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Yu C, Ding C, Hu L, Shi Y, Zhao P, Liu J, Zhang L, Sun D, Zhou W, Yu C, Wang T, Zhu L, Huang X, Bao H, Cheng X. Association of plasma homocysteine with peripheral arterial disease in the hypertensive adults: A cross-sectional study. J Clin Hypertens (Greenwich) 2024; 26:286-294. [PMID: 38375979 PMCID: PMC10918742 DOI: 10.1111/jch.14766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/03/2023] [Accepted: 12/08/2023] [Indexed: 02/21/2024]
Abstract
Increased plasma homocysteine (Hcy) has been identified as one of the important risk factors for cardiovascular disease. However, the association between plasma Hcy and peripheral artery disease (PAD) is still controversial. This study aimed to investigate the association between plasma Hcy and PAD and the potential modifier factors in Chinese hypertensive adults. A total of 25 300 hypertensive patients aged 18 years or older were included in the analysis in this cross-sectional study. The outcome was PAD, which defined as an ankle-brachial index ≤0.90 in either limb. Multiple logistic regression was used to analyze the relationship between plasma Hcy and PAD. The median plasma Hcy was 14.00 (interquartile range: 11.60-17.80) μmol/L. There was a significant positive association between plasma Hcy and PAD (per SD increment; OR: 1.13; 95% CI: 1.06-1.19). Patients in the upper plasma Hcy tertile (≥16.16 μmol/L) were associated with a 53% increased risk of PAD compared with patients in the lower tertile (<12.33 μmol/L) after adjustment for multiple potential confounders. Subgroup analyses showed the association between Hcy and PAD was robust among various strata. Among Chinese adults with hypertension, plasma Hcy is an independent risk factor for PAD. This finding may improve the risk stratification of PAD.
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Wang H, Wu P, Jiang D, Zhang H, Zhang J, Zong Y, Han Y. Relationship between serum homocysteine, fibrinogen, lipoprotein-a level, and peripheral arterial disease: a dose-response meta-analysis. Eur J Med Res 2022; 27:261. [PMID: 36411481 PMCID: PMC9677707 DOI: 10.1186/s40001-022-00870-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Accepted: 10/25/2022] [Indexed: 11/22/2022] Open
Abstract
AIM At present, the relationship between serum homocysteine (Hcy), fibrinogen (FIB), lipoprotein-a (LPa), and PAD is uncertain, and there has been no meta-analysis to establish the dose-response relationship between their exposure levels and PAD. METHODS AND RESULTS Relevant literature published in PubMed, Embase, and Web of Science was retrieved. The robust error meta-regression method was used to assess the linear and non-linear dose-response relationship between exposure level and PAD risk. A total of 68 articles, involving 565,209 participants, were included. Combined with continuous variables, the serum Hcy, FIB, and LPa levels of PAD patients were significantly higher than those of healthy individuals. The odds ratios (ORs) of PAD for individuals with high Hcy, FIB, and LPa levels compared with those with low levels were 1.47, 1.14, and 1.76, respectively. The study also showed that circulating Hcy, FIB, and LPa were significantly elevated in patients with PAD compared with controls. The level of Hcy and the risk of PAD presented a U-shaped distribution. The nonlinear dose-response model showed that each 1 μmol/L increase in serum Hcy increased the risk of PAD by 7%. Similarly, for each 10 mg/dL FIB and 10 mg/dL LPa increases, the risk of PAD increased by 3% and 6%, respectively. CONCLUSIONS This meta-analysis provided evidence that elevated Hcy, PIB, and LPa levels may increase the risk of PAD, and the risk of PAD increases with the increase in serum exposure within a certain range. By controlling Hcy level, the incidence of PAD may be reduced to control the PAD growing epidemic. TRIAL REGISTRATION NUMBER PROSPERO (CRD42021250501), https://www.crd.york.ac.uk/prospero/.
