1
|
Lin Y, Li W, Liu W, Liu M, Li Y, Chen Y. Mid-term outcomes of endovascular treatment and risk factors for recurrence in patients with Trans-Atlantic-Inter-Society II C/D femoropopliteal lesions. Quant Imaging Med Surg 2021; 11:2028-2039. [PMID: 33936984 DOI: 10.21037/qims-20-221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The purpose of this study was to determine the efficacy of interventional endovascular treatment (EVT) and the risk factors for postoperative restenosis in patients with Trans-Atlantic Inter-Society Consensus (TASC) II C/D femoropopliteal lesions. Methods A total of 55 patients who received EVT for TASC II C/D femoropopliteal lesions (64 affected limbs) from October 2014 to September 2017 were examined. The mean lesion length was 19.6±5.3 (range, 15.5-26.4 cm). The femoropopliteal lesions were classified as TASC II C and TASC II D in 39 and 16 cases, respectively. The ankle-brachial index (ABI), primary patency rate, secondary patency rate, and limb salvage rate were monitored in follow-up evaluations for up to 24 months. A Cox regression model was used to evaluate the correlation between each of these factors and the restenosis rate after EVT. Results Patent TASC II C/D femoropopliteal lesions were present in 59 of the 64 limbs. The mean ABI values for the dorsal pedal artery and posterior tibial artery increased 1 month after treatment from a baseline level of 0.35±0.12 to 0.89±0.10 and from 0.43±0.15 to 0.90±0.13, respectively (P<0.01). The mean follow-up time was 19.3 (range, 6-24) months. The cumulative primary patency rates at 1, 3, 6, 12, 18, and 24 months were 98.3%, 91.5%, 84.3%, 61.1%, 53.1%, and 31.1%, respectively. The secondary patency rates at 12 and 24 months were 70.4% and 60.0%, respectively. Factors with a high hazard ratio included male sex, TASC II D, smoking, and diabetes mellitus (DM). Conclusions EVT had a safe and satisfactory mid-term therapeutic effect on TASC II C/D femoropopliteal lesions. Male sex, TASC II D (compared to TASC II C), smoking, and DM were risk factors for restenosis. EVT has a secondary patency rate comparable to that of open surgery and can be considered a first-line treatment for TASC II C/D femoropopliteal lesions.
Collapse
Affiliation(s)
- Yisheng Lin
- Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, China.,Department of Interventional Radiology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Weihao Li
- Department of Interventional Radiology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Wendao Liu
- Department of Interventional Radiology, Guangdong Province Traditional Chinese Medical Hospital, Guangzhou, China
| | - Min Liu
- Department of Interventional Radiology, The First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, China
| | - Yin Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yong Chen
- Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| |
Collapse
|
2
|
Assem M, Mousa S, Abdelhamid A, Amin S, Elsamadony A, El-Sebaee E, Saif A, Elsawy S. The risk of micro and macrovascular disease in Egyptian patients with diabetes and peripheral arterial disease. J Community Hosp Intern Med Perspect 2021; 11:216-219. [PMID: 33889323 PMCID: PMC8043603 DOI: 10.1080/20009666.2021.1877906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Aim: The aim of this study was to assess the prevalence of micro- and macrovascular disease in Egyptian patients with diabetes mellitus (DM) and peripheral arterial disease (PAD). Methods: The study included 161 Egyptian patients with DM and PAD (91.3% had type 2 DM and 67.1% were females). Mean diabetes duration was 14.2 ± 5.2 years. Full history, clinical and fundus examination as well as laboratory investigations were done. PAD was diagnosed through assessment of ankle/brachial index (ABI) by Doppler ultrasonography. Results: ABI was <0.9 in 33.5% and >1.3 in 66.5% of patients. A significant positive correlation was found between abnormal ABI and diabetes duration, ischemic heart disease (IHD), diabetic retinopathy and neuropathy, foot ulcers, elevated blood pressure (BP), creatinine, urine albumin/creatinine ratio (ACR) and triglycerides and a significant negative correlation with HDL. Multivariate regression analysis revealed that the independent predictors for PAD in patients with ABI< 0.9 were neuropathy, creatinine, triglyceride, LDL, urine ACR and low HDL, and in patients with ABI >1.3 were IHD, neuropathy, elevated diastolic BP and triglyceride. Conclusion: The risk of micro- and macrovascular disease is high in Egyptian patients with diabetes and PAD. Early diagnosis and good control of risk factors could reduce PAD progression.
