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Peters F, Kreutzburg T, Kuchenbecker J, Debus S, Marschall U, L'Hoest H, Behrendt CA. A retrospective cohort study on the provision and outcomes of pharmacological therapy after revascularisation for peripheral arterial occlusive disease: a study protocol. BMJ SURGERY, INTERVENTIONS, & HEALTH TECHNOLOGIES 2020; 2:e000020. [PMID: 35047784 PMCID: PMC8749289 DOI: 10.1136/bmjsit-2019-000020] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 11/22/2019] [Accepted: 12/10/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Symptomatic peripheral arterial occlusive disease (PAOD) involves highly complex and costly revascularisations for preventing adverse limb events and impaired survival. Contrary to recommendations from valid guidelines, a large group of patients do not receive adequate pharmacological therapy after such interventions. Based on health insurance claims data, our study aims to assess (1) the extent of provision of pharmacological therapy after revascularisation and (2) related long-term outcomes for all patients and subgroups, that is, gender and disease severity. METHODS A retrospective observational population-based cohort study will be based on data from the second largest statutory health insurance fund in Germany (BARMER) covering about 13% of the insured population (~10 million patients). Study entry is the index revascularisation for symptomatic PAOD. Study variables will be analysed and compared among subgroups using parametric and non-parametric tests, generalised linear regression analysis and survival models. DISCUSSION This study will provide a comprehensive insight in the extent and time trends of adequate provision of pharmacological therapy and long-term outcomes for patients with symptomatic PAOD. This may help to identify those patients benefiting most from improved pharmacological therapy for increasing the success of revascularisations in general. TRIAL REGISTRATION NCT03909022.
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Affiliation(s)
- Frederik Peters
- Department of Vascular Medicine, University Medical Center Hamburg-Eppendorf, GermanVasc, Hamburg, Germany
| | - Thea Kreutzburg
- Department of Vascular Medicine, University Medical Center Hamburg-Eppendorf, GermanVasc, Hamburg, Germany
| | - Jenny Kuchenbecker
- Department of Vascular Medicine, University Medical Center Hamburg-Eppendorf, GermanVasc, Hamburg, Germany
| | - Sebastian Debus
- Department of Vascular Medicine, University Medical Center Hamburg-Eppendorf, GermanVasc, Hamburg, Germany
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Nastasi DR, Smith JR, Moxon JV, Trollope A, Golledge J. Prescription of Pharmacotherapy and the Incidence of Stroke in Patients With Symptoms of Peripheral Artery Disease. Stroke 2019; 49:2953-2960. [PMID: 30571405 DOI: 10.1161/strokeaha.118.022922] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background and Purpose- Current guidelines recommend prescription of a number of medications to prevent cardiovascular events in patients with peripheral artery disease (PAD). The impact that these medications have on the incidence of stroke in PAD patients has not been thoroughly investigated. This study aimed to investigate the association of prescription of antihypertensive drugs, antiplatelet medications, and statins, as well as cardiovascular disease risk factors, with stroke incidence in patients with symptoms of PAD. Methods- A database search was completed to identify studies reporting the incidence of stroke and prescription of antihypertensive drugs, antiplatelet medications, and statins in patients with PAD symptoms. A random-effects model was used to meta-analyze the incidence of stroke in patients with symptoms of PAD and in subgroups with intermittent claudication and critical limb ischemia. Metaregression was performed to explore the association between the incidence of stroke and the prescription of medications and the presence of cardiovascular disease risk factors. Results- Twelve studies including 67 915 patients with symptoms of PAD were included. A meta-analysis of data from 7 studies demonstrated an incidence of stroke of 1.31 per 100 patient-years. Patients with critical limb ischemia experienced stroke 2.3× more frequently than those with intermittent claudication (95% CI, 1.58-3.36; P<0.01). The reported prescription of antihypertensive agents varied between 10% and 71%, antiplatelet drugs between 49% and 90%, and statins between 11% and 79% in different studies. Metaregression suggested an association between a lower incidence of stroke and the prescription of antiplatelet drugs ( R2=0.81, P<0.01), and statins ( R2=0.85, P<0.01), but not antihypertensives medications. A prior history of cerebrovascular events was associated with a higher incidence of stroke ( R2=0.58, P<0.05). Conclusions- This review supports previous research which suggests the need for more effective means of ensuring more widespread prescription of preventative medications in patients with PAD.
