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Prasad A, Choh AC, Gonzalez ND, Garcia M, Lee M, Watt G, Maria Vasquez L, Laing S, Wu S, McCormick JB, Fisher-Hoch S. A high burden of diabetes and ankle brachial index abnormalities exists in Mexican Americans in South Texas. Prev Med Rep 2024; 38:102604. [PMID: 38375159 PMCID: PMC10874877 DOI: 10.1016/j.pmedr.2024.102604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 01/06/2024] [Accepted: 01/08/2024] [Indexed: 02/21/2024] Open
Abstract
Ethnic differences exist in the United States in the interrelated problems of diabetes (DM), peripheral arterial disease (PAD), and leg amputations. The purpose of this study was to determine the prevalence and risk factor associations for subclinical PAD in a population sample of Mexican Americans using the ankle brachial (ABI) index. The ABI-High (higher of the two ankle pressures/highest brachial pressure) and ABI-Low (lower of the two ankle pressures/highest brachial pressure) were calculated to define PAD. Toe brachial index (TBI) was also calculated. 746 participants were included with an age of 53.4 ± 0.9 years, 28.3 % had diabetes mellitus (DM), 12.6 % were smokers, and 51.2 % had hypertension (HTN). Using ABI-High ≤ 0.9, the prevalence of PAD was 2.7 %. This rose to 12.7 % when an ABI-Low ≤ 0.9 was used; 4.0 % of the population had an ABI-High > 1.4. The prevalence of TBI < 0.7 was 3.9 %. DM was a significant risk factor for ABI-High ≤ 0.9 and ABI-High > 1.4, and TBI < 0.7. Increased age, HTN, smoking was associated with ABI-High ≤ 0.9, while being male was associated with ABI-High > 1.4. Increased age, smoking, and lower education were all associated with abnormal TBI. Despite relatively younger mean age than other studied Hispanic cohorts, the present population has a high burden of ABI abnormalities. DM was a consistent risk factor for PAD. These abnormalities indicate an important underlying substrate of vascular and metabolic disease that may predispose this population to the development of symptomatic PAD and incident amputations.
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Affiliation(s)
- Anand Prasad
- The University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Audrey C. Choh
- University of Texas School of Public Health Brownsville Regional Campus, USA
| | - Nelson D. Gonzalez
- University of Texas School of Public Health Brownsville Regional Campus, USA
| | - Marlene Garcia
- The University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Miryoung Lee
- University of Texas School of Public Health Brownsville Regional Campus, USA
| | - Gordon Watt
- Memorial Sloan Kettering Cancer Center, Department of Epidemiology and Biostatistics, India
| | | | - Susan Laing
- The University of Texas Health Science Center at Houston, USA
| | - Shenghui Wu
- The University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Joseph B. McCormick
- University of Texas School of Public Health Brownsville Regional Campus, USA
| | - Susan Fisher-Hoch
- University of Texas School of Public Health Brownsville Regional Campus, USA
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Disparity in association of obesity measures with ankle and brachial systolic blood pressures in Europeans and South Asians. Sci Rep 2022; 12:9174. [PMID: 35655080 PMCID: PMC9163110 DOI: 10.1038/s41598-022-13372-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 05/17/2022] [Indexed: 11/22/2022] Open
Abstract
Obesity causes increases in brachial systolic-blood-pressures (SBP), risks of type 2 diabetes (T2DM) and cardiovascular diseases (CVD). Brachial and ankle SBPs have differential relationship with T2DM and CVD. Our objective was to study the relationship of obesity measures with brachial and ankle SBPs. A population of 1098 adults (South Asians n = 699; 41.70% male and 58.3% female) were recruited over 5 years from primary care practices in England. Their four limbs SBPs were measured using Doppler machine and body-mass-index (BMI) and waist-to-height-ratio (WHtR) calculated. Linear regressions were performed between SBPs and obesity measures, after adjustments for sex, age, ethnicity, T2DM and CVD. The mean age of all participants was 51.3 (SD = 17.2), European was 57.7 (SD 17.2) and South Asian was 47.8 (SD = 16.1). The left posterior tibial [Beta = 1.179, P = 4.559 × 10−15] and the right posterior tibial SBP [Beta = 1.178, P = 1.114 × 10−13] most significantly associated with the BMI. In South Asians, although the left brachial [Beta = 25.775, P = 0.032] and right brachial SBP [Beta = 22.792, P = 0.045] were associated to the WHtR, the left posterior tibial SBP [Beta = 39.894, P = 0.023], association was the strongest. For the first time, we have demonstrated that ankle SBPs had significant association with generalised obesity than brachial systolic blood pressures (SBP), irrespective of ethnicity. However, with respect to visceral obesity, the association with ankle SBP was more significant in South Asians compared to Europeans.