Collapse
Affiliation(s)
- Maha Assem
- Internal Medicine Department, Cairo University, Giza, Egypt
| | - Shrook Mousa
- Internal Medicine Department, Cairo University, Giza, Egypt
| | | | - Samar Amin
- Internal Medicine Department, Cairo University, Giza, Egypt
| | | | - Eman El-Sebaee
- Community Medicine Department, Cairo University, Giza, Egypt
| | - Aasem Saif
- Internal Medicine Department, Cairo University, Giza, Egypt
| | - Shereen Elsawy
- Internal Medicine Department, Cairo University, Giza, Egypt
| |
Collapse
|
3
|
Kronfli A, Boukerche F, Medina D, Geertsen A, Patel A, Ramedani S, Lehman E, Aziz F. Immediate postoperative hyperglycemia after peripheral arterial bypass is associated with short-term and long-term poor outcomes. J Vasc Surg 2020; 73:1350-1360. [PMID: 32890722 DOI: 10.1016/j.jvs.2020.08.126] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 08/12/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Although the impact of poorly controlled diabetes on surgical outcomes of patients undergoing lower extremity revascularization is well-known, it is not clear if immediate postoperative hyperglycemia (IPH) itself can be used as a surrogate for poor outcomes after peripheral arterial bypass. We sought to examine the effect of IPH in this patient population with its impact on short-term and long-term outcomes. METHODS Retrospective review was completed for 505 patients who underwent either suprainguinal bypass surgery or infrainguinal bypass surgery between July 2002 and April 2018 for the treatment of peripheral arterial disease. All patients were undergoing first-time open bypass grafting. Patients were stratified into those who were normoglycemic or hyperglycemic (glucose ≥ 140 mg/dL) within 24 hours after surgery. A comparative analysis was performed on comorbidities and outcomes. RESULTS Of 505 patients who underwent bypass grafting, 255 patients (50.5%) were hyperglycemic. The mean age of patients was 63.5 ± 14.1 years. The median follow-up was 5.2 years (range, 0.0-15.2 years). The distribution of procedures was as follows: femoral to popliteal bypasses (29%), femoral to femoral bypasses (17%), femoral to tibial bypasses (12%), aortobifemoral bypasses (10%), iliofemoral bypasses (9%), and axillofemoral bypasses (7%). At 30 days, hyperglycemic patients had an increased incidence of limb loss (8.3% vs 4.0%) and myocardial infarction (4.8% vs 0.8%) and incurred higher costs of hospital stay ($27,701 vs $22,990) (all P < .05). At 10 years, these patients had a higher incidence of needing major amputations (15.4% vs 9.4%; P = .025). Hyperglycemia after infrainguinal bypass was associated with nearly twice the risk of limb loss at 5 years (hazard ratio, 1.91; P = .034). Among the cohort of patients who required major amputations, the time duration between index revascularization and amputation was significantly shorter as compared with normoglycemic patients (P = .003). CONCLUSIONS In this single-institution study with long-term follow-up, IPH was associated with increased rates of 30-day amputation and myocardial infarction, as well as an increased cost of hospital stay. In the long term, postoperative hyperglycemia was associated with greater major limb loss. Among the cohort of patients who required major amputations, the time period between revascularization and amputation was shorter for those patients who had IPH. IPH is an independent marker for poor outcomes after lower extremity revascularization procedures.
Collapse
Affiliation(s)
- Anthony Kronfli
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pa
| | - Faiza Boukerche
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pa
| | - Daniela Medina
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pa
| | - Alex Geertsen
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pa
| | - Akshil Patel
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pa
| | - Shayann Ramedani
- Department of Surgery, The Pennsylvania State University, College of Medicine, Hershey, Pa
| | - Erik Lehman
- Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, Hershey, Pa
| | - Faisal Aziz
- Division of Vascular Surgery, Department of Penn State Hershey Heart & Vascular Institute, The Pennsylvania State University, College of Medicine, Hershey, Pa.