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Affiliation(s)
- Domenico R Nastasi
- From the Queensland Research Centre for Peripheral Arterial Disease (D.R.N., J.R.S., J.V.M., A.T., J.G.), James Cook University, Townsville, QLD, Australia.,College of Medicine and Dentistry, The Australian Institute of Tropical Health and Medicine (D.R.N., J.R.S., J.V.M., A.T., J.G.), James Cook University, Townsville, QLD, Australia
| | - Justin R Smith
- From the Queensland Research Centre for Peripheral Arterial Disease (D.R.N., J.R.S., J.V.M., A.T., J.G.), James Cook University, Townsville, QLD, Australia.,College of Medicine and Dentistry, The Australian Institute of Tropical Health and Medicine (D.R.N., J.R.S., J.V.M., A.T., J.G.), James Cook University, Townsville, QLD, Australia
| | - Joseph V Moxon
- From the Queensland Research Centre for Peripheral Arterial Disease (D.R.N., J.R.S., J.V.M., A.T., J.G.), James Cook University, Townsville, QLD, Australia.,College of Medicine and Dentistry, The Australian Institute of Tropical Health and Medicine (D.R.N., J.R.S., J.V.M., A.T., J.G.), James Cook University, Townsville, QLD, Australia
| | - Alexandra Trollope
- From the Queensland Research Centre for Peripheral Arterial Disease (D.R.N., J.R.S., J.V.M., A.T., J.G.), James Cook University, Townsville, QLD, Australia.,Discipline of Anatomy (A.T.), James Cook University, Townsville, QLD, Australia.,College of Medicine and Dentistry, The Australian Institute of Tropical Health and Medicine (D.R.N., J.R.S., J.V.M., A.T., J.G.), James Cook University, Townsville, QLD, Australia
| | - Jonathan Golledge
- From the Queensland Research Centre for Peripheral Arterial Disease (D.R.N., J.R.S., J.V.M., A.T., J.G.), James Cook University, Townsville, QLD, Australia.,College of Medicine and Dentistry, The Australian Institute of Tropical Health and Medicine (D.R.N., J.R.S., J.V.M., A.T., J.G.), James Cook University, Townsville, QLD, Australia.,Department of Vascular and Endovascular Surgery, The Townsville Hospital, QLD, Australia (J.G.)
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Dai W, Li D, Cai Y, Qiu E, Xu J, Li J, Wang Y, Guo Y, Li Y, Jiang B, Zhang Y, Ge J, Yao C, Zhang R, Liu G, Yao G, Cai J, Zhao X. Association between homocysteine and multivascular atherosclerosis in stroke-related vascular beds determined by three-dimensional magnetic resonance vessel wall imaging. J Clin Neurosci 2019; 70:72-78. [PMID: 31447358 DOI: 10.1016/j.jocn.2019.08.076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 08/08/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Atherosclerosis in stroke-related vascular beds is the major cause of stroke. Studies demonstrated that multivascular atherosclerosis is prevalent in stroke patients and those with multivascular plaques had higher risk of recurrent stroke. OBJECTIVES This study investigated the relationship between homocysteine and multivascular atherosclerosis in stroke-related vascular beds using magnetic resonance imaging. METHODS Patients with recent ischemic cerebrovascular symptoms were enrolled and underwent three-dimensional magnetic resonance vessel wall imaging for intracranial arteries, extracranial carotid arteries and aortic arch. Traditional risk factors and homocysteine were measured. Presence of multivascular plaques defined as plaques in at least two stroke-related vascular beds on magnetic resonance imaging was determined. The relationship between homocysteine and characteristics of multivascular plaques was determined. RESULTS Of 49 enrolled patients (mean age: 56.3 ± 13.8 years; 35 males), 23 had multivascular plaques. Homocysteine (odds ratio, 1.17; 95% confidence interval, 1.02-1.34; p = 0.022) and age (odds ratio, 1.71; 95% confidence interval, 1.22-2.41; p = 0.002) were significantly associated with presence of multivascular plaques. The adjusted associations remained significant (both p < 0.05). In discriminating presence of multivascular plaques, the area-under-the-curve of age, homocysteine and combination of them was 0.79, 0.70 and 0.87 respectively. CONCLUSIONS Homocysteine is independently associated with stroke-related multivascular plaques and combination of age and homocysteine has stronger predictive value.