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Abstract
OBJECTIVE Assessment of asymptomatic organ damage in the management of hypertension includes low (<0.9) ankle brachial index (ABI) values. No recommendations are given for patients with high ABI (≥1.3), despite evidence of an association with increased risk. We aimed to study the association of high ABI with all-cause mortality and cardiovascular outcomes in a hypertensive population. METHODS In anonymized clinical records from the Catalan Primary Care (SIDIAP) database, we designed a large cohort of hypertensive patients aged 35-85 years at the start date. Participants were excluded if they had previous heart failure, coronary heart disease, stroke, diabetes mellitus, or chronic kidney disease. The study population was categorized according to ABI values. Cox proportional hazards models were used to assess all-cause mortality, heart failure, acute myocardial infarction, and stroke. RESULTS From 2006 through 2015, SIDIAP records included 44 657 hypertensive patients with an ABI measurement 9126 of whom met inclusion criteria. The median follow-up (first to third quartiles) was 6.0 years (4.7-7.6). High ABI (≥ 1.3) was associated with an increase in mortality risk, hazard ratio, and 95% confidence interval: 1.44 (1.10-1.88), similar to the group with ABI at least 0.9 and less than 1.1, hazard ratio 1.36 (1.12-1.65), and lower than all groups with ABI less than 0.9. High ABI values tended to associate with heart failure, hazard ratio 1.34 (0.95-1.91), but the relation of high ABI with acute myocardial infarction and stroke was nonsignificant, hazard ratios 1.30 (0.72-2.35) and 0.97 (0.65-1.42), respectively. CONCLUSION Patients with high ABI values and hypertension presented an increased all-cause mortality risk that could be considered when advising such patients.
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Yang Y, Liu L, Sun H, Nie F, Hu X. Relation between high Ankle-Brachial Index and cardiovascular outcomes in the general population and cardiovascular disease: a meta-analysis. INT ANGIOL 2019; 39:131-138. [PMID: 31814377 DOI: 10.23736/s0392-9590.19.04276-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Conflicting findings have been reported on the association between high Ankle-Brachial Index (ABI) and cardiovascular outcomes. This meta-analysis aimed to assess the association of abnormally high ABI and cardiovascular outcomes in the general population and suspected or established cardiovascular disease (CVD) patients. EVIDENCE ACQUISITION A comprehensive literature search was conducted in PubMed and Embase databases through November 10th, 2018. All observational studies evaluating the association of high ABI with cardiovascular events including stroke, coronary heart disease (CHD), congestive heart failure, and composite of CVD/all-cause mortality in the general population and suspected or established CVD patients were included. We pooled risk ratios (RR) with 95% confidence intervals (CI) for the abnormally high ABI (> 1.3 or >1.4) versus the reference normal ABI category. EVIDENCE SYNTHESIS We identified 10 cohort studies enrolling 39,421 participants. A random effect model meta-analysis indicated that the pooled RR of composite of CVD/all-cause mortality was 1.07 (95% CI 0.83-1.38) in the general population and 1.26 (95% CI 1.03-1.55) in suspected or established CVD patients. Moreover, participants with abnormally high ABI did not increase the risk of stroke (RR 1.60; 95% CI 0.83-3.06) and CHD (RR 1.40; 95% CI 0.87-2.24) in the general population. CONCLUSIONS Abnormally high ABI appears to be associated with an increased risk of a composite of CVD/all-cause mortality in suspected or established CVD patients but not in the general population. However, additional well-designed studies are required to support the current findings.
