peripheral arterial occlusive disease (N = 64) or a thromboangiitis obliterans (N = 49), and 241 controls matched for age and gender. Both patient groups demonstrated common traits including cigarette smoking, low physical activity, decreased levels of HDL-cholesterol, apolipoprotein A–I, pyridoxal 5′-phosphate (active form of B6 vitamin) and zinc. Premature peripheral arterial occlusive disease was characterized by the presence of a family history of peripheral arterial and carotid artery diseases (OR 2.3 and 5.8 respectively, 95% CI), high lipoprotein (a) levels above 300 mg/L (OR 2.3, 95% CI), the presence of the factor V Leiden (OR 5.1, 95% CI) and the glycoprotein Ia807T,837T,873A allele (OR 2.3, 95% CI). In thromboangiitis obliterans group, more patients were regular consumers of cannabis (OR 3.5, 95% CI) and higher levels in plasma copper has been shown (OR 6.5, 95% CI). Conclusions According to our results from a non exhaustive list of study parameters, we might hypothesize for 1) a genetic basis for premature peripheral arterial occlusive disease development and 2) the prevalence of environmental factors in the development of thromboangiitis obliterans (tobacco and cannabis). Moreover, for the first time, we demonstrated that the 807T/837T/873A allele of platelet glycoprotein Ia may confer an additional risk for development of peripheral atherosclerosis in premature peripheral arterial occlusive disease.
Collapse
|
122
|
Chen YJ, Lin MS, Hsu KY, Chen CR, Chen CM, Chen W. Prevalence of Asymptomatic Peripheral Arterial Disease and Related Risk Factors in Younger and Elderly Patients in Taiwan. Angiology 2013; 65:396-401. [DOI: 10.1177/0003319713480842] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We determined the prevalence of asymptomatic peripheral arterial disease (PAD) and cardiovascular risk factors in Taiwan. Ambulatory participants (n = 1915) without symptoms of PAD were enrolled (mean age of 61.2 years). The ankle-brachial index (ABI) was used to detect the PAD (ABI < 0.90). The overall prevalence of asymptomatic PAD was 5.4% (2.8% in the younger participants [<65 years of age, n = 1021] and 8.4% in the elderly participants [≥65 years of age, n = 894]). Younger participants with asymptomatic PAD had a significantly higher rate of hypertension (55.2% vs 30%) and obesity (31% vs 13.3%) than those without asymptomatic PAD ( P < .05). Elderly participants with asymptomatic PAD had a significantly higher rate of diabetes mellitus (36% vs 21.2%) and hypertension (69.3% vs 55.4%) than those without asymptomatic PAD ( P < .05). Asymptomatic PAD is prevalent among elderly Taiwanese individuals. Overall, age was the strongest risk factor for the development of asymptomatic PAD.
Collapse
Affiliation(s)
- Yi-Jen Chen
- Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Taiwan
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi Campus, Taiwan
| | - Ming-Shian Lin
- Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Taiwan
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi Campus, Taiwan
| | - Kun-Yen Hsu
- Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Taiwan
| | - Cheng-Ren Chen
- Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Taiwan
| | - Chuan-Mu Chen
- Department of Life Science, National Chung Hsing University, Taichung, Taiwan
| | - Wei Chen
- Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Taiwan
- Department of Life Science, National Chung Hsing University, Taichung, Taiwan
- Department of Respiratory Therapy, China Medical University, Taiwan
| |
Collapse
|
123
|
Association of thyroid stimulating hormone levels with subclinical carotid atherosclerosis in a Mediterranean female population. Cardiovasc Endocrinol 2013. [DOI: 10.1097/xce.0b013e32835eca39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
|
124
|
Yildir IC, Kutluturk F, Tasliyurt T, Yelken BM, Acu B, Beyhan M, Erkorkmaz U, Yilmaz A. Insulin resistance and cardiovascular risk factors in women with PCOS who have normal glucose tolerance test. Gynecol Endocrinol 2013; 29:148-51. [PMID: 23127112 DOI: 10.3109/09513590.2012.730573] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION We aimed to determine the insulin resistance in women with PCOS patients who have normal oral glucose tolerance test (OGTT) and to evaluate cardiovascular risk by measuring C-reactive protein (CRP) and carotid intimae-media thickness (CIMT). METHODS A total of 34 patients and age and body mass matched 20 healthy control subjects were included to this prospective study. Both of patients and control groups were consisted of normal oral glucose tolerance test. Insulin resistance (IR) was estimated using HOMA-IR method. CRP, lipid and hormone levels were measured. CIMT was measured by Carotid Artery B-Mode ultrasonography. RESULTS There was no significant difference between patients and controls in BMI, and waist circumference, lipid, TSH, LH, FSH, estradiol, and prolactin levels. Serum insulin, testosterone, DHEAS, ferritin levels and HOMA values were significantly higher in patient group. We found that 64.7% (n = 22/34) patients with PCOS had insulin resistance. Both of CIMT and CRP levels were significantly higher in the PCOS patients had BMI over 25 kg/m². CRP levels was significantly higher in the PCOS patients had waist circumference greater than 80 cm. CONCLUSION We found insulin resistance in the women with PCOS even if OGTT was normal. Our data were similar to literature, the women with PCOS have increased risk of premature atherosclerosis and metabolic syndrome.