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Affiliation(s)
- Wei Dai
- Department of Neurology, Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China; Department of Neurology, Chinese PLA General Hospital & Medical School of Chinese PLA, Beijing 100853, China
| | - Dongye Li
- Center for Brain Disorders Research, Capital Medical University and Beijing Institute for Brain Disorders, Beijing 100069, China
| | - Ying Cai
- Department of Radiology, Taizhou People's Hospital, Taizhou 225300, China
| | - Enchao Qiu
- Department of Neurology, Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
| | - Jingwei Xu
- Department of Neurology, Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
| | - Jing Li
- Department of Neurology, Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
| | - Yunxia Wang
- Department of Neurology, Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
| | - Yueqi Guo
- Department of Neurology, Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
| | - Yifan Li
- Department of Neurology, Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
| | - Bo Jiang
- Department of Neurology, Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
| | - Yunyan Zhang
- Department of Neurology, Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
| | - Junling Ge
- Department of Neurology, Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
| | - Cunshan Yao
- Department of Neurology, Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China
| | - Runhua Zhang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Gaifen Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China
| | - Guoen Yao
- Department of Neurology, Fourth Medical Center of Chinese PLA General Hospital, Beijing 100048, China.
| | - Jianming Cai
- Department of Radiology, First Medical Center of Chinese PLA General Hospital, Beijing 100853, China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing 100084, China; Center of Stroke, Beijing Institute for Brain Disorders, Beijing 100069, China.
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Afzelius P, Molsted S, Tarnow L. Intermittent vacuum treatment with VacuMed does not improve peripheral artery disease or walking capacity in patients with intermittent claudication. Scandinavian Journal of Clinical and Laboratory Investigation 2018; 78:456-463. [DOI: 10.1080/00365513.2018.1497803] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Pia Afzelius
- Department of Diagnostic Imaging, Section of Clinical Physiology and Nuclear Medicine, Nordsjællands Hospital, University of Copenhagen, Hillerød, Denmark
| | - Stig Molsted
- Department of Clinical Research, Nordsjællands Hospital, Hillerød, Denmark
| | - Lise Tarnow
- Department of Clinical Research, Nordsjællands Hospital, Hillerød, Denmark
- Steno Diabetes Center, Zealand, Denmark
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Stam-Slob MC, van der Graaf Y, de Borst GJ, Cramer MJ, Kappelle LJ, Westerink J, Visseren FL. Effect of Type 2 Diabetes on Recurrent Major Cardiovascular Events for Patients With Symptomatic Vascular Disease at Different Locations. Diabetes Care 2015; 38:1528-35. [PMID: 26038582 DOI: 10.2337/dc14-2900] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2014] [Accepted: 04/07/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Our aim is to compare the effect of type 2 diabetes on recurrent major cardiovascular events (MCVE) for patients with symptomatic vascular disease at different locations. RESEARCH DESIGN AND METHODS A total of 6,841 patients from the single-center, prospective Second Manifestations of ARTerial disease (SMART) cohort study from Utrecht, the Netherlands, with clinically manifest vascular disease with (n = 1,155) and without (n = 5,686) type 2 diabetes were monitored between 1996 and 2013. The effect of type 2 diabetes on recurrent MCVE was analyzed with Cox proportional hazards models, stratified for disease location (cerebrovascular disease, peripheral artery disease, abdominal aortic aneurysm, coronary artery disease, or polyvascular disease, defined as ≥2 vascular locations). RESULTS Five-year risks for recurrent MCVE were 9% in cerebrovascular disease, 9% in peripheral artery disease, 20% in those with an abdominal aortic aneurysm, 7% in coronary artery disease, and 21% in polyvascular disease. Type 2 diabetes increased the risk of recurrent MCVE in coronary artery disease (hazard ratio [HR] 1.67; 95% CI 1.25-2.21) and seemed to increase the risk in cerebrovascular disease (HR 1.36; 95% CI 0.90-2.07), while being no risk factor in polyvascular disease (HR 1.12; 95% CI 0.83-1.50). Results for patients with peripheral artery disease (HR 1.42; 95% CI 0.79-2.56) or an abdominal aortic aneurysm (HR 0.93; 95% CI 0.23-3.68) were inconclusive. CONCLUSIONS Type 2 diabetes increased the risk of recurrent MCVE in patients with coronary artery disease, but there is no convincing evidence that it is a major risk factor for subsequent MCVE in all patients with symptomatic vascular disease.