| |
Collapse
|
4
|
Patel T, Baydoun H, Patel NK, Tripathi B, Nanavaty S, Savani S, Mojadidi MK, Agarwal N, Patel G, Patel S, Pancholy S. Peripheral Arterial Disease in Women: The Gender Effect. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:404-408. [DOI: 10.1016/j.carrev.2019.05.026] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2019] [Revised: 05/19/2019] [Accepted: 05/28/2019] [Indexed: 02/08/2023]
|
5
|
Mondesir FL, Brown TM, Muntner P, Durant RW, Carson AP, Safford MM, Levitan EB. Diabetes, diabetes severity, and coronary heart disease risk equivalence: REasons for Geographic and Racial Differences in Stroke (REGARDS). Am Heart J 2016; 181:43-51. [PMID: 27823692 PMCID: PMC5117821 DOI: 10.1016/j.ahj.2016.08.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 08/08/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Evidence is mixed regarding whether diabetes confers equivalent risk of coronary heart disease (CHD) as prevalent CHD. We investigated whether diabetes and severe diabetes are CHD risk equivalents. METHODS At baseline, participants in the REasons for Geographic and Racial Differences in Stroke (REGARDS) study (black and white US adults ≥45 years old recruited in 2003-2007) were categorized as having prevalent CHD only (self-reported or electrocardiogram evidence; n = 3,043), diabetes only (self-reported or elevated glucose; n = 4,012), diabetes and prevalent CHD (n = 1,529), and neither diabetes nor prevalent CHD (n = 17,155). Participants with diabetes using insulin and/or with albuminuria (urinary albumin-to-creatinine ratio ≥30 mg/g) were categorized as having severe diabetes. Participants were followed up through 2011 for CHD events (myocardial infarction or fatal CHD). RESULTS During a mean follow-up of 5 years, 1,385 CHD events occurred. The hazard ratios of CHD events comparing participants with diabetes only, diabetes, and prevalent CHD and neither diabetes nor prevalent CHD with those with prevalent CHD were 0.65 (95% CI 0.54-0.77), 1.54 (95% CI 1.30-1.83), and 0.41 (95% CI 0.35-0.47), respectively, after adjustment for demographics and risk factors. Compared with participants with prevalent CHD, the hazard ratio of CHD events for participants with severe diabetes was 0.88 (95% CI 0.72-1.09). CONCLUSIONS Participants with diabetes had lower risk of CHD events than did those with prevalent CHD. However, participants with severe diabetes had similar risk to those with prevalent CHD. Diabetes severity may need consideration when deciding whether diabetes is a CHD risk equivalent.
Collapse
Affiliation(s)
- Favel L Mondesir
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Todd M Brown
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Paul Muntner
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Raegan W Durant
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - April P Carson
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL
| | - Monika M Safford
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL; General Internal Medicine, Weill Cornell Medicine, New York, NY
| | - Emily B Levitan
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, AL.
| |
Collapse
|
6
|
Paul N, Vuddanda V, Mujib M, Aronow WS. Advances in our understanding of the influence of gender on patient outcomes with peripheral arterial disease co-occurring with diabetes. Expert Rev Endocrinol Metab 2016; 11:271-279. [PMID: 30058932 DOI: 10.1080/17446651.2016.1175936] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Peripheral arterial disease is an important predictor of cardiovascular morbidity and mortality. Patients with peripheral arterial disease are at a higher risk of myocardial infarction and stroke. The well-known coronary artery disease risk factors such as diabetes, hypertension, smoking and dyslipidemia are also risk factors for peripheral arterial disease. Hyperglycemia is an important mediator in the pathogenesis of this disease in diabetics, more so in women. The morbidity and poor outcomes associated with peripheral arterial disease in women are emerging. Women are more likely to present at an older age are often asymptomatic and have poorer outcomes with revascularization. Women experience specific sex-related challenges in the various diagnostic methods which could lead to a delay in diagnosis. This is a group which needs close attention and aggressive risk factor modification.