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Affiliation(s)
- Yu Yang
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Longguang Liu
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Hongxiao Sun
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Fengze Nie
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Xinhua Hu
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang, China -
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Gu X, Man C, Zhang H, Fan Y. High ankle-brachial index and risk of cardiovascular or all-cause mortality: A meta-analysis. Atherosclerosis 2019; 282:29-36. [DOI: 10.1016/j.atherosclerosis.2018.12.028] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 12/12/2018] [Accepted: 12/20/2018] [Indexed: 11/16/2022]
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Gaudio A, Xourafa A, Rapisarda R, Castellino P, Signorelli SS. Peripheral artery disease and osteoporosis: Not only age‑related (Review). Mol Med Rep 2018; 18:4787-4792. [PMID: 30272311 PMCID: PMC6236267 DOI: 10.3892/mmr.2018.9512] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 07/11/2018] [Indexed: 01/08/2023] Open
Abstract
Osteoporosis and atherosclerosis are two chronic degenerative diseases that share several biochemical pathways and risk factors. Previous studies have associated osteoporosis with carotid atherosclerosis, cardiovascular mortality and stroke, but data on the relationship with peripheral artery disease are few and conflicting. The OPG/RANK/RANKL system and Wnt/beta catenin signaling seem to be deeply involved in the pathogenesis of bone alterations and atherosclerotic processes also affect arteries of the lower extremities. Hypovitaminosis D could also play a role in the relationship of these two diseases. New and larger studies are necessary to shed light on this association and to design new drugs able to act in both these chronic degenerative diseases.
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Affiliation(s)
- Agostino Gaudio
- Department of Clinical and Experimental Medicine, University of Catania, University Hospital 'G. Rodolico', I‑95123 Catania, Italy
| | - Anastasia Xourafa
- Department of Clinical and Experimental Medicine, University of Catania, University Hospital 'G. Rodolico', I‑95123 Catania, Italy
| | - Rosario Rapisarda
- Department of Clinical and Experimental Medicine, University of Catania, University Hospital 'G. Rodolico', I‑95123 Catania, Italy
| | - Pietro Castellino
- Department of Clinical and Experimental Medicine, University of Catania, University Hospital 'G. Rodolico', I‑95123 Catania, Italy
| | - Salvatore Santo Signorelli
- Department of Clinical and Experimental Medicine, University of Catania, University Hospital 'G. Rodolico', I‑95123 Catania, Italy
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Valerio F, Stefano P, Michaela K, Santo SS. Arterial Wall Characteristics in Patients With Peripheral Arterial Disease. Preliminary Data Obtained at Different Arterial Sites by Radiofrequency-Based Wall Tracking System. Angiology 2017; 69:431-437. [DOI: 10.1177/0003319717727656] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Fiore Valerio
- Medical General Medicine Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
| | | | - Kozakova Michaela
- Medical Affairs, Esaote SpA, Genova, Italy
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Signorelli Salvatore Santo
- Medical General Medicine Unit, Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
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Li Q, Zeng H, Liu F, Shen J, Li L, Zhao J, Zhao J, Jia W. High Ankle-Brachial Index Indicates Cardiovascular and Peripheral Arterial Disease in Patients With Type 2 Diabetes. Angiology 2015; 66:918-24. [PMID: 25712289 DOI: 10.1177/0003319715573657] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We assessed the association between high ankle-brachial index (ABI) and cardiovascular disease (CVD) and peripheral arterial disease (PAD) in Chinese patients with type 2 diabetes mellitus (T2DM). The ABI was measured, and foot inspection was performed in 2080 outpatients with T2DM. The clinical characters in different ABI levels were analyzed, and the diagnostic value of high ABI to CVD and PAD was determined. Compared with the normal ABI group, the high ABI (>1.3) group had a higher prevalence of CVD and PAD but less than the low ABI (≤0.9) group. High ABI was an independent risk factor for the development of CVD and PAD. Receiver-operating characteristic curve analysis showed that the optimal cutoff of high ABI to predict CVD and PAD was 1.43 and 1.45, respectively. The odds ratio of high ABI for CVD and PAD was 2.25 and 6.97, respectively, after adjusting for other confounding risk factors. In conclusion, high ABI indicated the risk of CVD and PAD in Chinese populations with T2DM.