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Affiliation(s)
- Manon C Stam-Slob
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Yolanda van der Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Gert Jan de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Maarten J Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - L J Kappelle
- Department of Neurology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jan Westerink
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Frank L Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
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Jotoku M, Okura T, Miyoshi KI, Irita J, Nagao T, Kukida M, Tanino A, Kudo K, Enomoto D, Pei Z, Higaki J. Carotid hemodynamics is associated with monocyte count determined by serum homocysteine level in patients with essential hypertension. Clin Exp Hypertens 2014; 37:358-63. [PMID: 25347055 DOI: 10.3109/10641963.2014.972563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
To examine the association between pulsatility index (PI) in the common carotid artery (CCA) as a marker of vascular resistance and cardiovascular risk factors, including serum homocysteine and inflammation, 67 hypertensive patients were enrolled. PI correlated with homocysteine and interleukin-6, monocyte count, gender, age and BMI, with monocyte count and age being independent determinants for PI. In turn, monocyte count correlated with homocysteine, tumor necrosis factor-alpha, and HDL-cholesterol, BMI, and gender, with HDL-cholesterol and homocysteine being independent determinants for monocyte count. These results indicated monocyte count determined by homocysteine is associated with arterial stiffness in hypertensive patients.
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Affiliation(s)
- Masanori Jotoku
- Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine , Ehime , Japan
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The Modification of Diet in Renal Disease 4-calculated glomerular filtration rate is a better prognostic factor of cardiovascular events than classical cardiovascular risk factors in patients with peripheral arterial disease. J Vasc Surg 2012; 56:1324-30. [DOI: 10.1016/j.jvs.2012.04.049] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Revised: 04/16/2012] [Accepted: 04/17/2012] [Indexed: 02/07/2023]
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Vega de Céniga M, Estallo L, Esteban Salan M, Bravo E, Izagirre M, Barba A. Valor pronóstico de marcadores inflamatorios y perfil lipídico en pacientes con claudicación intermitente. Estudio piloto. Med Clin (Barc) 2011; 136:244-7. [DOI: 10.1016/j.medcli.2010.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2010] [Revised: 07/09/2010] [Accepted: 07/13/2010] [Indexed: 11/26/2022]
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Stansby G, Mister R, Fowkes G, Roughton M, Nugara F, Brittenden J, Bradbury A, Ashley S, Shearman C, Hannon R, Flather M. High Risk of Peripheral Arterial Disease in the United Kingdom: 2-Year Results of a Prospective Registry. Angiology 2011; 62:111-8. [DOI: 10.1177/0003319710387917] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
We report a prospective 2-year, multicenter study of patients presenting with intermittent claudication (IC; ankle brachial blood pressure index, ABPI ≤ 0.9). Mean age of the 473 patients enrolled was 68 years, 20% were diabetics, 30% had prior symptomatic coronary heart disease (CHD), 7% had prior stroke, and 39% were current smokers. At baseline, 26.2% of patients had BP ≤ 140/85 mm Hg or lower and at 2 years this figure was 32.5% (P = .01). Current smokers had fallen to 27% (from 39%) at 2 years (P < .001). Use of antiplatelet agents, statins, and angiotensin converting enzyme inhibitors increased significantly during the course of the study as did claudication distance. Death and the composite of death, stroke or myocardial infarction (MI), occurred in 8.4% and 11.6% of patients, respectively. Prognosis was worse in patients with prior history of CHD, older age, those with diabetes and a lower ABPI.
