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Alnima T, Meijer RI, Spronk HMH, Warlé M, Cate HT. Diabetes- versus smoking-related thrombo-inflammation in peripheral artery disease. Cardiovasc Diabetol 2023; 22:257. [PMID: 37735399 PMCID: PMC10514957 DOI: 10.1186/s12933-023-01990-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 09/11/2023] [Indexed: 09/23/2023] Open
Abstract
Peripheral artery disease (PAD) is a major health problem with increased cardiovascular mortality, morbidity and disabling critical limb threatening ischemia (CLTI) and amputation. Diabetes mellitus (DM) and cigarette smoke are the main risk factors for the development of PAD. Although diabetes related PAD shows an accelerated course with worse outcome regarding complications, mortality and amputations compared with non-diabetic patients, current medical treatment does not make this distinction and includes standard antiplatelet and lipid lowering drugs for all patients with PAD. In this review we discuss the pathophysiologic mechanisms of PAD, with focus on differences in thrombo-inflammatory processes between diabetes-related and smoking-related PAD, and hypothesize on possible mechanisms for the progressive course of PAD in DM. Furthermore, we comment on current medical treatment and speculate on alternative medical drug options for patients with PAD and DM.
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Affiliation(s)
- T Alnima
- Department of Internal Medicine, Section of Vascular Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
- Department of Internal Medicine, Section of Diabetology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - R I Meijer
- Department of Internal Medicine, Section of Diabetology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - H M H Spronk
- Thrombosis Expertise Center, Heart and Vascular Center, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - M Warlé
- Department of Vascular Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - H Ten Cate
- Thrombosis Expertise Center, Heart and Vascular Center, Maastricht University Medical Center+, Maastricht, The Netherlands
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Argyriou A, Rantner B, Stana J, Tsilimparis N, Sensebat Ö, Torsello G, Stavroulakis K. Moderne endovaskuläre Therapieoptionen bei diabetischem Fußsyndrom. DIABETOLOGE 2022. [DOI: 10.1007/s11428-022-00869-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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3
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Dimitrova DA, Mikhailov IA, Tokarev KY, Michurova MS, Gorbacheva AM, Danilova NV, Malkov PG, Kalashnikov VY. Leptin and leptin receptor evaluation in atherosclerotic plaques in patients with type 2 diabetes mellitus. TERAPEVT ARKH 2021; 93:1186-1192. [DOI: 10.26442/00403660.2021.10.201079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/04/2021] [Indexed: 11/22/2022]
Abstract
Background. Diabetes mellitus (DM) is a significant predictor of atherosclerosis, cardiovascular disease, and cardiovascular mortality. It is known that atherosclerosis occurs earlier in patients with diabetes, reducing the duration of their life. Leptin as well as other inflammatory markers can contribute to the progression of atherosclerosis in patients with DM, participate in the development of a local inflammatory reaction.
Aim. Determine the cells immunophenotype of atherosclerotic plaques in patients with diabetes.
Materials and methods. We analyzed 24 patients (20 men and 4 women), who underwent aortofemoral bypass, femoral-tibial bypass or carotid endarterectomy. During the operation, a fragment of the arterial wall with an atherosclerotic plaque was obtained for further immunohistochemical studies. Five histologic plaque characteristics (CD68+, -SMA, CD34, leptin and leptin receptor) were compared.
Results. No difference in the expression of CD68 (p=0.922), -SMA (p=0.192), CD34 (p=0.858), leptin receptor (p=0.741) and leptin (p=0.610) in atherosclerotic plaques were observed between patients with and without DM. The lack of significant differences between the two groups was possibly due to the small number of observations with DM. In particular, when assessing the expression of selected markers in atherosclerotic plaques, patients with DM showed significantly more leptin receptors than patients without DM (2160.716 and 1205.88 respectively); and also significantly less CD68+ (0.39 and 0.98 respectively) and -SMA+ (6.5 and 13.5 respectively).
Conclusion. Based on the expression of CD68, -SMA, CD34, leptin receptor and leptin, no significant differences were observed in atherosclerotic plaque between patients with and without DM. At the same time, despite the limitations of the study (a small number of patients, moderate severity of DM, elderly patients in the DM group), we found a tendency in the increased number of leptin receptors and a decreased number of -SMA+, CD68+ in DM atherosclerotic plaques. Further study needed, taking into account the limitations of this work.
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Weissler EH, Gutierrez JA, Patel MR, Swaminathan RV. Successful Peripheral Vascular Intervention in Patients with High-risk Comorbidities or Lesion Characteristics. Curr Cardiol Rep 2021; 23:32. [PMID: 33666765 DOI: 10.1007/s11886-021-01465-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/18/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Certain comorbidities and lesion characteristics are associated with increased risk for procedural complications, limb events, and cardiovascular events following peripheral vascular intervention (PVI) in patients with peripheral arterial disease (PAD). The purpose of this review is to provide an overview of high-risk modifiable and unmodifiable patient characteristics and its relative impact on clinical outcomes such as amputation risk and mortality. Furthermore, general approaches to potentially mitigating these risks through pre-intervention planning and use of modern devices and techniques are discussed. RECENT FINDINGS Diabetes, tobacco use, and older age remain strong risk factors for the development of peripheral arterial disease. Recent data highlight the significant risk of polyvascular disease on major limb and cardiac events in advanced PAD, and ongoing studies are assessing this risk specifically after PVI. Challenging lesion characteristics such as calcified disease and chronic total occlusions can be successfully treated with PVI by utilizing novel devices (e.g., intravascular lithotripsy, re-entry devices) and techniques (e.g., subintimal arterial "flossing" with antegrade-retrograde intervention). Understanding high-risk patient comorbidities and lesion characteristics will improve our ability to counsel and manage patients with advanced PAD. Continued device innovation and novel techniques will aid in procedural planning for successful interventions to improve clinical outcomes.