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Affiliation(s)
- Qing Li
- Department of Endocrinology & Metabolism, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai Key Laboratory of Diabetes, Shanghai, China
| | - Hui Zeng
- Department of Endocrinology & Metabolism, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai Key Laboratory of Diabetes, Shanghai, China
| | - Fang Liu
- Department of Endocrinology & Metabolism, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai Key Laboratory of Diabetes, Shanghai, China
| | - Jing Shen
- Department of Endocrinology & Metabolism, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai Key Laboratory of Diabetes, Shanghai, China
| | - Lianxi Li
- Department of Endocrinology & Metabolism, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai Key Laboratory of Diabetes, Shanghai, China
| | - Jungong Zhao
- Department of Interventional Radiology, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jun Zhao
- Department of Vascular Surgery, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Weiping Jia
- Department of Endocrinology & Metabolism, Shanghai Jiao-Tong University Affiliated Sixth People's Hospital, Shanghai Clinical Medical Center of Diabetes, Shanghai Key Clinical Center of Metabolic Diseases, Shanghai Institute for Diabetes, Shanghai Key Laboratory of Diabetes, Shanghai, China
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Kwiatkowska W, Knysz B, Arczyńska K, Drelichowska J, Czarnecki M, Gąsiorowski J, Karczewski M, Witkiewicz W. Peripheral arterial disease and ankle-brachial index abnormalites in young and middle-aged HIV-positive patients in lower Silesia, Poland. PLoS One 2014; 9:e113857. [PMID: 25503743 PMCID: PMC4264742 DOI: 10.1371/journal.pone.0113857] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 10/31/2014] [Indexed: 11/18/2022] Open
Abstract
Background Peripheral arterial disease (PAD) is a clinical manifestation of atherosclerosis and mainly refers to elderly patients, having a negative impact on their functionality and quality of life. The findings of previous studies in HIV-infected patients have shown that cardiovascular risk is higher and PAD occurs more frequently than in the general population. There are also contradictory observations. Much less is known about the ankle-brachial index (ABI) value in asymptomatic HIV-infected patients. The aim of this study was to evaluate the prevalence of PAD and ankle-brachial index abnormalities as well as to determine risk factors related to the disease in a group of Polish HIV–positive patients. Methods and Findings One hundred and eleven young to middle aged HIV–positive subjects and 40 noninfected subjects were enrolled into the study. Resting ABI measurements were performed and cardiovascular risk was analysed as well. Subgroups were created according to the ABI values: low (PAD), borderline, normal, high and altered ABI. Symptomatic PAD was observed in 2 HIV–positive patients, asymptomatic PAD was not diagnosed. The ABI value is lower and more varied, in 22.5% of the study group altered ABI values were found. Six subjects demonstrated borderline ABI, and 15 high ABI, including >1.4. In the control group no low or very high values were reported. A relation between low ABI and cardiovascular family history and between altered ABI and high–density–lipoprotein cholesterol (HDL–C) level was demonstrated. Conclusions In young and middle–aged HIV–positive patients, symptomatic PAD prevalence is comparable to that observed in the overall population. Among asymptomatic patients PAD is not reported. The ABI value in HIV–positive patients is more varied compared to the HIV–negative subjects; the altered ABI shows a strong relation with low HDL–C levels and metabolic syndrome.