Collapse
Affiliation(s)
- Neha Paul
- a Department of Medicine , New York Medical College , Valhalla , NY , USA
| | - Venkat Vuddanda
- a Department of Medicine , New York Medical College , Valhalla , NY , USA
| | - Marjan Mujib
- a Department of Medicine , New York Medical College , Valhalla , NY , USA
| | - Wilbert S Aronow
- b Division of Cardiology , New York Medical College , Valhalla , NY , USA
| |
Collapse
|
7
|
Chawla R, Loomba R, Guru D, Loomba V. Ischemia Modified Albumin (IMA) - A Marker of Glycaemic Control and Vascular Complications in Type 2 Diabetes Mellitus. J Clin Diagn Res 2016; 10:BC13-6. [PMID: 27134857 DOI: 10.7860/jcdr/2016/15282.7432] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 01/12/2016] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Ischemia modified albumin (IMA) has emerged as a marker for ischemic injury and oxidative damage, particularly in myocardial infarction. There are very few studies on the significance of IMA in other conditions associated with ischemia. The complications of diabetes mellitus (DM) arising out of poor glycaemic control have an underlying ischemic aetiology. AIM To evaluate correlation of IMA with glycaemic control in type 2 DM (T2DM). Secondary aim was to assess the utility of IMA as a marker for vascular complications in T2DM. MATERIALS AND METHODS During this cross-sectional study, a total of 100 diagnosed cases of T2DM were recruited between May 2013 and September 2013. The IMA, HbA1c, lipid profile, creatinine and urine micro-albumin levels were measured and analysed with respect to clinical condition of the patients. STATISTICAL ANALYSIS The epidemiological software, Epi-Info 7.1.5, was used for the statistical analysis, p-value<0.05 was defined as level of significance. RESULTS The study subjects were in the age group from 30 to 75 years and 52.4% were males. There was a great degree of variance in the level of glycaemic control and majority (64.6%) had poor or very poor glycaemic control as reflected by their HbA1c levels. The IMA (Mean ± SEM) levels were found to be higher (62.9 ± 1.7ABSU) in the patients with poor glycaemic control compared to those with good glycaemic control (54.2 ± 3.5 ABSU, p-value < 0.05) and correlated with HbA1c levels (r(2)=0.14). IMA levels also appeared to be related with the changes in lipid profile and increased with increasing total cholesterol levels. The subjects with macro-vascular complications (retinopathy and neuropathy) showed non-significantly higher levels of IMA. The elevation in IMA correlated with the HbA1c and changes in the lipid profile. CONCLUSION IMA correlates with poor glycaemic control and dyslipidaemia associated with T2 DM and could serve as an indicator of oxidant stress in these patients.
Collapse
Affiliation(s)
| | - Rinchu Loomba
- Associate Professor, Department of Biochemistry, Christian Medical College & Hospital , Ludhiana, India
| | - Deepak Guru
- Intern, Christian Medical College & Hospital , Ludhiana, India
| | - Vikas Loomba
- Associate Professor, Department of Medicine, Christian Medical College & Hospital , Ludhiana, India
| |
Collapse
|
8
|
Abstract
This article discusses four subsets of patients that have an increased risk of complications from tendon surgery in the foot and ankle: smokers, diabetics, and patients with peroneal or Achilles tendon pathology. Very little has been published on the complications of other tendon surgeries in the foot and ankle other than Achilles tendon repair. Data can be extrapolated from the general orthopedic literature and animal studies to help guide therapy and treatment options. The foot and ankle surgeon must take into account the entirety of the history and physical examination to develop a treatment plan that optimizes each patient's chance for a complication-free recovery.
Collapse
Affiliation(s)
- Eric A Barp
- The Iowa Clinic, 5950 University Avenue, West Des Moines, IA 50266, USA; Unity Point Health, 1415 Woodland Avenue, #100, Des Moines, IA 50309, USA.
| | - John G Erickson
- Unity Point Health, 1415 Woodland Avenue, #100, Des Moines, IA 50309, USA
| |
Collapse
|
9
|
|
10
|
Jin QH, Ye WL, Chen HH, He XJ, Li TL, Liu Q, Zhong L, Xu L, Han CM. Levels of brain natriuretic peptide are associated with peripheral arterial disease in subjects with type-2 diabetes mellitus. BMC Endocr Disord 2014; 14:27. [PMID: 24655436 PMCID: PMC3998194 DOI: 10.1186/1472-6823-14-27] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 03/17/2014] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The effects of brain natriuretic peptide (BNP) on the risk of cardiovascular disease and atherosclerosis have been studied. However, little information is available regarding peripheral arterial disease (PAD), particularly among subjects with type-2 diabetes mellitus (T2DM). The aim of our study was to assess the potential relationship between BNP levels and PAD among T2DM patients. METHODS The study cohort was 507 T2DM outpatients in which BNP levels were measured. Cross-sectional associations between BNP levels (in tertiles) and PAD were examined. RESULTS Compared withT2DM patients without PAD, BNP levels were markedly higher in patients with PAD (p = 0.001). Correlation analyses showed that the BNP level was negatively correlated with the ankle-brachial index (r = -0.453, p = 0.033). At a cutoff value of 78.2 pg/ml, the BNP level showed a sensitivity of 71.9%, a specificity of 68.1%, and a positive predictive value of 84.3% for a diagnosis of PAD. The area under the receiver-operating characteristic curve increased significantly if BNP levels were incorporated into a predictive model of the potential risk factors for PAD (0.85 vs 0.81, p = 0.029). CONCLUSIONS BNP is a potential and promising biomarker for PAD screening in T2DM patients.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | - Chun-Mao Han
- Department of Burn, The Second Affiliated Hospital of Zhejiang University School of Medicine, 88 JieFang Rd, Hangzhou, Zhejiang 310009, China.