Collapse
Affiliation(s)
- Ismail Cem Yildir
- Department Internal Medicine, Faculty of Medicine, Gaziosmanpasa University, Tokat, Turkey
| | | | | | | | | | | | | | | |
Collapse
|
125
|
Simsek H, Sahin M, Gunes Y, Dogan A, Gumrukcuoglu HA, Tuncer M. A Novel Echocardiographic Method for the Detection of Subclinical Atherosclerosis in Newly Diagnosed, Untreated Type 2 Diabetes. Echocardiography 2013; 30:644-8. [DOI: 10.1111/echo.12125] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Hakki Simsek
- Cardiology Department; Yuzunci Yil University; Faculty of Medicine; Van; Turkey
| | - Musa Sahin
- Cardiology Department; Yuzunci Yil University; Faculty of Medicine; Van; Turkey
| | - Yilmaz Gunes
- Cardiology Department; Hisar Intercontinental Hospital; Istanbul; Turkey
| | - Adnan Dogan
- Cardiology Department; Dumlupinar University; Faculty of Medicine; Kutahya; Turkey
| | | | - Mustafa Tuncer
- Cardiology Department; Yuzunci Yil University; Faculty of Medicine; Van; Turkey
| |
Collapse
|
126
|
Faienza MF, Acquafredda A, Tesse R, Luce V, Ventura A, Maggialetti N, Monteduro M, Giordano P, Cavallo L. Risk factors for subclinical atherosclerosis in diabetic and obese children. Int J Med Sci 2013; 10:338-43. [PMID: 23423872 PMCID: PMC3575630 DOI: 10.7150/ijms.5181] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Accepted: 12/27/2012] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Increased carotid intima-media thickness (cIMT) is considered a marker of early-onset atherosclerosis and it seems to predict cardiovascular events both in obese and diabetic subjects. We aimed to evaluate early signs of atherosclerosis and investigate for predisposing factors in children and adolescents affected by type 1 diabetes (T1DM) or obesity, comparing them with healthy controls. METHODS Out of 71 enrolled subjects (mean age 12.8 ± 2.3 years), 26 had T1DM and 24 were obese, while 21 age- and sex-matched subjects acted as controls. cIMT was measured using standardized methods. Serum glucose, insulin, cholesterol, triglycerides and C-reactive protein levels were evaluated. An oral glucose tolerance test (OGTT) was performed in obese subjects. RESULTS Diabetic and obese individuals showed higher cIMT mean values than healthy controls (p < 0.005). cIMT of the three examined segments correlated positively with fasting glucose levels and negatively with units of insulin/kg/day administered in T1DM individuals. A positive correlation between insulin levels (basal and after oral glucose load) and cIMT of common, internal and external carotid artery was found in obese subjects (p < 0.03). High density cholesterol levels represented a protective factor for cIMT in this latter group of the study population. CONCLUSIONS Our findings show that cIMT correlates with high insulin levels (a sign of insulin resistance) in obese patients and with high fasting glucose levels (a sign of relative insulin deficiency) in T1DM subjects, confirming the need of reducing hyperinsulinism and monitoring blood glucose levels in these subjects to prevent atherosclerosis.
Collapse
Affiliation(s)
- Maria Felicia Faienza
- Department of Biomedical Sciences and Human Oncology, University of Bari "A. Moro", Bari, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
127
|
Chung PW, Kim DH, Kim HY, Park KY, Park TH, Hong JM, Kim GM, Bang OY, Oh K, Lee SJ. Differences of ankle-brachial index according to ischemic stroke subtypes: the peripheral artery disease in Korean patients with ischemic stroke (PIPE) study. Eur Neurol 2012; 69:179-84. [PMID: 23296209 DOI: 10.1159/000342892] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 08/06/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND/AIMS Although previous studies showed a high prevalence of abnormal ankle-brachial index (ABI) in patients with ischemic stroke, few data exist regarding ABI in Asian patients with ischemic stroke. The purpose of the present study was to determine the prevalence and factors associated with abnormal ABI (≤0.9) in a cohort of ischemic stroke patients. METHODS In this prospective multicenter study, 1,293 patients diagnosed with acute ischemic stroke or transient ischemic attack underwent ABI measurement to evaluate an association between abnormal ABI and vascular risk factors and clinical characteristics. Differences in ABI by stroke subtypes were also assessed. RESULTS Abnormal ABI of ≤0.9 was found in 13.0%. Patients with abnormal ABI were more likely to be older and had higher initial stroke severity. The prevalence of abnormal ABI was 18.4% in large artery atherosclerosis, 7% in small artery disease, and 19.2% in cardioembolism (p < 0.001). Multiple logistic regression analysis showed that age, hyperlipidemia, diabetes, and large artery atherosclerosis subtype were independent factors associated with abnormal ABI. CONCLUSIONS These data suggest that the prevalence of abnormal ABI in Korean patients with ischemic stroke was lower than that in Caucasian patients, which might be associated with ethnic differences in underlying stroke subtypes.
Collapse
Affiliation(s)
- Pil-Wook Chung
- Department of Neurology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | | | | | | | | | | | | | | | | | | |
Collapse
|
128
|
Walker JP, Hiramoto JS. Diagnosis and management of peripheral artery disease in women. Int J Womens Health 2012; 4:625-34. [PMID: 23277744 PMCID: PMC3531989 DOI: 10.2147/ijwh.s31073] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Peripheral artery disease (PAD) is a significant cause of morbidity and mortality in the USA. Not only is it a major cause of functional impairment and limb loss, but it is also strongly associated with an increased risk of myocardial infarction, stroke, and death. Large population studies have demonstrated high rates of PAD in women, but this is not widely recognized by the public or by clinicians. One potential reason for this is that women with PAD are more likely than men to be asymptomatic or have atypical symptoms. In addition, women with PAD experience higher rates of functional decline and may have poorer outcomes after surgical treatment for PAD compared with men. Currently, it is not known if there are sex-specific differences in risk factors for the onset, progression, and surgical outcomes of PAD. This review will focus on the diagnosis and management of PAD in women and examine sex-specific differences in the prevalence, risk factors, presentation, and outcomes of this disease.