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Affiliation(s)
- E Hope Weissler
- Division of Vascular and Endovascular Surgery, Duke University School of Medicine, Durham, NC, USA
| | - J Antonio Gutierrez
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
- Duke University Medical Center, Duke Clinical Research Institute, 200 Morris St, Durham, NC, 27705, USA
| | - Manesh R Patel
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
- Duke University Medical Center, Duke Clinical Research Institute, 200 Morris St, Durham, NC, 27705, USA
| | - Rajesh V Swaminathan
- Division of Cardiology, Duke University School of Medicine, Durham, NC, USA.
- Duke University Medical Center, Duke Clinical Research Institute, 200 Morris St, Durham, NC, 27705, USA.
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Li YY, Zhang S, Wang H, Zhang SX, Xu T, Chen SW, Zhang Y, Chen Y. Identification of Crucial Genes and Pathways Associated with Atherosclerotic Plaque in Diabetic Patients. Pharmgenomics Pers Med 2021; 14:211-220. [PMID: 33568933 PMCID: PMC7869704 DOI: 10.2147/pgpm.s281705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 12/26/2020] [Indexed: 01/20/2023] Open
Abstract
Background Patients with diabetes have more calcification in atherosclerotic plaque and a higher occurrence of secondary cardiovascular events than patients without diabetes. The objective of this study was to identify crucial genes involved in the development of diabetic atherosclerotic plaque using a bioinformatics approach. Methods Microarray dataset GSE118481 was downloaded from the Gene Expression Omnibus (GEO) database; the dataset included 6 patients with diabetic atherosclerotic plaque (DBT) and 6 nondiabetic patients with atherosclerotic plaque (Ctrl). Differentially expressed genes (DEG) between the DBT and Ctrl groups were identified and then subjected to functional enrichment analysis. Based on the enriched pathways of DEGs, diabetic atherosclerotic plaque-related pathways were screened using the comparative toxicogenomics database (CTD). We then constructed a protein–protein interaction (PPI) network and transcription factor (TF)–miRNA–mRNA network. Results A total of 243 DEGs were obtained in the DBT group compared with the Ctrl group, including 85 up-regulated and 158 down-regulated DEGs. Functional enrichment analysis showed that up-regulated DEGs were mainly enriched in isoprenoid metabolic process, DNA-binding TF activity, and response to virus. Additionally, DEGs participating in the toll-like receptor signaling pathway were closely related to diabetes, carotid stenosis, and insulin resistance. The TF–miRNA–mRNA network showed that toll-like receptor 4 (TLR4), BCL2-like 11 (BCL2L11), and glutamate-cysteine ligase catalytic subunit (GCLC) were hub genes. Furthermore, TLR4 was regulated by TF signal transducer and activator of transcription 6 (STAT6); BCL2L11 was targeted by hsa-miR-24-3p; and GCLC was regulated by nuclear factor, erythroid 2 like 2 (NFE2L2). Conclusion Identification of hub genes and pathways increased our understanding of the molecular mechanisms underlying the atherosclerotic plaque in patients with or without diabetes. These crucial genes (TLR4, BC2L11, and GCLC) might function as molecular biomarkers for diabetic atherosclerotic plaque.
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Affiliation(s)
- Yuan-Yuan Li
- Department of Endocrinology, Baoshan Branch, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201999, People's Republic of China
| | - Sheng Zhang
- Department of Endocrinology, Baoshan Branch, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201999, People's Republic of China
| | - Hua Wang
- Department of Endocrinology, Baoshan Branch, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201999, People's Republic of China
| | - Shun-Xiao Zhang
- Department of Endocrinology, Baoshan Branch, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201999, People's Republic of China
| | - Ting Xu
- Department of Endocrinology, Baoshan Branch, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201999, People's Republic of China
| | - Shu-Wen Chen
- Department of Endocrinology, Baoshan Branch, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201999, People's Republic of China
| | - Yan Zhang
- Department of Endocrinology, Baoshan Branch, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201999, People's Republic of China
| | - Yue Chen
- Department of Endocrinology, Baoshan Branch, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, 201999, People's Republic of China
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Mencke R, van der Vaart A, Pasch A, Harms G, Waanders F, Bilo HJG, van Goor H, Hillebrands JL, van Dijk PR. Serum calcification propensity is associated with HbA1c in type 2 diabetes mellitus. BMJ Open Diabetes Res Care 2021; 9:9/1/e002016. [PMID: 33627317 PMCID: PMC7908279 DOI: 10.1136/bmjdrc-2020-002016] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 01/04/2021] [Accepted: 01/18/2021] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Serum calcification propensity is emerging as an independent predictor for cardiovascular outcomes in high-risk populations. Calcification propensity can be monitored by the maturation time of calciprotein particles in serum (T50 test). A low T50 value is an independent determinant of cardiovascular morbidity and mortality in various populations. Aim was to investigate the T50 and its relationship to type 2 diabetes mellitus. RESEARCH DESIGN AND METHODS Using nephelometry, serum T50 was cross-sectionally measured in 932 stable patients with type 2 diabetes mellitus (55% male) with a median age of 66 (62-75) years, diabetes duration of 6.5 (3.0-10.2) years and hemoglobin A1c (HbA1c) of 49 (44-54) mmol/mol. RESULTS Serum T50 was normally distributed with a mean value of 261±66 min. In linear regression, serum T50 was lower in women and current smokers. A lower T50 value was found in patients with a higher HbA1c or higher systolic blood pressure, insulin users and patients with a longer history of diabetes. The association with HbA1c was independent of other determinants in multivariable analysis. There was no association between T50 and previous macrovascular events or the presence of microvascular disease. CONCLUSIONS Serum calcification propensity is independently associated with glycemic control, suggesting that a lower HbA1c may be associated with better cardiovascular outcomes. Retrospective analysis could not establish an association between a history of macrovascular events and T50, and prospective studies will have to be performed to address this hypothesis. TRIAL REGISTRATION NUMBER NCT01570140.