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Affiliation(s)
- Wiesława Kwiatkowska
- Wrovasc – Integrated Cardiovascular Centre, Regional Specialist Hospital, Research and Development Center in Wroclaw, Wroclaw, Poland
- Department of Angiology, Regional Specialist Hospital in Wroclaw, Research and Development Center in Wroclaw, Wroclaw, Poland
| | - Brygida Knysz
- Wrovasc – Integrated Cardiovascular Centre, Regional Specialist Hospital, Research and Development Center in Wroclaw, Wroclaw, Poland
- Department of Infectious Diseases, Wroclaw Medical University, Wroclaw, Poland
- * E-mail:
| | - Katarzyna Arczyńska
- Wrovasc – Integrated Cardiovascular Centre, Regional Specialist Hospital, Research and Development Center in Wroclaw, Wroclaw, Poland
| | - Justyna Drelichowska
- Wrovasc – Integrated Cardiovascular Centre, Regional Specialist Hospital, Research and Development Center in Wroclaw, Wroclaw, Poland
- Department of Angiology, Regional Specialist Hospital in Wroclaw, Research and Development Center in Wroclaw, Wroclaw, Poland
| | - Marcin Czarnecki
- Wrovasc – Integrated Cardiovascular Centre, Regional Specialist Hospital, Research and Development Center in Wroclaw, Wroclaw, Poland
- Department of Infectious Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Jacek Gąsiorowski
- Wrovasc – Integrated Cardiovascular Centre, Regional Specialist Hospital, Research and Development Center in Wroclaw, Wroclaw, Poland
- Department of Infectious Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Maciej Karczewski
- Wrovasc – Integrated Cardiovascular Centre, Regional Specialist Hospital, Research and Development Center in Wroclaw, Wroclaw, Poland
| | - Wojciech Witkiewicz
- Wrovasc – Integrated Cardiovascular Centre, Regional Specialist Hospital, Research and Development Center in Wroclaw, Wroclaw, Poland
- Department of Angiology, Regional Specialist Hospital in Wroclaw, Research and Development Center in Wroclaw, Wroclaw, Poland
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Signorelli SS, Fiore V, Mangiafico M, Castrogiovanni D. Arterial Plaques in Peripheral Arteries Diagnosed by Ultrasound in a Cohort of Patients With Type 2 Diabetes Mellitus. Angiology 2014; 66:675-9. [DOI: 10.1177/0003319714548443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Macroangiopathy (eg, peripheral arterial disease) diagnosis in type 2 diabetes mellitus (T2DM) can be carried out by ultrasound. A surveillance study was performed in 366 consecutive patients (166 patients with T2DM and 200 non-T2DM) aiming to evaluate the frequency of single or multiple arterial plaques (Aplqs) in lower limbs and the relationship with different factors (age, duration of T2DM, glycemic balance, DM treatment, smoking habit, and microalbuminuria). Single and multiple Aplqs, respectively, were found in 10.2% and 38.6% among the patients with T2DM. Age, male gender ( P < .0002), duration of T2DM ( P < .009), insulin therapy ( P < .03), and mediocalcinosis ( P < .001) were risk factors in patients with T2DM. In conclusion, Aplqs of lower limbs are frequent in T2DM and several factors can play a determining role. Ultrasound is a helpful diagnostic tool.