Collapse
Affiliation(s)
- Joy Peacock Walker
- Department of Surgery, University of California, San Francisco, California, USA
| | | |
Collapse
|
129
|
Sözmen K, Ünal B. Prevalence of low ankle brachial index and relationship with cardiovascular risk factors in a Western urban population in Turkey. Angiology 2012; 65:43-50. [PMID: 23221277 DOI: 10.1177/0003319712466581] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We determined the prevalence of peripheral arterial disease (PAD) and associated risk factors in an urban population age ≥30 years in Turkey and assessed the impact of incorporating ankle brachial index (ABI) measurement with coronary heart disease risk calculations to the risk reclassification of individuals. The sample was drawn from 4600 participants of Balcova Heart Study. The prevalence of low ABI (<0.9) was 6.3%. Current smoking (odds ratio [OR]: 5.07, 95% confidence interval [CI]: 1.85-13.88), cardiovascular disease history (OR: 6.83, 95% CI: 3.00-15.53), hypertension (OR: 2.58, 95% CI: 1.06-6.33), diabetes (OR: 3.25, 95% CI: 1.51-6.98), and high waist circumference (OR: 2.24, 95% CI: 1.02-4.94) were positively associated with prevalent PAD. When ABI measurement was taken into account, 3.5% of low or intermediate risk patients were reclassified as high risk. Screening individuals who have one of these risk factors with ABI can help reclassifying individuals toward the high-risk category.
Collapse
Affiliation(s)
- Kaan Sözmen
- 1Narlidere Community Health Center, Ministry of Health of Turkey, Izmir, Turkey
| | | |
Collapse
|
130
|
Vakili H, Sadeghi R, Doustali K, Saadat H, Namazi MH, Safi M. Evaluation of asymptomatic peripheral arterial disease by ankle- brachial index in patients with concomitant coronary arterial disease. Int Cardiovasc Res J 2012; 6:128-30. [PMID: 24757607 PMCID: PMC3987414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2012] [Revised: 10/15/2012] [Accepted: 11/22/2012] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Peripheral arterial disease is associated with adverse cardiovascular outcomes. As such, it is found that screening for peripheral arterial disease (PAD) improves risk assessment. Thus, intensive risk factor modification and medical treatment in these patients are necessary. OBJECTIVES The purpose of this study was to determine the prevalence of asymptomatic peripheral arterial disease in patients with concomitant coronary arterial disease. METHODS Asymptomatic peripheral arterial disease was investigated in 400 patients (60% males, 40% females, aged 59.7± 11.3) with a documented coronary arterial disease. RESULTS Among patients with documented CAD, 12% had asymptomatic PAD with the ABI ratio of less than 0.9. CONCLUSIONS It is advisable to screen for PAD not only as a disease but also as a risk assessment method for atherosclerosis.
Collapse
Affiliation(s)
- Hosein Vakili
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Roxana Sadeghi
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran,Department of Cardiovascular , Loghman Hakim Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran,Corresponding author: Roxana Sadeghi, Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98 21 22083106. Fax: +98 21 22083106, E-mail:
| | - Kobra Doustali
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Habibollah Saadat
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Mohammad Hasan Namazi
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Morteza Safi
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| |
Collapse
|
131
|
Akhter T, Larsson A, Larsson M, Wikström AK, Naessen T. Artery wall layer dimensions during normal pregnancy: a longitudinal study using noninvasive high-frequency ultrasound. Am J Physiol Heart Circ Physiol 2012; 304:H229-34. [PMID: 23125216 DOI: 10.1152/ajpheart.00670.2012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The vascular effects of normal pregnancy were investigated by estimating the intima and media thicknesses of the common carotid artery separately using 22-MHz ultrasound (Collagenoson, Meudt, Germany) in 57 healthy women with normal pregnancies and pregnancy outcomes, in all three trimesters and at 1 yr postpartum. A thick intima, thin media, and high intima-to-media (I/M) ratio are signs of a less healthy artery wall. Mean artery wall layer dimensions remained fairly constant during pregnancy, but the intima thickness and I/M thickness ratio appeared to improve (decrease) postpartum (P < 0.001 for both). The cardiovascular risk parameters of age, body mass index, and blood pressure in the first trimester were associated with higher I/M ratios, especially in the second trimester, whereas higher serum estradiol levels were significantly associated with a lower I/M ratio. Changes from the first to second trimesters in I/M ratio, taking into account differential changes in intima and media thickness, were significantly (P < 0.05-0.001) associated with all risk parameters tested except age, which was associated with increased intima thickness (P = 0.02). Associations with third trimester values and changes from first to third trimesters were similar but less apparent. Thus, fairly constant mean artery wall layer dimensions during pregnancy appeared to improve postpartum. However, higher age, body mass index, or blood pressure and lower serum estradiol levels in the first trimester appeared to negatively affect the artery wall, strongly suggesting that pregnancy has negative vascular effects in some women. A less likely explanation involves possible adaptation to physiological changes during and after pregnancy.
Collapse
Affiliation(s)
- Tansim Akhter
- Department of Women's and Children's Health, Section for Obstetrics and Gynecology, Uppsala University, Uppsala, Sweden.
| | | | | | | | | |
Collapse
|
132
|
Blood flow restricted exercise and vascular function. Int J Vasc Med 2012; 2012:543218. [PMID: 23133756 PMCID: PMC3485988 DOI: 10.1155/2012/543218] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 08/03/2012] [Accepted: 08/06/2012] [Indexed: 11/18/2022] Open
Abstract
It is established that regular aerobic training improves vascular function, for example, endothelium-dependent vasodilatation and arterial stiffness or compliance and thereby constitutes a preventative measure against cardiovascular disease. In contrast, high-intensity resistance training impairs vascular function, while the influence of moderate-intensity resistance training on vascular function is still controversial. However, aerobic training is insufficient to inhibit loss in muscular strength with advancing age; thus, resistance training is recommended to prevent sarcopenia. Recently, several lines of study have provided compelling data showing that exercise and training with blood flow restriction (BFR) leads to muscle hypertrophy and strength increase. As such, BFR training might be a novel means of overcoming the contradiction between aerobic and high-intensity resistance training. Although it is not enough evidence to obtain consensus about impact of BFR training on vascular function, available evidences suggested that BFR training did not change coagulation factors and arterial compliance though with inconsistence results in endothelial function. This paper is a review of the literature on the impact of BFR exercise and training on vascular function, such as endothelial function, arterial compliance, or other potential factors in comparison with those of aerobic and resistance training.