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Affiliation(s)
- Rik Mencke
- Department of Pathology and Medical Biology - Division of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Amarens van der Vaart
- Department of Pathology and Medical Biology - Division of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Geert Harms
- Department of Pathology and Medical Biology - Division of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Femke Waanders
- Department of Internal Medicine, Isala, Zwolle, The Netherlands
| | - Henk J G Bilo
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Diabetes Centre, Isala, Zwolle, The Netherlands
| | - Harry van Goor
- Department of Pathology and Medical Biology - Division of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Jan-Luuk Hillebrands
- Department of Pathology and Medical Biology - Division of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Peter R van Dijk
- Department of Internal Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- Diabetes Centre, Isala, Zwolle, The Netherlands
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Laivuori M, Tolva J, Lokki AI, Linder N, Lundin J, Paakkanen R, Albäck A, Venermo M, Mäyränpää MI, Lokki ML, Sinisalo J. Osteoid Metaplasia in Femoral Artery Plaques Is Associated With the Clinical Severity of Lower Extremity Artery Disease in Men. Front Cardiovasc Med 2020; 7:594192. [PMID: 33363220 PMCID: PMC7758249 DOI: 10.3389/fcvm.2020.594192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 10/16/2020] [Indexed: 11/29/2022] Open
Abstract
Lamellar metaplastic bone, osteoid metaplasia (OM), is found in atherosclerotic plaques, especially in the femoral arteries. In the carotid arteries, OM has been documented to be associated with plaque stability. This study investigated the clinical impact of OM load in femoral artery plaques of patients with lower extremity artery disease (LEAD) by using a deep learning-based image analysis algorithm. Plaques from 90 patients undergoing endarterectomy of the common femoral artery were collected and analyzed. After decalcification and fixation, 4-μm-thick longitudinal sections were stained with hematoxylin and eosin, digitized, and uploaded as whole-slide images on a cloud-based platform. A deep learning-based image analysis algorithm was trained to analyze the area percentage of OM in whole-slide images. Clinical data were extracted from electronic patient records, and the association with OM was analyzed. Fifty-one (56.7%) sections had OM. Females with diabetes had a higher area percentage of OM than females without diabetes. In male patients, the area percentage of OM inversely correlated with toe pressure and was significantly associated with severe symptoms of LEAD including rest pain, ulcer, or gangrene. According to our results, OM is a typical feature of femoral artery plaques and can be quantified using a deep learning-based image analysis method. The association of OM load with clinical features of LEAD appears to differ between male and female patients, highlighting the need for a gender-specific approach in the study of the mechanisms of atherosclerotic disease. In addition, the role of plaque characteristics in the treatment of atherosclerotic lesions warrants further consideration in the future.