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Affiliation(s)
- Gerard Stansby
- Northern Vascular Unit, University of Newcastle, Freeman Hospital, Newcastle, UK,
| | - Rebecca Mister
- Clinical Trials and Evaluation Unit, Royal Brompton and Harefield NHS Trust, London, UK, NHMRC Clinical Trials Centre, University of Sydney, Australia
| | - Gerry Fowkes
- Wolfson Unit for Prevention of Peripheral Vascular Diseases, University of Edinburgh, UK
| | - Michael Roughton
- Clinical Trials and Evaluation Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | - Fiona Nugara
- Clinical Trials and Evaluation Unit, Royal Brompton and Harefield NHS Trust, London, UK
| | - Julie Brittenden
- Vascular Surgery Department, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Andrew Bradbury
- University Department of Vascular and Endovascular Surgery, Heart of England NHS Foundation Trust Birmingham, UK
| | - Simon Ashley
- Vascular Surgery Department, Derriford Hospital, Plymouth, UK
| | - Cliff Shearman
- University Department of Vascular Surgery Southampton General Hospital, Southampton, UK
| | - Ray Hannon
- Vascular Surgery Department, Belfast City Hospital, Belfast, UK
| | - Marcus Flather
- Clinical Trials and Evaluation Unit, Royal Brompton and Harefield NHS Trust, London, UK, National Heart and Lung Institute, Imperial College London, UK
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Are Toe Pressures Measured by a Portable Photophlethysmograph Equivalent to Standard Laboratory Tests? J Wound Ostomy Continence Nurs 2010; 37:475-86. [DOI: 10.1097/won.0b013e3181eda0c5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Vega de Céniga M, Estallo L, Barba A, de la Fuente N, Viviens B, Gómez R. Long-term cardiovascular outcome after elective abdominal aortic aneurysm open repair. Ann Vasc Surg 2010; 24:655-62. [PMID: 20363099 DOI: 10.1016/j.avsg.2010.01.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Revised: 12/03/2009] [Accepted: 01/11/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND We analyzed the incidence of late cardiovascular events and mortality after elective infra-/juxtarenal abdominal aortic aneurysm open repair (AAA-OR). METHODS We included patients who survived AAA-OR in our center in 1988-2006. We registered late cardiac, cerebrovascular, and peripheral vascular events, as well as all-cause and cardiovascular mortality. We calculated patient survival and freedom from cardiovascular events (Kaplan-Meier) and evaluated risk factors (multivariate analysis). RESULTS We studied 297 patients: 292 (98.3%) men, aged 67 +/- 7 (44-83) years, 143 (48.1%) bifurcated grafts. In a mean follow-up of 78.7 +/- 52.9 months, we registered 203 cardiovascular events in 123 (41.4%) patients, at a rate of 0.16 cardiovascular events/patient-year. Eleven (3.7%) patients suffered graft-related complications. Freedom from cardiovascular events was 94.2%, 67.2%, 45.7%, and 27.6% at 1, 5, 10, and 15 years, respectively. Survival was 96.6%, 74.7%, 50.7%, and 31.5%, respectively. The main cause of death was cardiovascular disease (n = 54, 18.2%), followed by cancer (n = 43, 14.5%). Only four (1.3%) deaths were graft-related. Coronary artery disease and chronic renal failure were predictive of cardiovascular mortality (p = 0.033 and 0.006). CONCLUSION Although long-term survival is similar to that in the general population, successful AAA-OR patients remain at increased risk of cardiovascular events throughout their lifetime. Graft-related complications are rare, confirming the durability of the procedure.
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Affiliation(s)
- M Vega de Céniga
- Department of Angiology and Vascular Surgery, Hospital de Galdakao-Usansolo, Galdakao-Usansolo, Bizkaia, Spain.