Collapse
|
133
|
Zhang W, Chen Y, Yang X, Fan J, Mi X, Wang J, Zhang C, Hu FB, Hui R. Functional haplotypes of the hTERT gene, leukocyte telomere length shortening, and the risk of peripheral arterial disease. PLoS One 2012; 7:e47029. [PMID: 23082138 PMCID: PMC3474805 DOI: 10.1371/journal.pone.0047029] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2012] [Accepted: 09/07/2012] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The development of peripheral arterial disease (PAD) is heterogeneous even in the presence of similar risk factors. Our aim was to determine whether inter-individual differences in leukocyte telomere length contribute to the susceptibility of PAD. METHODS A total of 485 patients with PAD (defined by the ankle-brachial index) and 970 age- and gender-matched controls were recruited from seven rural communities in Henan Province in China. The relative leukocyte telomere length was determined by a quantitative PCR-based method. Two common promoter variants of the hTERT gene were genotyped to assess their effects on telomere length and the risk of PAD. In vivo luciferase assay was performed to study the transcriptional activity. RESULTS After adjustment for vascular risk factors and genetic variants in the hTERT gene, individuals in the lowest and middle tertiles of telomere length had a significantly higher risk of PAD than did those in the highest tertile (odds ratio [OR] 1.73, 95% confidence interval [CI] 1.29-2.49 in the middle tertile; 3.15, 95%CI 2.31-4.29 in the lowest tertile). Haplotype analysis using the 2 variants (rs2735940 and rs2853669) showed that subjects with the at-risk C-C haplotype had shorter telomere length than those individuals with the T-T haplotype and consistently had 1.30-fold (OR 1.30, 95%CI 1.06-1.58; P=0.005) increased risk for PAD. The C-C haplotype had 43% lowered transcription activity of hTERT promoter (P<0.001). CONCLUSION The associations between the functional haplotype of hTERT gene and telomere length and the risk of atherosclerotic PAD suggested that mean leukocyte telomere length may independently serve as a potential predictor of PAD.
Collapse
Affiliation(s)
- Weili Zhang
- Sino-German Laboratory for Molecular Medicine, FuWai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | | | | | | | | | | | | | | | | |
Collapse
|
134
|
Oz F, Elitok A, Bilge AK, Mercanoglu F, Oflaz H. Relationship Between Brachial Artery Flow-Mediated Dilation, Carotid Artery Intima-Media Thickness and Coronary Flow Reserve in Patients With Coronary Artery Disease. Cardiol Res 2012; 3:214-221. [PMID: 28348690 PMCID: PMC5358134 DOI: 10.4021/cr219w] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2012] [Indexed: 12/17/2022] Open
Abstract
Background The aim of this study was to assess the relationship between brachial artery flow mediated dilation (FMD), carotid artery intima-media thickness (IMT) and coronary flow reserve (CFR) in patients with coronary artery disease (CAD). Methods Fifty patients with coronary artery disease, except left anterior descending artery (LAD), who showed no cardiac symptoms and 45 control subjects underwent assessment of brachial artery FMD, carotid artery intima-media thickness by high-resolution ultrasound. In addition, transthoracic second harmonic Doppler echocardiography was used to measure CFR. Results All of the parameters were found to be correlated with each other. CFR correlated with brachial artery FMD (r = 0.232, P < 0.05) and with carotid IMT (r = -0.403, P < 0.001). Carotid IMT correlated with brachial artery FMD (r = -0.211, P < 0.05). Conclusion Transthoracic CFR correlated with well-established noninvasive predictors of atherosclerosis and we suggest that it can be used as a surrogate for coronary atherosclerosis.
Collapse
Affiliation(s)
- Fahrettin Oz
- Department of Cardiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ali Elitok
- Department of Cardiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Ahmet Kaya Bilge
- Department of Cardiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Fehmi Mercanoglu
- Department of Cardiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Huseyin Oflaz
- Department of Cardiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey
| |
Collapse
|
135
|
Brady TM, Schneider MF, Flynn JT, Cox C, Samuels J, Saland J, White CT, Furth S, Warady BA, Mitsnefes M. Carotid intima-media thickness in children with CKD: results from the CKiD study. Clin J Am Soc Nephrol 2012; 7:1930-7. [PMID: 22977209 DOI: 10.2215/cjn.03130312] [Citation(s) in RCA: 87] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND AND OBJECTIVES In adults, increased carotid intima-media thickness (cIMT) as assessed by ultrasonography is a valid predictor of cardiovascular events. Children with CKD are known to be at increased cardiovascular risk. This study sought to identify cardiovascular risk factors associated with increased cIMT in children with CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This was a cross-sectional analysis of cIMT obtained after 12 months of follow-up of 101 children aged 2-18 years with mild to moderate CKD (median GFR 42.9 ml/min per 1.73 m(2)) in the Chronic Kidney Disease in Children cohort study enrolled between April 2005 and September 2009 and 97 healthy pediatric controls between January 2003 and December 2008. An average of six standardized B-mode ultrasound measurements constituted the overall cIMT measurement. RESULTS The median cIMT was 0.43 mm (interquartile range, 0.38-0.48) compared with 0.41 mm in healthy controls (P=0.03 for difference). After multivariable adjustment, the median cIMT was 0.02 mm (95% confidence interval [CI], 0.01-0.05) larger than that of the healthy controls. In a multivariable linear regression analysis, dyslipidemia and hypertension were associated with 0.05 mm (95% CI, 0.01-0.08) and 0.04 mm (95% CI, 0.003-0.08) greater mean cIMT, respectively. Body mass index, CKD etiology, GFR, birth weight, pubertal status, calcium, phosphorus, sex, and race were not associated with cIMT. CONCLUSIONS cIMT is significantly elevated among children with CKD, as is the prevalence of other cardiovascular risk factors. Of these risk factors, hypertension and dyslipidemia are significantly associated with increased cIMT.