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Affiliation(s)
- Mirjami Laivuori
- Department of Vascular Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Johanna Tolva
- Transplantation Laboratory, Department of Pathology, University of Helsinki, Helsinki, Finland
| | - A Inkeri Lokki
- Transplantation Laboratory, Department of Pathology, University of Helsinki, Helsinki, Finland.,Department of Cardiology, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.,Translational Immunology Research Program, Research Programs Unit, University of Helsinki, Helsinki, Finland
| | - Nina Linder
- Institute for Molecular Medicine Finland, HILIFE, University of Helsinki, Helsinki, Finland
| | - Johan Lundin
- Institute for Molecular Medicine Finland, HILIFE, University of Helsinki, Helsinki, Finland.,Department of Global Public Health, Global Health/IHCAR, Karolinska Institutet, Stockholm, Sweden
| | - Riitta Paakkanen
- Transplantation Laboratory, Department of Pathology, University of Helsinki, Helsinki, Finland.,Department of Cardiology, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Anders Albäck
- Department of Vascular Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Maarit Venermo
- Department of Vascular Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Mikko I Mäyränpää
- Department of Pathology, HUSLAB, Meilahti Central Laboratory of Pathology, University of Helsinki, Helsinki, Finland
| | - Marja-Liisa Lokki
- Transplantation Laboratory, Department of Pathology, University of Helsinki, Helsinki, Finland
| | - Juha Sinisalo
- Department of Cardiology, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Patel KK, Alturkmani H, Gosch K, Mena-Hurtado C, Shishehbor MH, Peri-Okonny PA, Creager MA, Spertus JA, Smolderen KG. Association of Diabetes Mellitus With Health Status Outcomes in Patients With Peripheral Artery Disease: Insights From the PORTRAIT Registry. J Am Heart Assoc 2020; 9:e017103. [PMID: 33153398 PMCID: PMC7763706 DOI: 10.1161/jaha.120.017103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background Patients with peripheral artery disease (PAD) and coexisting diabetes mellitus (DM) have greater PAD progression and adverse limb events. Our aim was to study whether PAD‐specific health status differs by DM. Methods and Results The PORTRAIT (Patient‐Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories) trial is a 16‐center international registry that includes patients with recent exacerbations or new‐onset symptomatic PAD presenting to specialty clinics. We assessed PAD‐specific health status initially and at 3, 6, and 12 months (Peripheral Artery Questionnaire [PAQ]). We used hierarchical, multivariable, linear regression, and repeated measures analyses to study the association between DM and baseline health status initially and over 3 to 12 months. Models were adjusted for demographics, socioeconomic factors, PAD severity, comorbidities, and psychosocial characteristics. The interaction of DM with PAD revascularization on 3‐ to 12‐month health status was also tested. Of 1204 patients, 398 (33%) had DM (94% type 2). Patients with versus those without DM had lower unadjusted PAQ summary scores at baseline and 3, 6, and 12 months (46.1 versus 50.8, 63.6 versus 68.2, 65.7 versus 71.7, and 65.4 versus 72.6; P≤0.01). In fully adjusted models, the effect of DM on baseline (mean difference, −0.65; 95% CI, −2.86 to 1.56 [P=0.56]) and over 3‐ to 12‐month PAQ summary scores (mean difference, −1.59; 95% CI, −4.06 to 0.88 [P=0.21]) was no longer significant. Twelve‐month health status gains following revascularization were similar in both groups (P=0.69). Conclusions Patients with PAD with coexisting DM have poorer health status, mostly explained by the differences in their psychosocial and other comorbidity burden. Patients with PAD and DM versus those without DM experience similar health status benefits following PAD revascularization.
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Affiliation(s)
- Krishna K Patel
- University of Missouri-Kansas City Kansas City MO.,Saint Luke's Mid America Heart Institute Kansas City MO
| | - Hani Alturkmani
- University of Missouri-Kansas City Kansas City MO.,Truman Medical Centers Kansas City MO
| | - Kensey Gosch
- Saint Luke's Mid America Heart Institute Kansas City MO
| | | | - Mehdi H Shishehbor
- University Hospital Cleveland Medical Center and Case Western Reserve University School of Medicine Cleveland OH
| | - Poghni A Peri-Okonny
- University of Missouri-Kansas City Kansas City MO.,Saint Luke's Mid America Heart Institute Kansas City MO
| | - Mark A Creager
- Dartmouth-Hitchcock Heart and Vascular Center Lebanon NH
| | - John A Spertus
- University of Missouri-Kansas City Kansas City MO.,Saint Luke's Mid America Heart Institute Kansas City MO
| | - Kim G Smolderen
- University of Missouri-Kansas City Kansas City MO.,Saint Luke's Mid America Heart Institute Kansas City MO
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Khan A, Hughes M, Ting M, Riding G, Simpson J, Egun A, Banihani M. A 'hot clinic' for cold limbs: the benefit of urgent clinics for patients with critical limb ischaemia. Ann R Coll Surg Engl 2020; 102:412-417. [PMID: 32306742 DOI: 10.1308/rcsann.2020.0068] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The national reconfiguration of vascular surgery means that arterial centres serve larger populations with increased demand on resources. Emergency general surgery ambulatory clinics facilitate timely review and intervention, avoiding admission; a critical limb ischaemia (CLI) 'hot clinic' (HC) was implemented to achieve similar for vascular patients. The aim of the study was to determine HC efficacy. METHODS This was a prospective cohort study comparing HC patients with emergency admission (EA) patients between 1 May and 1 December 2017. Age, sex, comorbidities, CLI severity and smoking status were noted. HC patients were provided with satisfaction surveys. Primary outcome measures were freedom from reintervention and major amputation. Secondary outcome measures included time to procedure, length of stay, returns to theatre and 30-day readmission. RESULTS A total of 147 patients (72 HC, 75 EA) were enrolled in the study. No statistical difference was found in age, sex, smoking status, severity of CLI or prevalence of comorbidities between the groups except that diabetes was more prevalent in EA patients (p=0.028). The median length of stay for the HC cohort was shorter (3 days vs 17 days, p<0.001), with no difference between time to procedure, return to theatre or 30-day readmission. HC patients were nearly 6 times more likely to experience freedom from reintervention (odds ratio: 5.824, p<0.001) and 2.5 times less likely to undergo amputation (odds ratio: 2.616, p=0.043). HC utilisation saved a total of 441 bed days. Over 90% of attendees responded with 100% positive feedback. CONCLUSIONS A vascular HC facilitates urgent review and revascularisation. It provides comparable in-hospital outcomes and better long-term outcomes, with greater efficiency than hospital admission, demonstrating its value in treating CLI.