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Affiliation(s)
- Hecheng Wang
- grid.30055.330000 0000 9247 7930School of Life and Pharmaceutical Sciences, Dalian University of Technology, Dalian, China
| | - Pengpeng Wu
- grid.30055.330000 0000 9247 7930School of Life and Pharmaceutical Sciences, Dalian University of Technology, Dalian, China
| | - Deying Jiang
- grid.452337.40000 0004 0644 5246Department of Vascular Surgery, Dalian Municipal Central Hospital, Dalian, China
| | - Hao Zhang
- grid.30055.330000 0000 9247 7930School of Life and Pharmaceutical Sciences, Dalian University of Technology, Dalian, China
| | - Jian Zhang
- grid.412636.40000 0004 1757 9485Department of Vascular Surgery, The First Hospital of China Medical University, Shengyang, China
| | - Yu Zong
- grid.30055.330000 0000 9247 7930School of Life and Pharmaceutical Sciences, Dalian University of Technology, Dalian, China
| | - Yanshuo Han
- grid.30055.330000 0000 9247 7930School of Life and Pharmaceutical Sciences, Dalian University of Technology, Dalian, China
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Bundugji MH, Bafarat D, Bundagji N, Arafsha Y, Hassan H. Assessment of oral health and care in head and neck oncology patients in King Faisal Specialist Hospital and Research Center-Jeddah. Saudi Dent J 2021; 33:1174-1183. [PMID: 34938064 PMCID: PMC8665203 DOI: 10.1016/j.sdentj.2021.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 12/17/2020] [Accepted: 01/24/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives To assess oral hygiene indices, dental status, and oral health practices among head and neck cancer patients at King Faisal Specialist Hospital and Research Center (KFSHRC)-Jeddah. Materials and Methods The charts of 117 patients with head and neck cancer were reviewed to identify the decayed/missing/filled teeth (DMFT) index, calculus index (CI), gingival index (MGI), and oral hygiene index. The type of cancer, other systemic diseases, and sex data were extracted from the records and analyzed using SPSS statistical software for descriptive statistics, Student’s t-test, analysis of variance (ANOVA), and Spearman correlation statistical analyses. Results The total mean DMFT index was 14.33. The significant caries index (SiC) for the studied sample was 25.87. Men had a mean DMFT of 14.11 (SD 9.8). The mean DMFT index for women was 14.63 (SD 9.7). The DMFT score for patients with systemic disease was 17.47 (SD 9.9). Patients with no other diseases had a mean DMFT score of 12.82 (SD 9.3). The DMFT index was not significantly different between men and women (p = 0.925). One-way ANOVA (F = 1.729) revealed no significant difference (p = 0.110) between DMFT scores according to the location of the cancer. DMFT with systemic disease showed no significant difference (p = 0.6) in comparison to patients without systemic disease. The Spearman rho statistic revealed no correlation between the DMFT score and CI (p = 0.383). Conclusions The total DMFT score was 14.33. The total SiC was 25.87. The DMFT scores of men and women were not significantly different. Cancer location and presence or absence of systemic diseases did not affect the DMFT score. The DMFT score and CI were not correlated, but a correlation was found between the DMFT score and MGI and the oral hygiene index.
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Affiliation(s)
- Maha H Bundugji
- Consultant General Dentistry, King Faisal Specialist Hospital and Research Center Jeddah, Saudi Arabia
| | - Dalia Bafarat
- Consultant General Dentistry, King Faisal Specialist Hospital and Research Center Jeddah, Saudi Arabia
| | - Najwa Bundagji
- Consultant General Dentistry, King Faisal Specialist Hospital and Research Center Jeddah, Saudi Arabia
| | - Yasmeen Arafsha
- Dental Hygienist, King Faisal Specialist Hospital and Research Center Jeddah, Saudi Arabia
| | - Hiba Hassan
- Former employee at King Faisal Specialist Hospital and Research Center Jeddah, Saudi Arabia
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Almoosawy SA, McGowan M, Hijazi K, Patey R, Bachoo P, Cherukara G. The oral health status of patients with peripheral vascular disorders: A systematic review. Vascular 2020; 29:556-566. [PMID: 33045941 PMCID: PMC8366191 DOI: 10.1177/1708538120963914] [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] [Indexed: 11/15/2022]
Abstract
Objectives Periodontal disease and tooth loss were found to be associated with several peripheral vascular disorders. Nonetheless, an evaluation of the literature on the broader domains of oral health in individuals with peripheral vascular disorders is lacking. This systematic review aims to collate the current evidence on the oral health status of individuals with peripheral vascular disorders. Methods Five electronic databases were searched for studies assessing oral health parameters in individuals with peripheral vascular disorders. Outcome measures considered were periodontal health, dentition status, caries indices, oral prostheses, oral pathologies and oral hygiene behaviours. The Newcastle-Ottawa scale was used to appraise the quality of the studies. Results From 3025 records identified, 24 studies involving 1232 participants with peripheral vascular disorders were included in this review. In nine studies, periodontitis was significantly more prevalent in peripheral vascular disorders compared to non-peripheral vascular disorders participants. A further six studies reported individuals with peripheral vascular disorders also had significantly fewer teeth and increased rates of edentulism. Only one study reported a higher incidence of dental caries in peripheral vascular disorders participants. Other aspects of oral health such as oral prosthesis, oral pathology and oral hygiene behaviours were seldom assessed. Conclusions The scarcity of studies reporting on broader domains limited our ability to arrive at a conclusion regarding the oral health status of individuals with peripheral vascular disorders. Future studies ought to assess these domains in individuals with peripheral vascular disorders and controls to gain a more complete understanding of oral health and its potential association with peripheral vascular disorders.