| |
Collapse
|
11
|
Peripheral Arterial Disease. TOPICS IN GERIATRIC REHABILITATION 2013. [DOI: 10.1097/tgr.0b013e31828aef5d] [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]
|
12
|
Jin X, Ma JH, Shen Y, Luo Y, Su XF, Chen YY, Qi SK, Wu JD. An analysis of the relationship between ankle-brachial index and estimated glomerular filtration rate in type 2 diabetes. Angiology 2012; 64:237-41. [PMID: 23162006 DOI: 10.1177/0003319712464515] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We investigated the relationship between peripheral arterial disease (PAD) and renal function in patients with type 2 diabetes mellitus (T2DM). We enrolled 2057 hospitalized patients with T2DM and measured kidney function and ankle-brachial index (ABI). The estimated glomerular filtration rate (eGFR) was derived using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation and ABI was grouped as low (<0.9), low-normal (0.9-1.09), normal (1.1-1.3), and high (>1.3). Logistic regression was used to evaluate the associations of eGFR with ABI. Generally speaking, the ABI was negatively correlated with systolic blood pressure, fasting C-peptide, total cholesterol, and low-density lipoprotein cholesterol while positively correlated with body mass index (P < .05 to <.01). Only a low ABI was positively correlated with eGFR (P < .01). In addition to the association of the ABI with cardiovascular events, stroke, and PAD, ABI may also predict the change in renal function in patients with T2DM.
Collapse
Affiliation(s)
- Xing Jin
- Department of Endocrinology, Nanjing Medical University Affiliated Nanjing Hospital, Nanjing, China
| | | | | | | | | | | | | | | |
Collapse
|
13
|
Aronow WS. Peripheral arterial disease of the lower extremities. Arch Med Sci 2012; 8:375-88. [PMID: 22662015 PMCID: PMC3361053 DOI: 10.5114/aoms.2012.28568] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 10/05/2011] [Accepted: 10/17/2011] [Indexed: 11/17/2022] Open
Abstract
Persons with peripheral arterial disease (PAD) are at increased risk for all-cause mortality, cardiovascular mortality, and mortality from coronary artery disease. Smoking should be stopped and hypertension, dyslipidemia, diabetes mellitus, and hypothyroidism treated. Statins reduce the incidence of intermittent claudication and improve exercise duration until the onset of intermittent claudication in persons with PAD and hypercholesterolemia. The serum low-density lipoprotein cholesterol should be reduced to < 70 mg/dl. Antiplatelet drugs such as aspirin or clopidogrel, angiotensin-converting enzyme inhibitors, and statins should be given to persons with PAD. β-Blockers should be given if coronary artery disease is present. Cilostazol improves exercise time until intermittent claudication. Exercise rehabilitation programs should be used. Revascularization should be performed if indicated.