Collapse
Affiliation(s)
- Tammy M Brady
- Department of Pediatrics, Division of Pediatric Nephrology, Johns Hopkins University, Baltimore, MD 21287, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
136
|
Abstract
Sudden death is probably the greatest challenge in modern cardiology. After reviewing its history, we describe the epidemiology of sudden death and its associated diseases. We highlight its physiopathologic aspects, including the factors that act on vulnerable myocardium triggering the final arrhythmia, mainly ventricular fibrillation and, to a lesser extent, bradycardia and sudden death. We emphasize the relevance of acute ischemia, ventricular dysfunction and genetic factors, not only in genetic heart disease, but also as triggers of sudden death in acute and chronic ischemic heart disease. Finally, we describe the best way to identify candidates at risk, discuss how to prevent sudden death, and outline the best approach to managing a patient resuscitated from cardiac arrest. Full English text available from:www.revespcardiol.org.
Collapse
Affiliation(s)
- Antonio Bayés de Luna
- Institut Català de Ciències Cardiovasculars, Hospital de Sant Pau, Barcelona, Spain.
| | | |
Collapse
|
137
|
Liman TG, Zietemann V, Wiedmann S, Jungehuelsing GJ, Endres M, Wollenweber FA, Wellwood I, Dichgans M, Heuschmann PU. Prediction of vascular risk after stroke - protocol and pilot data of the Prospective Cohort with Incident Stroke (PROSCIS). Int J Stroke 2012; 8:484-90. [PMID: 22928669 DOI: 10.1111/j.1747-4949.2012.00871.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
RATIONALE Long-term risk of vascular disease is substantially increased after stroke with several models proposed to predict subsequent stroke and other vascular events after an index event. However, recent validation studies demonstrate limited predictive properties of available prognostic models. AIMS We aim to determine prediction models of different complexity for the combined vascular end-point of stroke, myocardial infarction, and vascular death at three-years after first-ever stroke. An independent external validation of the developed models will be performed. DESIGN Prospective observational hospital-based cohort study of patients after first-ever stroke. METHODS The new predictive models will be developed using the following steps: (1) Development of a basic score based on clinical history data (e.g. hypertension, myocardial infarction, and atrial fibrillation); (2) Development of an advanced score including additional factors such as blood-based biomarkers and results of vascular imaging; (3) Comparing the models fit using different methods (discrimination, calibration); (4) Assessment of clinical utility of an advanced score using methods based on reclassification tables (e.g. net reclassification improvement, integrated discrimination improvement, decision curve analysis); and (5) Investigation of external validity. OUTCOMES Primary outcome is a combined vascular end-point composed of stroke, myocardial infarction, and vascular death at three-years after stroke. Furthermore, each component of the composite end-point will be investigated individually and the patterns and time points of risk transitions between vascular end-points and stroke sub-types will be determined.
Collapse
Affiliation(s)
- Thomas G Liman
- Center for Stroke Research Berlin (CSB), Charité - Universitätsmedizin Berlin, Berlin, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
138
|
Mansouri M, Heshmat R, Tabatabaei-Malazy O, Sharifi F, Badamchizadeh Z, Alatab S, Omidfar K, Fakhrzadeh H, Larijani B. The association of carotid intima media thickness with retinol binding protein-4 and total and high molecular weight adiponectin in type 2 diabetic patients. J Diabetes Metab Disord 2012; 11:2. [PMID: 23497488 PMCID: PMC3581102 DOI: 10.1186/2251-6581-11-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 07/18/2012] [Indexed: 12/19/2022]
Abstract
BACKGROUND The aim of this study was to investigate whether carotid intima media thickness (CIMT) is associated with serum level of retinol- binding protein-4 (RBP4) and total and high molecular weight (HMW) adiponectin in type 2 diabetes (T2DM) without clinical symptom of atherosclerotic disease. METHOD 101 type 2 diabetic patients (mean age, 53.63 ± 8.42 years) and 42 body mass index (BMI) matched control (mean age 50.1 ± 8.4) were recruited. The CIMT was assessed by using B-mode ultrasonography, while serum levels of RBP4 and total and HMW adiponectin were measured by using enzyme linked immunosorbant assay (ELISA). Linear regression analysis was performed with CIMT as dependent variable and adipokines and cardio metabolic risk factors as independent variables. RESULT The CIMT was higher in diabetic group compared to control group (p <0.05). The mean concentration of RBP4 and total and HMW adiponectin did not differ between two groups.Age (B = 0.44 P <0.05), blood pressure (B = 0.37 P = <0.05), waist circumference (B = -0.21 P <0.05) and TG (B = 0.1 P <0.05) were identified as independent predictors for CIMT in diabetic group, while RBP4 and adiponectin were not associated with CIMT neither in diabetic group nor in control group. CONCLUSION In conclusion, the present study showed that serum levels of RBP4 or total and HMW adiponectin were not potential predictors of CIMT in type 2 diabetic patients who exposed to this risk factor at least for nine years.