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Affiliation(s)
- A Khan
- Lancashire Teaching Hospitals NHS Foundation Trust, UK
| | - M Hughes
- Lancashire Teaching Hospitals NHS Foundation Trust, UK
| | - M Ting
- University of Manchester, UK
| | - G Riding
- Lancashire Teaching Hospitals NHS Foundation Trust, UK
| | - J Simpson
- Lancashire Teaching Hospitals NHS Foundation Trust, UK
| | - A Egun
- Lancashire Teaching Hospitals NHS Foundation Trust, UK
| | - M Banihani
- Lancashire Teaching Hospitals NHS Foundation Trust, UK
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10
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Gao X, Song J, Watase H, Hippe DS, Zhao X, Canton G, Tian F, Du R, Ji S, Yuan C. Differences in Carotid Plaques Between Symptomatic Patients With and Without Diabetes Mellitus. Arterioscler Thromb Vasc Biol 2020; 39:1234-1239. [PMID: 31070472 DOI: 10.1161/atvbaha.118.312092] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Objective- Diabetes mellitus is associated with high-risk atherosclerotic plaques. This study aimed to compare characteristics of carotid atherosclerotic plaques in symptomatic Chinese diabetic and nondiabetic patients using vessel wall magnetic resonance imaging. Approach and Results- Patients with cerebral ischemic symptoms in the anterior circulation and carotid atherosclerotic plaque determined by ultrasound were recruited from a cross-sectional, observational, multicenter study of CARE-II (Chinese Atherosclerosis Risk Evaluation). All patients underwent magnetic resonance imaging for carotid arteries. The morphological and compositional characteristics of carotid plaques were compared between diabetic and nondiabetic patients using linear (continuous variables) and logistic regression (binary variables). In a total of 584 recruited patients, 182 (31.2%) had diabetes mellitus. From the univariate analysis, diabetic patients had significantly greater mean wall area (33.7 versus 31.1 mm2; P=0.002), maximum wall thickness (3.2 versus 2.8 mm; P<0.001), and mean normalized wall index (43.8% versus 41.0%; P<0.001) and had significantly higher prevalence of calcification (51.6% versus 36.6%; P=0.001), lipid-rich necrotic core (77.5% versus 58.5%; P<0.001), and high-risk plaque (29.7% versus 19.9%; P=0.011) than nondiabetic patients. After adjusting for clinical characteristics, the differences in presence of calcification ( P=0.018) and lipid-rich necrotic core ( P=0.001) remained statistically significant. Conclusions- Symptomatic Chinese diabetic patients are more likely to have carotid plaques with calcification and lipid-rich necrotic core than nondiabetic patients, suggesting that diabetic patients may develop more severe atherosclerotic disease that should be accounted for in their clinical management.
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Affiliation(s)
- Xiao Gao
- From the Department of Radiology (X.G., J.S., R.D., S.J.), Tianjin Fourth Central Hospital, China
| | - Jinyu Song
- From the Department of Radiology (X.G., J.S., R.D., S.J.), Tianjin Fourth Central Hospital, China
| | - Hiroko Watase
- Department of Surgery (H.W.), University of Washington, Seattle
| | - Daniel S Hippe
- Department of Radiology (D.S.H., G.C., C.Y.), University of Washington, Seattle
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China (X.Z., C.Y.)
| | - Gador Canton
- Department of Radiology (D.S.H., G.C., C.Y.), University of Washington, Seattle
| | - Fengshi Tian
- Department of Cardiology (F.T.), Tianjin Fourth Central Hospital, China
| | - Ran Du
- From the Department of Radiology (X.G., J.S., R.D., S.J.), Tianjin Fourth Central Hospital, China
| | - Shengzhang Ji
- From the Department of Radiology (X.G., J.S., R.D., S.J.), Tianjin Fourth Central Hospital, China
| | - Chun Yuan
- Department of Radiology (D.S.H., G.C., C.Y.), University of Washington, Seattle.,Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University, Beijing, China (X.Z., C.Y.)
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11
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Han Y, Zhu Z, Guan M, Yang D, Wang W, Li C, Chen H, Zhao X. Diabetes-specific characteristics of atherosclerotic plaques in femoral arteries determined by three-dimensional magnetic resonance vessel wall imaging. Diabetes Metab Res Rev 2020; 36:e3201. [PMID: 31278827 DOI: 10.1002/dmrr.3201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 05/28/2019] [Accepted: 07/03/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES This study aimed to investigate the characteristics of femoral atherosclerotic plaques in patients with diabetes mellitus (DM) compared with those without DM using three-dimensional magnetic resonance vessel wall imaging. METHODS Lower extremity atherosclerotic disease patients with and without DM (age ≥ 50 year-old) were recruited and underwent three-dimensional magnetic resonance imaging for femoral arteries. The femoral arteries were divided into common femoral artery (CFA), proximal of superficial femoral artery (pSFA), adductor canal (AC), and popliteal artery (PA) segments. The characteristics of femoral artery atherosclerotic plaques were compared between patients with and without DM. RESULTS Forty-eight patients with DM (69.5 ± 8.2 years; 26 males) and 50 patients without DM (71.9 ± 5.7 years; 28 males) were included. Significant differences were found in maximum wall thickness in CFA and AC segments, eccentricity index in AC segment, prevalence of plaque in CFA, pSFA and AC segments, stenosis and prevalence of calcification in pSFA, AC and PA segments, prevalence of lipid-rich necrotic core (LRNC) in all segments, and prevalence of intraplaque haemorrhage in PA segment between patients with and without DM (all P < .05). After adjusted for confounding factors of age, gender, hyperlipidemia, coronary artery disease, and statin use, the differences in eccentricity index, stenosis and prevalence of plaque, calcification and LRNC in pSFA and AC segments, and stenosis and prevalence of LRNC in PA segment remained statistically significant between patients with and without DM (all P < .05). CONCLUSIONS Patients with DM have significantly larger plaque burden, higher prevalence of plaques, and more complex plaque compositions in femoral arteries than those without DM.