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Affiliation(s)
- Salvatore Santo Signorelli
- Department of Medical and Pediatric Science, University of Catania, Medical Angiology Unit, Garibaldi Hospital, Catania, Italy
| | - Valerio Fiore
- Department of Medical and Pediatric Science, University of Catania, Medical Angiology Unit, Garibaldi Hospital, Catania, Italy
| | - Marco Mangiafico
- Department of Medical and Pediatric Science, University of Catania, Medical Angiology Unit, Garibaldi Hospital, Catania, Italy
| | - Davide Castrogiovanni
- Department of Medical and Pediatric Science, University of Catania, Medical Angiology Unit, Garibaldi Hospital, Catania, Italy
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Lilly SM, Jacobs DR, Kronmal R, Bluemke DA, Criqui M, Lima J, Allison M, Duprez D, Segers P, Chirinos JA. Arterial compliance across the spectrum of ankle-brachial index: the Multiethnic Study of Atherosclerosis. Atherosclerosis 2014; 233:691-696. [PMID: 24583417 DOI: 10.1016/j.atherosclerosis.2014.01.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 12/06/2013] [Accepted: 01/08/2014] [Indexed: 12/27/2022]
Abstract
OBJECTIVE A low ankle-brachial index is associated with cardiovascular disease and reduced arterial compliance. A high ankle-brachial index is also associated with an increased risk of cardiovascular events. We tested the hypothesis that subjects with a high ankle-brachial index demonstrate a lower arterial compliance. In addition, we assessed whether pulse pressure amplification is increased among subjects with a high ankle-brachial index. METHODS We studied 6814 adults enrolled in the Multiethnic Study of Atherosclerosis who were, by definition, free of clinical cardiovascular disease at baseline. Differences in total arterial compliance (ratio of stroke volume to pulse pressure), aortic and carotid distensibility (measured with magnetic resonance imaging and duplex ultrasound, respectively) were compared across ankle-brachial index subclasses (≤0.90, 0.91-1.29; ≥1.30) with analyses adjusted for cardiovascular risk factors and subclinical atherosclerosis. RESULTS Peripheral arterial disease was detected in 230 (3.4%) and high ABI in 648 (9.6%) of subjects. Those with high ankle-brachial index demonstrated greater aortic/radial pulse pressure amplification than those with a normal ankle-brachial index. In adjusted models aortic and carotid distensibility as well as total arterial compliance, were lowest among those with ankle-brachial index≤0.9 (p<0.01 vs. all), but were not reduced in subjects with an ankle-brachial index≥1.3. CONCLUSION Lower aortic, carotid and total arterial compliance is not present in subjects free of overt cardiovascular disease and with a high ankle-brachial index. However, increased pulse pressure amplification contributes to a greater ankle-brachial index in the general population and may allow better characterization of individuals with this phenotype.
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Affiliation(s)
- Scott M Lilly
- Division of Cardiovascular Medicine, Ohio State University Heart and Vascular Center, Columbus, OH, USA
| | - David R Jacobs
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, MN, USA
| | - Richard Kronmal
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | - David A Bluemke
- Departments of Radiology and Medicine, John Hopkins University School of Medicine, Baltimore, MD, USA
| | - Michael Criqui
- Division of Preventive Medicine, University of California, San Diego, San Diego, CA, USA
| | - Joao Lima
- Departments of Radiology and Medicine, John Hopkins University School of Medicine, Baltimore, MD, USA
| | - Matthew Allison
- Division of Preventive Medicine, University of California, San Diego, San Diego, CA, USA
| | - Daniel Duprez
- Cardiovascular Division, University of Minnesota, University of Minnesota, MN, USA
| | - Patrick Segers
- Institute Biomedical Technology, Ghent University, Gent, Belgium
| | - Julio A Chirinos
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, USA; Philadelphia VA Medical Center, Philadelphia, PA, USA.