Collapse
|
14
|
Ma SG, Wei CL, Hong B, Yu WN. Ischemia-modified albumin in type 2 diabetic patients with and without peripheral arterial disease. CLINICS (SAO PAULO, BRAZIL) 2012; 66:1677-80. [PMID: 22012037 PMCID: PMC3180151 DOI: 10.1590/s1807-59322011001000003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 06/14/2011] [Indexed: 01/24/2023]
Abstract
OBJECTIVE: To determine whether there is an association between serum ischemia-modified albumin and the risk factor profile in type 2 diabetic patients with peripheral arterial disease and to identify the risk markers for peripheral arterial disease. METHODS: Participants included 290 patients (35.2% women) with type 2 diabetes. The ankle-brachial pressure index was measured using a standard protocol, and peripheral arterial disease was defined as an ankle-brachial index <0.90 or ≥1.3. The basal ischemia-modified albumin levels and clinical parameters were measured and analyzed. The risk factors for peripheral arterial disease were examined by multiple logistic analyses. RESULTS: Age, systolic blood pressure, total cholesterol, low-density lipoprotein cholesterol, urine albumin, homocysteine, and ischemia-modified albumin were significantly higher in patients with peripheral arterial disease than in disease-free patients (p<0.05), while ankle-brachial index was lower in the former group (p<0.05). Ischemia-modified albumin was positively associated with HbA1c and homocysteine levels (r = 0.220, p = 0.030; r = 0.446, p = 0.044, respectively), while no correlation was found with ankle-brachial index. Multiple logistic analyses indicated that HbA1c, systolic blood pressure, homocysteine and ischemia-modified albumin were independent risk factors for peripheral arterial disease in the diabetic subjects. CONCLUSION: The baseline ischemia-modified albumin levels were significantly higher and positively associated with HbA1c and homocysteine levels in type 2 diabetic patients with peripheral arterial disease. Ischemia-modified albumin was a risk marker for peripheral arterial disease. Taken together, these results might be helpful for monitoring diabetic peripheral arterial disease.
Collapse
Affiliation(s)
- Shao-gang Ma
- Department of Endocrinology and Metabolism, Affiliated Huai'an Hospital, uzhou Medical College, Huai'an, China.
| | | | | | | |
Collapse
|
15
|
Faglia E. Characteristics of peripheral arterial disease and its relevance to the diabetic population. INT J LOW EXTR WOUND 2011; 10:152-66. [PMID: 21856972 DOI: 10.1177/1534734611417352] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Peripheral arterial disease (PAD) is very frequent in diabetics, and it increases with age. Foot examination contributes poorly to diagnosis of PAD. The ankle-brachial index (ABI) measurement is considered the most accurate noninvasive diagnostic method when evaluating PAD: ABI evaluation is recommended in all diabetics aged >50 years. Many diabetic patients with PAD have a concomitant sensitive neuropathy: as a consequence, perception of ischemic pain is remarkably reduced or completely blocked. The result is that the prevalence of claudication in the diabetic population with PAD is lower than the prevalence of critical limb ischemia (CLI) in this population. CLI is a major risk factor for lower extremity amputation without revascularization. Ankle and toe pressures and oxygen tension at the foot are the noninvasive diagnostic parameters of CLI though the medial artery calcification inhibits accurate determination of the ankle and toe pressures, especially when a forefoot ulcer is present. In diabetics, the anatomical localization is mainly distal; arterial wall calcification is frequently observed and occlusion occurs more frequently than stenosis. Such anatomical features, along with the difficulties in the diagnostic approach, account for the fundamental role of CLI as the main prognostic indicator for major amputation. PAD is an expression of systemic atherosclerotic disease. Prognosis of patients with PAD is related to the presence and extent of underlying coronary artery disease (CAD) but also to the severity of PAD: in particular, patients in whom revascularization is not feasible have the highest mortality rate.
Collapse
Affiliation(s)
- Ezio Faglia
- Diabetic Foot Centre, IRCCS MultiMedica, Milan, Italy.
| |
Collapse
|
16
|
Choi SW, Shin MH, Yun WJ, Kim HY, Lee YH, Kweon SS, Rhee JA, Choi JS. Association between hemoglobin A1c, carotid atherosclerosis, arterial stiffness, and peripheral arterial disease in Korean type 2 diabetic patients. J Diabetes Complications 2011; 25:7-13. [PMID: 20106681 DOI: 10.1016/j.jdiacomp.2009.12.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Revised: 11/04/2009] [Accepted: 12/02/2009] [Indexed: 10/19/2022]
Abstract
AIMS To evaluate the association between hemoglobin A(1c) (HbA(1c)), carotid atherosclerosis, arterial stiffness, and peripheral arterial disease (PAD) in Korean type 2 diabetic patients. METHODS A total of 370 type 2 diabetic patients registered with the public health center in Gokseng-gun, Korea, participated in this study. Following an overnight fast, venous blood was collected and analyzed by high-performance liquid chromatography. The carotid intima-media thickness (IMT), amount of carotid plaque, brachial ankle pulse wave velocity (baPWV), and ankle-brachial index (ABI) of each patient were also assessed. RESULTS For categorical variables, we performed logistic regression after adjustment for other CVD risk factors. There was a significant association between HbA(1c) and carotid plaque [OR 2.66, 95% confidence interval (CI) 1.01 to 5.67 for the highest vs. the lowest tertile of HbA(1c)], and PAD (OR 3.75, 95% CI 1.30 to 10.81). For continuous variables, we performed analysis of covariance (ANCOVA) after adjustment for other covariates. The mean values of common carotid artery intima-media thickness (CCA-IMT) and baPWV were not significantly different according to the HbA(1c) tertiles. CONCLUSION HbA(1c) was significantly associated with carotid plaque and PAD, but not CCA-IMT and baPWV in Korean type 2 diabetic patients.