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Affiliation(s)
- Yongjun Han
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Zhu Zhu
- Department of Radiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Maobin Guan
- Department of Radiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Dandan Yang
- Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
- Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Wei Wang
- Department of Radiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
| | - Cheng Li
- Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Huijun Chen
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
- Center of Stroke, Beijing Institute of Brain Disorders, Beijing, China
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12
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Kim K, Lim C, Kim G, Chung JH, Cho YS, Cho JH, Seo JB, Chung WY, Oh SJ, Choi JS, Kim JS, Park JJ, Suh JW, Youn TJ, Chae IH, Choi DJ. Association of Plasma Marker of Oxidized Lipid with Histologic Plaque Instability in Patients with Peripheral Artery Disease. Ann Vasc Surg 2019; 66:554-565. [PMID: 31706994 DOI: 10.1016/j.avsg.2019.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 10/05/2019] [Accepted: 11/01/2019] [Indexed: 12/24/2022]
Abstract
BACKGROUND The association between oxidized low-density lipoprotein (OxLDL) and plaque instability in coronary and carotid artery disease is well established. However, the association between OxLDL and the histologic changes of plaque in peripheral artery disease has not been clearly elucidated. This study aims to investigate the association between plasma OxLDL and histologic plaque instability in patients with peripheral artery disease. METHODS Prospectively obtained plaques from 48 patients who underwent endovascular atherectomy (n = 20), surgical endarterectomy (n = 9), or bypass surgery (n = 19) for treatment of atherosclerotic femoropopliteal artery disease were evaluated for histologic fibrosis, sclerosis, calcification, necrosis, cholesterol cleft, and foamy macrophages using hematoxylin and eosin, oil red O, and immunohistochemical staining. Unstable plaques were defined as plaques that were positive for foamy macrophages and with lipid content of more than 10% of the total plaque area. Plasma OxLDL levels were measured using an enzyme-linked immunosorbent assay (Mercodia AB, Uppsala, Sweden). RESULTS Of the 48 patients, 26 (54%) had unstable plaques. The unstable plaque group was younger, had fewer angiographic total occlusions, less calcification, and more CD68-positive and LOX-1-positive cells than the stable plaque group. Plasma OxLDL levels were significantly higher in the unstable plaque group than in the stable plaque group (57.4 ± 13.9 vs. 47.2 ± 13.6 U/L, P = 0.014). Multivariate analysis revealed that plasma OxLDL level, smoking, angiographic nontotal occlusion, and statin nonuse were independent predictors of unstable plaque. CONCLUSIONS Among patients with peripheral artery disease, the histologic instability of femoropopliteal plaque was independently associated with high plasma OxLDL, smoking, nontotal occlusion, and statin nonuse. Further large-scale studies are necessary to evaluate the role of noninvasive OxLDL measurement for predicting plaque instability and future adverse vascular event.
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Affiliation(s)
- Kichun Kim
- The Armed Forces Medical Command, Seongnam, South Korea
| | - Cheong Lim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Gilhyang Kim
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jin-Haeng Chung
- Department of Pathology, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Young-Seok Cho
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
| | - Jun Hwan Cho
- Department of Internal Medicine, Chung-Ang University Hospital, Seoul, South Korea
| | - Jae-Bin Seo
- Department of Internal Medicine, Seoul National University-Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea
| | - Woo-Young Chung
- Department of Internal Medicine, Seoul National University-Seoul Metropolitan Government Boramae Medical Center, Seoul, South Korea
| | - Se-Jin Oh
- Department of Cardiothoracic Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Jae-Sung Choi
- Department of Cardiothoracic Surgery, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Jun-Sung Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jin Joo Park
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jung-Won Suh
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Tae-Jin Youn
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - In-Ho Chae
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Dong-Ju Choi
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
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13
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van Koeverden ID, Scholtes VPW, den Ruijter HM, Hazenberg SCE, de Kleijn DPV, de Borst GJ. The Impact of Diabetes and Time on the Atherosclerotic Plaque and Cardiovascular Outcome in Patients Undergoing Iliofemoral Endarterectomy. Eur J Vasc Endovasc Surg 2019; 57:832-841. [PMID: 30910497 DOI: 10.1016/j.ejvs.2018.10.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 10/13/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE The incidence of diabetes is rapidly increasing and diabetes is associated with an increased risk of peripheral artery disease. Recent studies have shown a time dependent decline in vulnerable plaque features and secondary cardiovascular events in iliofemoral endarterectomy (IFE) patients. IFE patients with diabetes have a high risk of cardiovascular events. It is not known, however, whether vulnerable plaque features and cardiovascular events reduce over time in IFE patients with diabetes. METHODS Between 2003 and 2014, 691 atherosclerotic plaques were obtained by IFE, from 212 patients with and 479 patients without diabetes. Plaques were immunohistochemically stained and analysed for the presence of intraplaque haemorrhage, lipid core, calcification, collagen, smooth muscle cells, and macrophages. Patients were stratified according to their diabetic status and year of inclusion. All patients had a follow up of three years in which cardiovascular adverse events were recorded. RESULTS A time dependent decrease was observed in intraplaque haemorrhage, plaque lipid core, and percentage of macrophages in IFE patients with diabetes. After multivariable correction for changes in risk factors over time, intraplaque haemorrhage (64.2% [2002-2005] vs. 39.6% [2012-2014], p = .01) became significantly less prevalent. Interestingly, the percentage of severely calcified plaques remained high over time. The number of secondary events decreased over time in patients without diabetes (HR 1.80, 95% CI 1.15-2.81 (p = .010) for 2002-2005 vs. 2012-2014), but remained high and unchanged in patients with diabetes. CONCLUSION In patients with diabetes undergoing IFE, a time dependent stabilisation of atherosclerotic plaque features was found in line with previous observations in patients with severe atherosclerosis. The presence of severely calcified lesions remained high and unchanged. The secondary event rate remained high in patients with diabetes in contrast to a significant decrease in patients without diabetes. These findings stress the need for improvement of care in IFE patients with diabetes.