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Affiliation(s)
| | - Mhairi McGowan
- Institute of Dentistry, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - Karolin Hijazi
- Institute of Dentistry, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - Rona Patey
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, Scotland, United Kingdom
| | - Paul Bachoo
- Department of Vascular Surgery, Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom
| | - George Cherukara
- Institute of Dentistry, University of Aberdeen, Aberdeen, Scotland, United Kingdom
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A Pro-Inflammatory Biomarker-Profile Predicts Amputation-Free Survival in Patients with Severe Limb Ischemia. Sci Rep 2019; 9:10740. [PMID: 31341203 PMCID: PMC6656730 DOI: 10.1038/s41598-019-47217-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 07/08/2019] [Indexed: 12/13/2022] Open
Abstract
Patients with Severe Limb Ischemia (SLI) have a high risk of amputation and mortality. Here, we investigated a panel of serum biomarkers with the aim of identifying biomarkers for major events and mechanisms that contribute to disease progression in established SLI. A panel of biomarkers including GROα, HGF, SCF, SCGFβ, SDF1α, TRAIL, IL-6, IL-8, FGFβ, GCSF, GMCSF, IP10, MCP1, PDGFbb, RANTES, TNFα, VEGF, sICAM, sVCAM, TM, and E-selectin was measured in serum samples from a subset (n = 108) of the JUVENTAS cohort. The primary outcome was major events, defined as major amputation or death. The inflammatory biomarkers IL-6, IL-8, GROα and IP-10 were significantly elevated in patients who reached a major endpoint. Results were validated in a secondary cohort (n = 146). Cox regression showed that adjusted hazard ratios were 1.40 (95% CI: 1.15-1.70, p = 0.0007) and 1.48 (95% CI 1.16-1.87, p = 0.001) for IL-6 and IP-10 in a fully adjusted model containing both biomarkers. A prediction model using IL-6 and IP-10 showed predictive accuracy with an AUC of ~ 78% in both discovery and validation cohorts, which is higher than previously published models. We conclude that inflammatory biomarkers predict major events in patients with SLI and allow the creation of biomarker-based risk-prediction models.
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Kaschwich M, Behrendt CA, Heydecke G, Bayer A, Debus ES, Seedorf U, Aarabi G. The Association of Periodontitis and Peripheral Arterial Occlusive Disease-A Systematic Review. Int J Mol Sci 2019; 20:E2936. [PMID: 31208079 PMCID: PMC6627595 DOI: 10.3390/ijms20122936] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 06/10/2019] [Accepted: 06/12/2019] [Indexed: 12/24/2022] Open
Abstract
Background: Observational studies support an association between periodontitis (PD) and atherosclerotic vascular disease, but little is known specifically about peripheral arterial occlusive disease (PAOD). OBJECTIVES To systematically review the evidence for an association between PD and PAOD. DATA SOURCES Medline via PubMed. REVIEW METHODS We searched the Pubmed database for original studies, case reports, case series, meta-analyses and systematic reviews that assessed whether there is an association between PD (all degrees of severity) and PAOD (all degrees of severity). The reporting of this systematic review was in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement following the Population, Intervention, Control, and Outcome (PICO) format. RESULTS 17 out of 755 detected studies were included in the qualitative synthesis. Nine studies demonstrated associations between PD and PAOD, and two studies reported associations between tooth loss and PAOD. Six studies addressed the pathomechanism regarding PD as a possible trigger for PAOD. No study that dismissed an association could be detected. Odds ratios or hazard ratios ranged from 1.3 to 3.9 in four large cohort studies after adjusting for established cardiovascular risk factors. CONCLUSIONS The presented evidence supports a link between PD and PAOD. Further studies which address the temporality of PD and PAOD and randomized controlled intervention trials examining the causal impact of PD on PAOD are needed. Although our results cannot confirm a causal role of PD in the development of PAOD, it is likely that PD is associated with PAOD and plays a contributing role.