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Aboyans V, Salazar J, Lacroix P. [Obliterating arterial disease of the legs in women]. Presse Med 2009; 39:263-70. [PMID: 20015610 DOI: 10.1016/j.lpm.2009.04.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2009] [Revised: 04/07/2009] [Accepted: 04/08/2009] [Indexed: 10/20/2022] Open
Abstract
The widespread use of the ankle-brachial index (ABI) enabled to reveal the high prevalence of lower extremities peripheral arterial disease (PAD) in women, even higher than in men in several series. Nonetheless, the use of a same ABI threshold for men and women may overestimate the prevalence of subclinical PAD in women. Conversely, the clinical manifestations of PAD are more often atypical in women, with as a result, a delayed diagnosis and management. The level of association between cardiovascular disease risk factors and PAD is similar in both genders. To date, there is no evidence for any association between PAD and different hormonal events in women. Despite an inverse association between hormonal replacement therapy (HRT) after menopause and PAD in epidemiological studies, the trials failed to evidence any protective effect of HRT to prevent PAD. Women with PAD are advised to discontinue HRT in case of limb revascularization. The long-term local and functional prognosis of PAD seems more severe in women, but this is partly explained by a delayed onset of the disease, occurring at a later age. Similarly, the general cardiovascular prognosis PAD is also poorer in women than in men.
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Affiliation(s)
- Victor Aboyans
- Service de chirurgie thoracique et cardiovasculaire et angiologie, Hôpital universitaire Dupuytren, CHU de Limoges, F-87042 Limoges Cedex, France.
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Abstract
OBJECTIVE Obesity is an independent cardiovascular risk factor, but its prognostic role in patients with peripheral arterial disease (PAD) is not well defined. Accordingly, we assessed the impact of body mass index (BMI) and waist circumference (WC) on cardiovascular risk in a homogeneous cohort of PAD patients. METHODS BMI and WC were measured in 190 consecutive PAD patients with ABI <0.90, referred to our university hospital for intermittent claudication. The occurrence of cardiac, cerebrovascular and peripheral events was prospectively assessed. The ability to classify risk was determined by calculating the hazard ratios (HRs) and c-statistics. RESULTS During a median follow-up of 31.5 months, 63 patients (33.2%) had a cardiovascular event. Considered as continuous variables, both adiposity indices were significantly associated with increased cardiovascular risk, even after adjustment for possible confounding factors (HR=1.08, 95% CI 1.01-1.15, P=0.045 for BMI and HR=1.04, 95% CI 1.01-1.07, P=0.004 for WC). When BMI and WC were included together in a fully adjusted Cox model, the significant association between BMI and cardiovascular risk disappeared (HR=0.98, 95% CI 0.88-1.10, P=0.772), whereas WC remained significantly associated with a worse outcome (HR=1.04, 95% CI 1.01-1.08, P=0.033). The better discriminative ability of WC vs BMI was confirmed by the c-statistic, which was significantly higher for WC (0.63, 95% CI 0.56-0.70) than for BMI (0.56, 95% CI 0.51-0.63, P=0.038). CONCLUSIONS Abdominal obesity and, to a lesser degree, general obesity worsen the prognosis of PAD patients independently of possible confounding factors. Weight reduction should be integrated in the active management of these patients.
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Afaq A, Patel JH, Gardner AW, Hennebry TA. Predictors of change in walking distance in patients with peripheral arterial disease undergoing endovascular intervention. Clin Cardiol 2009; 32:E7-11. [PMID: 19645033 DOI: 10.1002/clc.20553] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Endovascular treatment of peripheral artery disease is becoming frequent, yet the clinical factors which predict ambulatory outcomes are not known. HYPOTHESIS To identify predictors of change in walking distance in patients who underwent endovascular intervention for their lower extremity peripheral arterial disease (PAD). METHODS A total of 134 patients underwent lower extremity peripheral arterial intervention, 52 patients were contacted via phone between 1 and 36 months (a mean of 22 mo) after their initial procedure. The remaining 82 patients were excluded due to the following reasons: death (n = 13), contact information was not available (n = 50), and refusal to participate in the follow-up (n = 19). RESULTS The patients were 63 +/- 12 years old (mean +/- standard deviation [SD]), 46% were male, 47% were diabetics, 49% had coronary artery disease, of whom 29% had prior revascularization, and 22% had coronary artery bypass grafts (CABG). The disease severity described by Fontaine classification were as follows: 44.2% were in stage II, 15.4% were in stage III, and 40.4% were in stage IV. Walking distance was improved in 21% of patients, worsened in 73% of patients, and unchanged in 6% of patients. Stepwise multiple regression demonstrated that patients who started to walk or exercise (R = 0.372, P < 0.012) and who had a prior history of CABG (R = 0.467, P < 0.006) were the only independent predictors of the change in walking distance at follow-up. Those who started to walk reported worse walking distance at follow-up, while those with a history of CABG reported better walking distance at follow-up. CONCLUSION CABG prior to endovascular intervention is predictive of favorable change in walking distance in patients with PAD at follow-up. Therefore, post-CABG patients are good candidates for exercise rehabilitation and risk factor modification.