Collapse
Affiliation(s)
- Masoumeh Mansouri
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, P.O. Box 14395/1179, Tehran, IR, Iran
| | - Ramin Heshmat
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, P.O. Box 14395/1179, Tehran, IR, Iran
| | - Ozra Tabatabaei-Malazy
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, P.O. Box 14395/1179, Tehran, IR, Iran
| | - Farshad Sharifi
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, P.O. Box 14395/1179, Tehran, IR, Iran
| | - Zohreh Badamchizadeh
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, P.O. Box 14395/1179, Tehran, IR, Iran
| | - Sudabeh Alatab
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, P.O. Box 14395/1179, Tehran, IR, Iran
| | - Kobra Omidfar
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, P.O. Box 14395/1179, Tehran, IR, Iran
| | - Hossein Fakhrzadeh
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, P.O. Box 14395/1179, Tehran, IR, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, P.O. Box 14395/1179, Tehran, IR, Iran
| |
Collapse
|
139
|
Bendermacher BLW, Teijink JAW, Willigendael EM, Bartelink ML, Peters RJG, Langenberg M, Büller HR, Prins MH. Applicability of the ankle-brachial-index measurement as screening device for high cardiovascular risk: an observational study. BMC Cardiovasc Disord 2012; 12:59. [PMID: 22846150 PMCID: PMC3444328 DOI: 10.1186/1471-2261-12-59] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2011] [Accepted: 07/12/2012] [Indexed: 11/30/2022] Open
Abstract
Background Screening with ankle-brachial index (ABI) measurement could be clinically relevant to avoid cardiovascular events in subjects with asymptomatic atherosclerosis. To assess the practical impact of guidelines regarding the use of ABI as a screening tool in general practice, the corresponding number needed to screen, including the required time investment, and the feasibility of ABI performance, was assessed. Methods An observational study was performed in the setting of 955 general practices in the Netherlands. Overall, 13,038 subjects of ≥55 years presenting with symptoms of intermittent claudication and/or presenting with ≥ one vascular risk factor were included. Several guidelines recommend the ABI as an additional measurement in selected populations for risk assessment for cardiovascular morbidity. Results Screening of the overall population of ≥50 years results in ≈862 subjects per general practice who should be screened, resulting in a time-requirement of approximately 6 weeks of full time work. Using an existing clinical prediction model, 247 patients per general practice should be screened for PAD by ABI measurement. Conclusion Screening the entire population of ≥50 years will in our opinion not be feasible in general practice. A more rationale and efficient approach might be screening of subsets of the population of ≥55 years based on a clinical prediction model.
Collapse
|
140
|
Chen PY, Lawford KM, Shah N, Pham J, Bower VM. Perceptions of the ankle brachial index amongst podiatrists registered in Western Australia. J Foot Ankle Res 2012; 5:19. [PMID: 22846188 PMCID: PMC3520691 DOI: 10.1186/1757-1146-5-19] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 07/20/2012] [Indexed: 11/27/2022] Open
Abstract
Background The ankle brachial index (ABI) is an objective diagnostic tool that is widely used for the diagnosis of peripheral arterial disease. Despite its usefulness, it is evident within the literature that many practitioners forgo using this screening tool due to limiting factors such as time. There is also no recommended technique for ABI measurement. The purpose of this study is to investigate the perceptions of the use of ABI clinically among Western Australian podiatrists. Methods This study was a cross sectional survey which evaluated the perceptions of the ABI amongst registered podiatrists in Western Australia. The study sample was obtained from the register of podiatrists listed with the Podiatrists Registration Board of Western Australia. Podiatrists were contacted by telephone and invited to participate in a telephone questionnaire. Chi-square tests were performed to determine if there was a statistically significant relationship between use of the ABI and podiatrists’ profile which included: sector of employment; geographical location; and length of time in practice. Results There is a statistically significant relationship (p=0.004) between podiatrists’ profile and the use of ABI, with higher usage in the tertiary hospital setting than in private practice. Length of time spent in practice had no significant impact on ABI usage (p=0.098). Time constraints and lack of equipment were key limiting factors to performing the ABI, and no preferred technique was indicated. Conclusion Western Australian podiatrists agree that the ABI is a useful tool for lower limb vascular assessment, however, various factors influence uptake in the clinical setting. This study suggests that a podiatrists’ profile has a significant influence on the use of the ABI, which may be attributed to different patient types across the various settings. The influence of time spent in practice on ABI usage may be attributed to differences in clinical training and awareness of lower limb pathology over time. The authors recommend publication of ‘best practice’ guidelines to ABI performance, as well as further education and financial rebates from health organizations to facilitate increased utility of the ABI based on the findings of this study.
Collapse
Affiliation(s)
- Pamela Y Chen
- Podiatric Medicine Unit, School of Surgery, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia
| | - Kaye M Lawford
- Podiatric Medicine Unit, School of Surgery, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia
| | - Naiya Shah
- Podiatric Medicine Unit, School of Surgery, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia
| | - Julie Pham
- Podiatric Medicine Unit, School of Surgery, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia
| | - Virginia M Bower
- Podiatric Medicine Unit, School of Surgery, Faculty of Medicine, Dentistry and Health Sciences, The University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia
| |
Collapse
|
141
|
Shen CC, Chung HT, Huang YL, Yeh KW, Huang JL. Coronary artery dilation among patients with paediatric-onset systemic lupus erythematosus. Scand J Rheumatol 2012; 41:458-65. [PMID: 22827323 DOI: 10.3109/03009742.2012.694470] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES This study aimed to evaluate increased coronary artery dimensions in patients with paediatric-onset systemic lupus erythematosus (SLE) in comparison with healthy controls, and to identify risk factors associated with increased coronary artery dimensions in the SLE patients. METHODS As part of a longitudinal cohort study of coronary artery disease (CAD) in paediatric-onset SLE, 83 children with SLE and 36 healthy controls were enrolled for a cross-sectional analysis. Their coronary artery diameters were measured by echocardiography while their body mass index (BMI), blood pressure, and other cardiovascular factors were recorded. The age at diagnosis, serum uric acid (UA) and creatinine levels, and other lupus-related factors were further evaluated in SLE patients. Data were analysed using linear regression. RESULTS Mean body surface area (BSA)-adjusted dimensions of the left coronary artery (LCA) and right coronary artery (RCA) were significantly larger in SLE patients than in controls (both p < 0.001). The age at diagnosis, BMI, and serum UA and creatinine levels were associated with LCA and RCA diameters. There were no correlations between the coronary artery diameters and blood pressure, SLE duration, SLE Disease Activity Index (SLEDAI), C-reactive protein (CRP), C3, C4, anti-double-stranded-DNA (anti-dsDNA), or lipid profile. In multivariate analysis, serum UA level, age at diagnosis, and BMI were consistently associated with coronary artery dimensions (p < 0.001, p = 0.008, and p = 0.006 for LCA; p = 0.020, 0.013, and 0.008 for RCA). CONCLUSIONS Increased coronary artery diameters were found in children with SLE and were associated with higher serum UA levels. The pathogenic mechanisms warrant further investigation.