Collapse
Affiliation(s)
- Seong-Woo Choi
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju 501-746, Republic of Korea
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Office management of peripheral arterial disease. Am J Med 2010; 123:790-2. [PMID: 20800143 DOI: 10.1016/j.amjmed.2010.03.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Revised: 03/25/2010] [Accepted: 03/30/2010] [Indexed: 11/22/2022]
Abstract
Patients with peripheral arterial disease are at increased risk for all-cause mortality, cardiovascular mortality, and mortality from coronary artery disease. Smoking should be stopped, and hypertension, diabetes mellitus, and dyslipidemia should be treated. Statins reduce the incidence of intermittent claudication and increase exercise duration until the onset of intermittent claudication in patients with peripheral arterial disease and hypercholesterolemia. Antiplatelet drugs, such as aspirin or clopidogrel, angiotensin-converting enzyme inhibitors, and statins, should be given to all patients with peripheral arterial disease. Beta-blockers should be given if coronary artery disease is present. Exercise rehabilitation programs and cilostazol improve exercise time until the onset of intermittent claudication. Indications for lower-extremity angioplasty, preferably with stenting, or bypass surgery are incapacitating claudication interfering with work or lifestyle in patients; limb salvage in patients with limb-threatening ischemia as manifested by rest pain, nonhealing ulcers, infection, or gangrene; and vasculogenic impotence.
Collapse
|
18
|
Abstract
Many elderly patients have hypertension, although it is more likely to go untreated in this population. Treatment goals are the same in elderly patients as in younger patients, but elderly patients are more likely to have multiple comorbidities, which must be factored into treatment plans. This article highlights the unique challenges in treating this population.
Collapse
Affiliation(s)
- Wilbert S Aronow
- Department of Medicine, Divisions of Cardiology, Geriatrics, and Pulmonary/Critical Care, New York Medical College, Valhalla, NY 10595, USA.
| |
Collapse
|
19
|
Prevalence of Appropriate Management of Diabetes Mellitus in an Academic General Medicine Clinic. Am J Ther 2010; 17:42-5. [PMID: 19262367 DOI: 10.1097/mjt.0b013e3181822e78] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
|
20
|
Abstract
Peripheral arterial disease (PAD) is chronic arterial occlusive disease of the lower extremities caused by atherosclerosis whose prevalence increases with age. Only one-half of women with PAD are symptomatic. Symptomatic and asymptomatic women with PAD are at increased risk for all-cause mortality, cardiovascular mortality, and mortality from coronary artery disease. Modifiable risk factors that predispose women to PAD include active cigarette smoking, passive smoking, diabetes mellitus, hypertension, dyslipidemia, increased plasma homocysteine levels and hypothyroidism. With regard to management, women who smoke should be encouraged to quit and referred to a smoking cessation program. Hypertension, diabetes mellitus, dyslipidemia, and hypothyroidism require treatment. Statins reduce the incidence of intermittent claudication and improve exercise duration until the onset of intermittent claudication in women with PAD and hypercholesterolemia. Anti-platelet drugs such as aspirin or especially clopidogrel, angiotensin-converting enzyme inhibitors and statins should be given to all women with PAD. Beta blockers are recommended if coronary artery disease is present. Exercise rehabilitation programs and cilostazol increase exercise time until intermittent claudication develops. Chelation therapy should be avoided as it is ineffective. Indications for lower extremity percutaneous transluminal angioplasty or bypass surgery in women are (1) incapacitating claudication interfering with work or lifestyle; and (2) limb salvage in women with limb-threatening ischemia as manifested by rest pain, non-healing ulcers, and/or infection or gangrene. Future research includes investigation of mechanisms underlying why women have a higher risk of graft failure and major amputation.