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Affiliation(s)
- A Afaq
- Department of Medicine, Section of Endocrinology, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma 73190, USA
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Abstract
Migration to the UK is associated with higher incidence of stroke in African populations. A low folate status has been associated with increased risk of stroke, likely to be mediated through raised plasma homocysteine concentrations. We conducted a cross-sectional study to compare blood folate and homocysteine concentrations in eighty healthy Ghanaian migrants living in London matched by sex, age and occupation to 160 individuals from an urban population in Accra, Ghana. Folate intake was determined using three 24 h recalls. Fasting blood samples were collected for the determination of serum and erythrocyte folate and plasma homocysteine concentrations and the methylenetetrahydrofolate reductase (MTHFR) 677C → T polymorphism. Reported mean folate intake was 20 % lower in London compared with Accra (P < 0·001). However, serum folate was 44 % higher, erythrocyte folate 30 % higher and plasma homocysteine was 26 % lower in subjects from London compared with those from Accra (P < 0·001). These differences persisted after adjusting for confounders including the MTHFR 677C → T mutation, which was rare in both populations. Although there were no associations between dietary folate intake and blood folates (P>0·05), folic acid supplement use, which was more prevalent in London than Accra (25 and 10 %, respectively,P = 0·004) was associated with erythrocyte folate in both populations (P < 0·01). The main predictors of plasma homocysteine concentrations were erythrocyte folate and male sex (P < 0·001). Findings from the present study suggest that migration from Ghana to the UK results in improvement of biomarkers of folate status despite the fact that reported dietary intake of folate was apparently lower in subjects from London.
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16
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Khandanpour N, Loke Y, Meyer F, Jennings B, Armon M. Homocysteine and Peripheral Arterial Disease: Systematic Review and Meta-analysis. Eur J Vasc Endovasc Surg 2009; 38:316-22. [DOI: 10.1016/j.ejvs.2009.05.007] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Accepted: 05/09/2009] [Indexed: 01/29/2023]
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17
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Paraskevas KI, Giannoukas AD, Mikhailidis DP. Renal Function Impairment in Peripheral Arterial Disease: An Important Parameter that Should not Be Neglected. Ann Vasc Surg 2009; 23:690-9. [DOI: 10.1016/j.avsg.2009.06.002] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Revised: 02/15/2009] [Accepted: 06/04/2009] [Indexed: 11/30/2022]
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18
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Metabolic syndrome and vascular risk in patients with peripheral arterial occlusive disease. J Vasc Surg 2009; 50:61-9. [DOI: 10.1016/j.jvs.2008.12.070] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2008] [Revised: 12/16/2008] [Accepted: 12/29/2008] [Indexed: 11/23/2022]
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19
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Bonham PA, Flemister BG, Goldberg M, Crawford PE, Johnson JJ, Varnado MF. What's new in lower-extremity arterial disease? WOCN's 2008 clinical practice guideline. J Wound Ostomy Continence Nurs 2009; 36:37-44. [PMID: 19155822 DOI: 10.1097/01.won.0000345174.12999.89] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Lower-extremity arterial disease (LEAD) affects 8 to 10 million people in the United States, resulting in pain, tissue loss, infection, limb loss, and an impaired quality of life. LEAD is underdiagnosed, undertreated, and often unrecognized. The purpose of this article is to provide a summary of the recommendations from the 2008 evidence-based, clinical practice guideline, Guideline for the Management of Patients With Lower-Extremity Arterial Disease, recently released from the Wound, Ostomy and Continence Nurses Society. This article presents an overview of the process used to develop the guideline, a discussion of risks for LEAD, and specific recommendations for assessment, interventions, patient education, and risk-reduction strategies.