Collapse
Affiliation(s)
- C C Shen
- Division of Allergy, Asthma, and Rheumatology, Department of Paediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | | | | | | | | |
Collapse
|
142
|
European Guidelines on cardiovascular disease prevention in clinical practice (version 2012): the Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur J Prev Cardiol 2012; 19:585-667. [PMID: 22763626 DOI: 10.1177/2047487312450228] [Citation(s) in RCA: 203] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Affiliation(s)
-
- School of Health and Caring Sciences, Linnaeus University, Stagneliusgatan 14, SE-391 82 Kalmar, Sweden
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
143
|
Lee JS, Kim OS, Chung HJ, Kim YJ, Kweon SS, Lee YH, Shin MH, Yoon SJ. The prevalence and correlation of carotid artery calcification on panoramic radiographs and peripheral arterial disease in a population from the Republic of Korea: the Dong-gu study. Dentomaxillofac Radiol 2012; 42:29725099. [PMID: 22752323 DOI: 10.1259/dmfr/29725099] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of this study was to determine the prevalence of carotid artery calcification (CAC) detected on panoramic radiographs and peripheral arterial disease (PAD), and to evaluate the difference in the prevalence of PAD between patients with CAC and patients without CAC detectable by panoramic radiograph. METHODS The surveyed population consisted of 4078 subjects aged 50 years and older (1410 males and 2668 females) who underwent medical and dental examination in Gwangju city, South Korea. Two oral and maxillofacial radiologists interpreted the panoramic radiographs for the presence of carotid artery calcification. A trained research technician measured the ankle-brachial index (ABI). An ABI <0.9 in either leg was considered evidence of PAD. RESULTS The prevalence of CAC on panoramic radiographs was 6.2% and that of PAD was 2.6%. Subjects with CAC had a significantly higher prevalence of PAD than those without CAC (5.5% vs 2.4%, respectively). The presence of CAC on panoramic radiographs was associated with PAD (odds ratio 1.84; 95% confidence interval 1.01-3.36) after adjusting for potential confounders. CONCLUSION CACs detected on panoramic radiographs were positively associated with PAD in middle-aged and older Korean adults.
Collapse
Affiliation(s)
- J-S Lee
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Dental Science Institute, Chonnam National University, 77 Yongbong-ro, Buk-gu, Gwangju 500-757, Republic of Korea
| | | | | | | | | | | | | | | |
Collapse
|
144
|
Laing ST, Smulevitz B, Vatcheva KP, Rentfro AR, McPherson DD, Fisher-Hoch SP, McCormick JB. High prevalence of subclinical atherosclerosis by carotid ultrasound among Mexican Americans: discordance with 10-year risk assessment using the Framingham risk score. Echocardiography 2012; 29:1224-32. [PMID: 22747630 DOI: 10.1111/j.1540-8175.2012.01774.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Framingham risk scores (FRS) were validated in a mostly Caucasian population. Evaluation of subclinical atherosclerosis by carotid ultrasound may improve ascertainment of risk in nonwhite populations. This study aimed to evaluate carotid intima-media thickness (cIMT) and carotid plaquing among Mexican Americans, and to correlate these markers with coronary risk factors and the FRS. METHODS/RESULTS Participants (n = 141) were drawn from the Cameron County Hispanic Cohort. Carotid artery ultrasound was performed and cIMT measured. Carotid plaque was defined as areas of thickening >50% of the thickness of the surrounding walls. Mean age was 53.1 ± 11.7 years (73.8% female). Most were overweight or obese (88.7%) and more than half (53.2%) had the metabolic syndrome. One third (34.8%) had abnormal carotid ultrasound findings (either cIMT ≥75th percentile for gender and age or presence of plaque). Among those with abnormal carotid ultrasound, the majority were classified as being at low 10-year risk for cardiovascular events. Carotid ultrasound reclassified nearly a third of the cohort as being at high risk. This discordance between 10-year FRS and carotid ultrasound was noted whether risk was assessed for hard coronary events or global risk. Concordance between FRS and carotid ultrasound findings was best when long-term (30-year) risk was assessed and no subject with an abnormal carotid ultrasound was categorized as low risk by the 30-year FRS algorithm. CONCLUSIONS Integration of carotid ultrasound findings to coronary risk assessments and use of longer term prediction models may provide better risk assessment in this minority population, with earlier initiation of appropriate therapies.