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Affiliation(s)
- Ian D van Koeverden
- Laboratory of Experimental Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Vincent P W Scholtes
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Hester M den Ruijter
- Laboratory of Experimental Cardiology, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Stijn C E Hazenberg
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Dominique P V de Kleijn
- Department of Experimental Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Centre Utrecht, Utrecht, the Netherlands.
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14
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Nativel M, Potier L, Alexandre L, Baillet-Blanco L, Ducasse E, Velho G, Marre M, Roussel R, Rigalleau V, Mohammedi K. Lower extremity arterial disease in patients with diabetes: a contemporary narrative review. Cardiovasc Diabetol 2018; 17:138. [PMID: 30352589 PMCID: PMC6198374 DOI: 10.1186/s12933-018-0781-1] [Citation(s) in RCA: 93] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2018] [Accepted: 10/17/2018] [Indexed: 12/24/2022] Open
Abstract
Lower-extremity arterial disease (LEAD) is a major endemic disease with an alarming increased prevalence worldwide. It is a common and severe condition with excess risk of major cardiovascular events and death. It also leads to a high rate of lower-limb adverse events and non-traumatic amputation. The American Diabetes Association recommends a widespread medical history and clinical examination to screen for LEAD. The ankle brachial index (ABI) is the first non-invasive tool recommended to diagnose LEAD although its variable performance in patients with diabetes. The performance of ABI is particularly affected by the presence of peripheral neuropathy, medial arterial calcification, and incompressible arteries. There is no strong evidence today to support an alternative test for LEAD diagnosis in these conditions. The management of LEAD requires a strict control of cardiovascular risk factors including diabetes, hypertension, and dyslipidaemia. The benefit of intensive versus standard glucose control on the risk of LEAD has not been clearly established. Antihypertensive, lipid-lowering, and antiplatelet agents are obviously worthfull to reduce major cardiovascular adverse events, but few randomised controlled trials (RCTs) have evaluated the benefits of these treatments in terms of LEAD and its related adverse events. Smoking cessation, physical activity, supervised walking rehabilitation and healthy diet are also crucial in LEAD management. Several advances have been achieved in endovascular and surgical revascularization procedures, with obvious improvement in LEAD management. The revascularization strategy should take into account several factors including anatomical localizations of lesions, medical history of each patients and operator experience. Further studies, especially RCTs, are needed to evaluate the interest of different therapeutic strategies on the occurrence and progression of LEAD and its related adverse events in patients with diabetes.
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Affiliation(s)
- Mathilde Nativel
- Département d'Endocrinologie, Diabétologie, Nutrition, Hôpital Haut-Lévêque, Avenue de Magellan, 33604, Pessac Cedex, France
| | - Louis Potier
- Département d'Endocrinologie, Diabétologie, Nutrition, Assistance Publique - Hôpitaux de Paris, Hospital Bichat, DHU FIRE, Paris, France.,UFR de Médecine, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,INSERM, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Laure Alexandre
- Département d'Endocrinologie, Diabétologie, Nutrition, Hôpital Haut-Lévêque, Avenue de Magellan, 33604, Pessac Cedex, France.,Faculté de Médecine, Université de Bordeaux, Bordeaux, France
| | - Laurence Baillet-Blanco
- Département d'Endocrinologie, Diabétologie, Nutrition, Hôpital Haut-Lévêque, Avenue de Magellan, 33604, Pessac Cedex, France
| | - Eric Ducasse
- Faculté de Médecine, Université de Bordeaux, Bordeaux, France.,Département de Chirurgie Vasculaire, CHU de Bordeaux, Bordeaux, France
| | - Gilberto Velho
- INSERM, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Michel Marre
- Département d'Endocrinologie, Diabétologie, Nutrition, Assistance Publique - Hôpitaux de Paris, Hospital Bichat, DHU FIRE, Paris, France.,UFR de Médecine, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,INSERM, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France.,Fondation Adolphe de Rothschild Hospital, Paris, France
| | - Ronan Roussel
- Département d'Endocrinologie, Diabétologie, Nutrition, Assistance Publique - Hôpitaux de Paris, Hospital Bichat, DHU FIRE, Paris, France.,UFR de Médecine, Université Paris Diderot, Sorbonne Paris Cité, Paris, France.,INSERM, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Vincent Rigalleau
- Département d'Endocrinologie, Diabétologie, Nutrition, Hôpital Haut-Lévêque, Avenue de Magellan, 33604, Pessac Cedex, France.,Faculté de Médecine, Université de Bordeaux, Bordeaux, France
| | - Kamel Mohammedi
- Département d'Endocrinologie, Diabétologie, Nutrition, Hôpital Haut-Lévêque, Avenue de Magellan, 33604, Pessac Cedex, France. .,Faculté de Médecine, Université de Bordeaux, Bordeaux, France.