Collapse
Affiliation(s)
- Wilbert S Aronow
- Department of Medicine, Divisions of Cardiology, Geriatrics, and Pulmonary/Critical Care, New York Medical College, Macy Pavilion, Room 138, Valhalla, NY, USA.
| |
Collapse
|
21
|
Abstract
Hypertension is a common comorbidity in persons with diabetes mellitus, and its prevalence increases with advancing age. Both diabetes mellitus and hypertension are independent risk factors for development in older persons of coronary artery disease, ischemic stroke, peripheral arterial disease, and of congestive heart failure. This article reviews studies addressing the implications of hypertension and the older diabetic.
Collapse
Affiliation(s)
- Wilbert S Aronow
- Divisions of Cardiology, Geriatrics, and Pulmonary/Critical Care, Department of Medicine, Westchester Medical Center/New York Medical College, Macy Pavilion, Room 138, Valhalla, NY 10595, USA.
| |
Collapse
|
22
|
Aronow WS. Hypertension in the Nursing Home. J Am Med Dir Assoc 2008; 9:486-90. [PMID: 18755421 DOI: 10.1016/j.jamda.2008.03.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Accepted: 03/27/2008] [Indexed: 01/13/2023]
|
23
|
Aronow WS. Management of peripheral arterial disease of the lower extremities. ACTA ACUST UNITED AC 2008; 33:247-56. [PMID: 18025617 DOI: 10.1007/s12019-007-8013-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2007] [Revised: 11/30/1999] [Accepted: 08/10/2007] [Indexed: 10/22/2022]
Abstract
Smoking should be stopped and hypertension, diabetes mellitus, dyslipidemia, and hypothyroidism treated in patients with peripheral arterial disease (PAD) of the lower extremities. Statins decrease the incidence of intermittent claudication and improve exercise duration until the onset of intermittent claudication in persons with PAD and hypercholesterolemia. Antiplatelet drugs such as aspirin or clopidogrel, especially clopidogrel, angiotensin-converting enzyme inhibitors, and statins should be given to all persons with PAD. Beta blockers should be given if coronary artery disease is present. Exercise rehabilitation programs and cilostazol increase exercise time until intermittent claudication develops. Chelation therapy should be avoided. Indications for lower extremity percutaneous transluminal angioplasty or bypass surgery are (1) incapacitating claudication in persons interfering with work or lifestyle, (2) limb salvage in persons with limb-threatening ischemia as manifested by rest pain, nonhealing ulcers, and/or infection or gangrene, and (3) vasculogenic impotence.
Collapse
Affiliation(s)
- Wilbert S Aronow
- Department of Medicine, Division of Cardiology, New York Medical College, Valhalla, NY 10595, USA.
| |
Collapse
|
24
|
Joseph J, Koka M, Aronow WS. Prevalence of a Hemoglobin A1c Less Than 7.0%, of a Blood Pressure Less Than 130/80 mm Hg, and of a Serum Low-Density Lipoprotein Cholesterol Less Than 100 mg/dL in Older Patients With Diabetes Mellitus in an Academic Nursing Home. J Am Med Dir Assoc 2008; 9:51-4. [PMID: 18187113 DOI: 10.1016/j.jamda.2007.08.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2007] [Revised: 08/29/2007] [Accepted: 08/29/2007] [Indexed: 11/27/2022]
|
25
|
Abstract
Smoking should be stopped and hypertension, diabetes mellitus, dyslipidemia, and hypothyroidism treated in elderly patients with peripheral arterial disease (PAD) of the lower extremities. Statins reduce the incidence of intermittent claudication and improve exercise duration until the onset of intermittent claudication in patients with PAD and hypercholesterolemia. Antiplatelet drugs such as aspirin or clopidogrel, especially clopidogrel, angiotensin-converting enzyme inhibitors, and statins should be given to all elderly patients with PAD without contraindications to these drugs. Beta blockers should be given if coronary artery disease is present. Exercise rehabilitation programs and cilostazol increase exercise time until intermittent claudication develops. Chelation therapy should be avoided. Indications for lower extremity percutaneous transluminal angioplasty or bypass surgery are (1) incapacitating claudication in patients interfering with work or lifestyle; (2) limb salvage in patients with limb-threatening ischemia as manifested by rest pain, nonhealing ulcers, and/or infection or gangrene; and (3) vasculogenic impotence.
Collapse
Affiliation(s)
- Wilbert S Aronow
- Cardiology Division, Department of Medicine, New York Medical College, Valhalla, New York 10595, USA.
| |
Collapse
|