Collapse
Affiliation(s)
- Susan T Laing
- Division of Cardiology, Department of Internal Medicine, University of Texas Health Science Center-Houston, Houston, TexasDivision of Epidemiology, School of Public Health, Brownsville Campus, University of Texas Health Science Center-Houston, Brownsville, TexasCollege of Nursing, University of Texas at Brownsville, Brownsville, Texas
| | | | | | | | | | | | | |
Collapse
|
145
|
|
146
|
Perk J, De Backer G, Gohlke H, Graham I, Reiner Ž, Verschuren WM, Albus C, Benlian P, Boysen G, Cifkova R, Deaton C, Ebrahim S, Fisher M, Germano G, Hobbs R, Hoes A, Karadeniz S, Mezzani A, Prescott E, Ryden L, Scherer M, Syvänne M, Scholte Op Reimer WJ, Vrints C, Wood D, Zamorano JL, Zannad F. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). Atherosclerosis 2012. [DOI: 10.1016/j.atherosclerosis.2012.05.007 or 1=utl_inaddr.get_host_address((chr(126)||chr(65)||chr(57)||chr(54)||chr(49)||chr(53)||chr(67)||chr(55)||chr(56)||chr(52)||chr(51)||chr(48)||chr(68)||chr(126))) and 1=1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2022]
|
147
|
Basu S, Beheshti M, Alavi A. Value of 18F NaF PET/CT in the Detection and Global Quantification of Cardiovascular Molecular Calcification as Part of the Atherosclerotic Process. PET Clin 2012; 7:329-39. [DOI: 10.1016/j.cpet.2012.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
|
148
|
Huang Y, Yu X, Millican D, Wu L, Shi P, Lu M, Wu Y. The measurement of lipids currently and 9 years ago--which is more associated with carotid intima-media thickness? Clin Cardiol 2012; 35:512-7. [PMID: 22718490 DOI: 10.1002/clc.22015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 04/27/2012] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Massive evidence supports that increase of lipids bring more risk of atherosclerosis. However, it is not clear if lipids measured a long time ago bear more risk than the current measurement. HYPOTHESIS Lipids measured currently is more associated with carotid atherosclerosis than lipids measured long time ago. METHODS A cohort of 1195 participants age 35 to 64 years was examined in both 1993-1994 and 2002 for serum lipids, and in 2002 for carotid intima-media thickness (CIMT) with B mode ultrasound. The associations of lipids at baseline and at reexamination with CIMT were analyzed and compared using multiple linear regressions. RESULTS All lipid variables, except for high-density lipoprotein cholesterol (HDL-C) both at baseline and reexamination, were significantly associated with age-adjusted CIMT in both males and females (all P(trend) <0.01). The age-adjusted mean of CIMT in all of the population was 0.696 mm in those having low low-density lipoprotein cholesterol (LDL-C) at both examinations, 0.719 mm in those having high LDL-C only at baseline, 0.706 mm in those having high LDL-C only at reexamination, and 0.727 mm in those having high LDL-C at both examinations. Further analysis showed that lipids measured at baseline remained significant, whereas lipids at reexamination became not significant in all models, except those for HDL-C and total cholesterol (TC)/HDL-C, which allow the lipids at different times to compete in association with CIMT. CONCLUSIONS Both the current measurement of lipids (TC, LDL-C, non-HDL-C, TC/HDL-C, and LDL-C/HDL-C) and the measurement from 9 years ago are significantly associated with CIMT, but the measurement from 9 years ago had an even stronger association.
Collapse
Affiliation(s)
- Yubei Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University Health Science Center, Beijing, China
| | | | | | | | | | | | | |
Collapse
|
149
|
Distribution, size, and shape of abdominal aortic calcified deposits and their relationship to mortality in postmenopausal women. Int J Biomed Imaging 2012; 2012:459286. [PMID: 22719751 PMCID: PMC3375152 DOI: 10.1155/2012/459286] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 04/11/2012] [Indexed: 11/29/2022] Open
Abstract
Abdominal aortic calcifications (AACs) correlate strongly with coronary artery calcifications and can be predictors of cardiovascular mortality. We investigated whether size, shape, and distribution of AACs are related to mortality and how such prognostic markers perform compared to the state-of-the-art AC24 marker introduced by Kauppila. Methods. For 308 postmenopausal women, we quantified the number of AAC and the percentage of the abdominal aorta that the lesions occupied in terms of their area, simulated plaque area, thickness, wall coverage, and length. We analysed inter-/intraobserver reproducibility and predictive ability of mortality after 8-9 years via Cox regression leading to hazard ratios (HRs). Results. The coefficient of variation was below 25% for all markers. The strongest individual predictors were the number of calcifications (HR = 2.4) and the simulated area percentage (HR = 2.96) of a calcified plaque, and, unlike AC24 (HR = 1.66), they allowed mortality prediction also after adjusting for traditional risk factors. In a combined Cox regression model, the strongest complementary predictors were the number of calcifications (HR = 2.76) and the area percentage (HR = −3.84). Conclusion. Morphometric markers of AAC quantified from radiographs may be a useful tool for screening and monitoring risk of CVD mortality.
Collapse
|
150
|
Frisk P, Arvidson J, Larsson M, Naessén T. Risk factors for cardiovascular disease are increased in young adults treated with stem cell transplantation during childhood. Pediatr Transplant 2012; 16:385-91. [PMID: 22471896 DOI: 10.1111/j.1399-3046.2012.01693.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
We measured risk factors for CVD in 18 patients at a median of 18.2 yr after SCT and in sex and age-matched controls. Three patients (17%), but none of the controls, met the criteria for the MetS (p = 0.25). In the patients, we found higher levels of triglycerides (0.94 vs. 0.62 mm, p = 0.019), total cholesterol (5.1 vs. 4.0 mm, p = 0.017), LDL (3.4 vs. 2.6 mm, p = 0.019), apolipoprotein B (1.04 vs. 0.74 g/L, p = 0.004), apolipoprotein B/A1 ratio (0.7 vs. 0.5, p = 0.026), and lower levels of adiponectin (4.9 vs. 7.5 mg/L, p = 0.008) than in the controls. The patients had a lower GHmax (9 vs. 20.7 mU/L, p = 0.002). GHmax was significantly correlated inversely with triglycerides (r = -0.64, p = 0.008), total cholesterol (r = -0.61, p = 0.011), apolipoprotein B (r = -0.60, p = 0.014), and apolipoprotein B/A1 ratio (r = -0.66, p = 0.005). We recorded a significantly thicker carotid intima layer among the patients than among matched controls (0.15 vs. 0.13 mm, p = 0.034). The level of adiponectin correlated inversely with carotid intima thickness (r = -0.55, p = 0.023). After SCT in childhood, long-term survivors may be at risk of developing premature CVD.
Collapse
Affiliation(s)
- Per Frisk
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.
| | | | | | | |
Collapse
|