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15
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van Haelst ST, Haitjema S, Derksen W, van Koeverden I, de Vries JPP, Moll FL, den Ruijter HM, Pasterkamp G, de Borst GJ. Atherosclerotic plaque characteristics are not associated with future cardiovascular events in patients undergoing iliofemoral endarterectomy. J Vasc Surg 2018; 67:809-816.e1. [DOI: 10.1016/j.jvs.2017.07.112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 07/12/2017] [Indexed: 10/18/2022]
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16
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Abstract
PURPOSE OF REVIEW The pivotal role of macrophages in experimental atherosclerosis is firmly established, but their contribution to human disease is less well defined. In this review we have outlined the current insights on macrophage phenotypes and their presumed precursors, monocytes, in clinical atherosclerosis, and their association with disease progression. Moreover, we will assess major clinical modifiers of macrophage-mediated plaque inflammation and define the outstanding questions for further study. RECENT FINDINGS Our survey indicates that macrophage accumulation and status in human plaques are linked with lesion progression and destabilization as well as with symptomatic coronary artery disease. Likewise, levels of their precursors, circulating monocytes were repeatedly seen to associate with atherosclerosis and to predict clinical outcome. Furthermore, the presence and phenotype of both macrophages and monocytes appears to be responsive to the traditional risk factors of atherosclerosis, including hypercholesterolemia, hypertension, and type 2 diabetes, and to treatment thereof, with clear repercussions on disease development. SUMMARY Although plaque macrophages and their precursor cells do represent attractive targets for treating cardiovascular diseases, this therapeutic avenue requires much deeper understanding of the complexity of macrophage biology in human atherosclerosis than available at present.
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Affiliation(s)
- Erik A L Biessen
- aDepartment of Pathology bDepartment of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, the Netherlands cInstitute for Molecular Cardiovascular Research (IMCAR), University Hospital RWTH, Aachen, Aachen, Germany
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17
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Engelen SE, van der Graaf Y, Stam-Slob MC, Grobbee DE, Cramer MJ, Kappelle LJ, de Borst GJ, Visseren FLJ, Westerink J. Incidence of cardiovascular events and vascular interventions in patients with type 2 diabetes. Int J Cardiol 2017; 248:301-307. [PMID: 28802735 DOI: 10.1016/j.ijcard.2017.07.081] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 07/02/2017] [Accepted: 07/13/2017] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Diabetes mellitus is associated with an increased risk for cardiovascular morbidity and mortality. The vascular burden in terms of incidence of cardiovascular events (CVE) and vascular interventions is however poorly quantified. In this study we evaluated the incidence rates of CVE and vascular interventions in patients with type 2 diabetes (T2DM) with and without cardiovascular disease (CVD) in comparison to patients without type 2 diabetes. RESEARCH DESIGN AND METHODS In a cohort of 9.808 high-risk patients with and without cardiovascular disease and type 2 diabetes originated from the ongoing, single-center prospective SMART (Second Manifestations of ARTerial disease) cohort, the number and incidence rates of CVE and interventions were calculated. The incidence rates were adjusted for confounders using Poisson regression models. CVE were defined as vascular death, stroke and myocardial infarction (MI). Interventions were defined as percutaneous coronary intervention, coronary artery bypass grafting, percutaneous transluminal angioplasty or stenting of the peripheral arteries and amputation. RESULTS Patients with T2DM and CVD had a 4-fold higher incidence rate of CVE and a 8-fold higher incidence rate of vascular interventions compared to high-risk patients without T2DM and CVD after adjusting for confounders. The incidence rate for the composite of non-fatal MI, non-fatal stroke and vascular death was 5.8 per 1000person-years in patients without T2DM or CVD at baseline, 15.2 per 1000person-years in patients with T2DM but without CVD at baseline, 26.0 per 1000person-years in patients without T2DM but with CVD and 40.7 per 1000person-years in patients with both T2DM and CVD at baseline. A similar increasing incidence rate was seen for all vascular interventions from patients without T2DM or CVD to patients with both T2DM and CVD. CONCLUSIONS Patients with type 2 diabetes or CVD are subject to an increased incidence of cardiovascular events and interventions compared to high-risk patients without type 2 diabetes or vascular disease. Patients with type 2 diabetes and CVD have the highest incidence of new cardiovascular diseases and vascular interventions when compared to patients without type 2 diabetes and CVD. These results underline the need for optimal risk factor treatment as well as the need for new prevention and treatment strategies in this very high risk population.
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Affiliation(s)
- Suzanne E Engelen
- Department of Vascular Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Yolanda van der Graaf
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Manon C Stam-Slob
- Department of Vascular Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Maarten J Cramer
- Department of Cardiology, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - L Jaap Kappelle
- Department of Neurology, Brain Center Rudolf Magnus, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG, Utrecht, The Netherlands
| | - Gert J de Borst
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Jan Westerink
- Department of Vascular Medicine, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands.
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