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Affiliation(s)
- Phyllis A Bonham
- Medical University of South Carolina, College of Nursing, Charleston, SC 29425, USA.
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20
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Weis-Müller B, Lippelt I, Römmler V, Porath M, Godehardt E, Sandmann W. Ergebnisse der operativen Revaskularisation beim Diabetespatienten mit arterieller Verschlusskrankheit. DIABETOLOGE 2008. [DOI: 10.1007/s11428-008-0340-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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21
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Craft LL, Guralnik JM, Ferrucci L, Liu K, Tian L, Criqui MH, Tan J, McDermott MM. Physical activity during daily life and circulating biomarker levels in patients with peripheral arterial disease. Am J Cardiol 2008; 102:1263-8. [PMID: 18940304 DOI: 10.1016/j.amjcard.2008.06.051] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2008] [Revised: 06/30/2008] [Accepted: 06/30/2008] [Indexed: 01/08/2023]
Abstract
Higher levels of inflammation are associated with adverse outcomes in patients with lower extremity peripheral arterial disease (PAD). This study evaluated associations of physical activity during daily life with levels of inflammatory biomarkers, D-dimer, and homocysteine in patients with PAD. Participants were 244 men and women (mean age 74.4 +/- 8.2 years) with PAD (ankle brachial index <0.90). C-reactive protein, interleukin-6, soluble intracellular adhesion molecule-1, soluble vascular cellular adhesion molecule-1, D-dimer, and homocysteine were assessed at study entry. Physical activity was objectively assessed with a vertical accelerometer, which participants wore continuously for 7 days. After adjusting for age, gender, race, body mass index, smoking, co-morbidities, ankle brachial index, and other potential confounders, higher physical activity levels were associated linearly and significantly with lower levels of all measured circulating biomarkers: soluble vascular cellular adhesion molecule-1 (p trend = 0.001), D-dimer (p trend = 0.005), homocysteine (p trend = 0.006), interleukin-6 (p trend = 0.010), C-reactive protein (p trend = 0.028), and soluble intracellular adhesion molecule-1 (p trend = 0.033). In conclusion, higher levels of physical activity were associated independently with lower levels of inflammatory markers, homocysteine, and D-dimer in patients with PAD.
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Affiliation(s)
- Lynette L Craft
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
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22
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Alpagut U, Ugurlucan M, Banach M, Mikhailidis DP, Dayioglu E. Does Gender Influence the Patency of Infrainguinal Bypass Grafts? Angiology 2008; 59:278-82. [DOI: 10.1177/0003319708316898] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Infrainguinal revascularization is an effective method of treatment for femoropopliteal/tibial occlusive diseases. However, these bypass grafts are prone to stenosis. In this retrospective study, the authors investigate the association of gender with patency of infrainguinal bypass grafts. The outcomes for consecutive 375 male and 200 female patients who underwent infrainguinal bypass surgery for arterial occlusive disease are compared, and associations with characteristics of the patients, surgical procedure, and graft stenosis are determined. It is found that several demographic, biochemical, and etiological factors could influence the patency of bypass procedures in different genders. However, infrainguinal arterial reconstruction procedures performed in women have a worse outcome when compared with that in men.
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Affiliation(s)
- Ufuk Alpagut
- Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
| | - Murat Ugurlucan
- Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey,
| | - Maciej Banach
- Department of Cardiology, 1st Chair of Cardiology and Cardiac Surgery, Lodz University Medical Faculty, Lodz, Poland
| | - Dimitri P. Mikhailidis
- Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free University College School of Medicine, University College London, London, UK
| | - Enver Dayioglu
- Department of Cardiovascular Surgery, Istanbul University Istanbul Medical Faculty, Istanbul, Turkey
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23
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Paraskevas KI, Baker DM, Pompella A, Mikhailidis DP. Does Diabetes Mellitus Play a Role in Restenosis and Patency Rates Following Lower Extremity Peripheral Arterial Revascularization? A Critical Overview. Ann Vasc Surg 2008; 22:481-91. [DOI: 10.1016/j.avsg.2007.12.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2007] [Accepted: 12/26/2007] [Indexed: 10/21/2022]
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