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Lilly SM, Qasim AN, Mulvey CK, Churchill TW, Reilly MP, Eraso LH. Non-compressible arterial disease and the risk of coronary calcification in type-2 diabetes. Atherosclerosis 2013; 230:17-22. [PMID: 23958247 DOI: 10.1016/j.atherosclerosis.2013.06.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 06/10/2013] [Accepted: 06/11/2013] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Ankle-brachial index (ABI) screening is recommended for the detection of asymptomatic peripheral arterial disease (PAD) in at-risk populations, including diabetics. A low ABI identifies obstructive lower extremity vascular disease and predicts CVD events and increased mortality. A high ABI represents non-compressible arterial disease (NCAD), and is also associated with increased mortality and vascular events. Our objective is to investigate whether low and high ABI have distinct patterns of association with cardiovascular disease (CVD) risk factors and subclinical atherosclerosis in individuals with type-II diabetes mellitus. METHODS The Penn Diabetes Heart Study (PDHS) is a prospective observational cohort of diabetic individuals without clinically evident CVD. Multivariate logistic and Tobit linear regression were used to compare CVD risk factors and coronary artery (CAC) among 1863 subjects with PAD (ABI ≤ 0.9), NCAD (ABI ≥ 1.4 or non-compressible) or normal ABI (0.91-1.39). RESULTS Compared to those with normal ABI, PAD was associated with smoking, obesity, and lower HDL-c; while diabetes duration and reduced renal function were associated with NCAD. Both PAD and NCAD were independently associated with increased CAC compared to those with normal ABI, and these relationships were not attenuated in multiply adjusted models. CONCLUSION NCAD bears a distinct relationship to traditional CVD risk factors among diabetics, though like PAD is independently associated with increased CAC. These findings support the recognition of NCAD as a high-risk phenotype and provide additional relevance to ABI screening in diabetics.
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Affiliation(s)
- Scott M Lilly
- Division of Cardiovascular Medicine, Section of Interventional Cardiology, The Ohio State University, Columbus, 43210, USA.
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Weinberg I, Giri J, Calfon MA, Hawkins BM, Weinberg MD, Margey R, Hannon K, Schainfeld RM, Jaff MR. Anatomic correlates of supra-normal ankle brachial indices. Catheter Cardiovasc Interv 2013; 81:1025-30. [DOI: 10.1002/ccd.24604] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 08/09/2012] [Indexed: 11/08/2022]
Affiliation(s)
- Ido Weinberg
- Section of Vascular Medicine; Division of Cardiovascular Medicine; The Massachusetts General Hospital Vascular Center; Boston; Massachusetts
| | - Jay Giri
- Section of Vascular Medicine; Division of Cardiovascular Medicine; The Massachusetts General Hospital Vascular Center; Boston; Massachusetts
| | - Marcella A. Calfon
- Section of Vascular Medicine; Division of Cardiovascular Medicine; The Massachusetts General Hospital Vascular Center; Boston; Massachusetts
| | - Beau M. Hawkins
- Section of Vascular Medicine; Division of Cardiovascular Medicine; The Massachusetts General Hospital Vascular Center; Boston; Massachusetts
| | - Mitchell D. Weinberg
- Section of Vascular Medicine; Division of Cardiovascular Medicine; The Massachusetts General Hospital Vascular Center; Boston; Massachusetts
| | - Ronan Margey
- Section of Vascular Medicine; Division of Cardiovascular Medicine; The Massachusetts General Hospital Vascular Center; Boston; Massachusetts
| | - Kathleen Hannon
- Section of Vascular Medicine; Division of Cardiovascular Medicine; The Massachusetts General Hospital Vascular Center; Boston; Massachusetts
| | - Robert M. Schainfeld
- Section of Vascular Medicine; Division of Cardiovascular Medicine; The Massachusetts General Hospital Vascular Center; Boston; Massachusetts
| | - Michael R. Jaff
- Section of Vascular Medicine; Division of Cardiovascular Medicine; The Massachusetts General Hospital Vascular Center; Boston; Massachusetts
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Yang B, Li M, Chen B, Xu Y, Li TD. Deterioration of endothelial function and carotid intima-media thickness in Tibetan male adolescents exposed to second-hand smoke. J Renin Angiotensin Aldosterone Syst 2012; 13:413-9. [PMID: 22465995 DOI: 10.1177/1470320312440901] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
INTRODUCTION It has been commonly accepted that second-hand smoke (SHS) is associated with atherosclerosis and endothelial dysfunction. There is growing evidence that the changes might begin in childhood. Unfortunately, no study has focused on the early atherosclerosis of Tibetan adolescents exposed to SHS. AIMS We aimed to investigate the endothelial function and carotid atherosclerosis in healthy school-aged Tibetan male adolescents. MATERIALS AND METHODS All passive smoking participants (SHS) were students were 16 years old and male, and were recruited through middle schools in Lhasa city. In total 624 subjects were accepted after excluding subjects who actively smoked. The adolescents were divided into three groups according to serum cotinine level: high cotinine group (High Group) with 205 boys, intermediate cotinine group (Intermediate Group) with 210 boys, and low cotinine group (Low Group) with 209 boys. Venous blood was sampled for the measurement of cotinine concentration, lipid profile and endothelin-1 (ET-1) quantitation. High-resolution B-mode ultrasonography was performed to evaluate carotid intima-media thickness (cIMT) and intima smoothness. The invasive vascular endothelial function was evaluated through the measurement of flow-mediated dilation (FMD) with B-mode ultrasound and ankle-brachial index (ABI) by using a blood pressure cuff and a Doppler instrument. RESULTS No statistical significance was found between groups in total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglyceride, ApoA-I, systolic blood pressure, diastolic blood pressure, and heart rate (p>0.05). In the lipid profile, only apolipoprotein B (ApoB) values were different between groups: ApoB in the High Group was higher than in the Low Group (p=0.0164). Plasma ET-1 concentrations in the High Group were also much higher than in the Intermediate and Low Groups (p=0.0112, p<0.001). The cIMT and intima smoothness had deteriorated in the High Group compared with the Low Group (p<0.001 and p<0.05 respectively). FMD and ABI, which indicate vascular endothelial function, was decreased in the High Group compared with the Intermediate and Low Groups (FMD, p<0.001; ABI, p<0.001). CONCLUSIONS SHS was associated with sub-clinical carotid atherosclerosis and endothelial dysfunction in Tibetan school-aged male adolescents. Considering the widespread exposure to SHS and the clinical relevance of early atherosclerosis, this result is of public health importance in Tibet, where health education is not satisfactory. Data from our study emphasize the importance of endorsing smoke-free environments for adolescents.
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Affiliation(s)
- Bo Yang
- Cardiovascular Department, Chinese PLA General Hospital, Beijing, China.
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Abstract
Serum uric acid (SUA) is a potential risk factor for atherosclerosis. We assessed the relationship between SUA and subclinical atherosclerosis in Korean men (n = 3010). Multidetector computed tomography (MDCT) and ultrasonographic measurements of coronary artery calcification (CAC) and carotid intima–media thickness (cIMT), respectively, are markers of subclinical atherosclerosis. Odds ratios (ORs) of CAC score and cIMT across SUA levels were 1.101 ( P = .046) and 1.266 ( P = .002), respectively, after adjustment for several variables. The independent association between CAC and cIMT was observed (OR = 1.231, P < .001). Serum uric acid was independently associated with metabolic syndrome (MetS) with an OR of 1.415 ( P < .001). Metabolic syndrome was only independently associated with cIMT, with an OR of 2.103 ( P = .003). High-sensitivity C-reactive protein was positively correlated with SUA ( r = .125, P < .001). Serum uric acid level is independently associated with CAC, cIMT, and MetS in Korean men.
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Affiliation(s)
- Zhengyun Zhang
- Department of Surgery, Shanghai Children’s Medical Center, School of Medicine, Shanghai Jiaotong University, Shanghai, China
- Transplantation Research Center, Samsung Biomedical Research Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Luqin Bian
- Department of Pneumoconiosis, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yoonho Choi
- Center for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
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