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Affiliation(s)
- Mark Kaschwich
- Department of Vascular Medicine, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany.
- Department of Surgery, University Medical Centre Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany.
| | - Christian-Alexander Behrendt
- Department of Vascular Medicine, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany.
| | - Guido Heydecke
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
| | - Andreas Bayer
- Department of Surgery, University Medical Centre Schleswig-Holstein, Campus Luebeck, Ratzeburger Allee 160, 23538 Luebeck, Germany.
| | - Eike Sebastian Debus
- Department of Vascular Medicine, University Heart Center Hamburg, University Medical Center Hamburg-Eppendorf, 20251 Hamburg, Germany.
| | - Udo Seedorf
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
| | - Ghazal Aarabi
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany.
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Barriers and enablers to walking in individuals with intermittent claudication: A systematic review to conceptualize a relevant and patient-centered program. PLoS One 2018; 13:e0201095. [PMID: 30048501 PMCID: PMC6062088 DOI: 10.1371/journal.pone.0201095] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 07/09/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Walking limitation in patients with peripheral arterial disease (PAD) and intermittent claudication (IC) contributes to poorer disease outcomes. Identifying and examining barriers to walking may be an important step in developing a comprehensive patient-centered self-management intervention to promote walking in this population. AIM To systematically review the literature regarding barriers and enablers to walking exercise in individuals with IC. METHODS A systematic review was conducted utilizing integrative review methodology. Five electronic databases and the reference lists of relevant studies were searched. Findings were categorized into personal, walking activity related, and environmental barriers and enablers using a social cognitive framework. RESULTS Eighteen studies including quantitative (n = 12), qualitative (n = 5), and mixed method (n = 1) designs, and reporting data from a total of 4376 patients with IC, were included in the review. The most frequently reported barriers to engaging in walking were comorbid health concerns, walking induced pain, lack of knowledge (e.g. about the disease pathology and walking recommendations), and poor walking capacity. The most frequently reported enablers were cognitive coping strategies, good support systems, and receiving specific instructions to walk. Findings suggest additionally that wider behavioral and environmental obstacles should be addressed in a patient-centered self-management intervention. CONCLUSIONS This review has identified multidimensional factors influencing walking in patients with IC. Within the social cognitive framework, these factors fall within patient level factors (e.g. comorbid health concerns), walking related factors (e.g. claudication pain), and environmental factors (e.g. support systems). These factors are worth considering when developing self-management interventions to increase walking in patients with IC. Systematic review registration CRD42018070418.
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Yang S, Zhao LS, Cai C, Shi Q, Wen N, Xu J. Association between periodontitis and peripheral artery disease: a systematic review and meta-analysis. BMC Cardiovasc Disord 2018; 18:141. [PMID: 29980169 PMCID: PMC6035462 DOI: 10.1186/s12872-018-0879-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 07/02/2018] [Indexed: 12/26/2022] Open
Abstract
Background Inflammation is a common feature of both peripheral arterial disease (PAD) and periodontitis. Some studies have evaluated the association between PAD and periodontitis. However, there is still no specialized meta-analysis that has quantitatively assessed the strength of the association. Thus, we conducted this meta-analysis to critically assess the strength of the association between PAD and periodontitis. Methods PubMed, Embase, and the Cochrane Library were searched for observational studies of the association between periodontitis and PAD in February 2018. Risk ratios (RRs) and their 95% confidence intervals (CIs) from included studies were pooled to evaluate the strength of the association between periodontitis and PAD. Weighted mean differences (WMDs) and their 95% CIs were pooled to compare the difference in periodontal-related parameters between PAD and non-PAD patients. Results Seven studies including a total of 4307 participants were included in the meta-analysis. The pooled analysis showed that there was a significant difference in the risk of periodontitis between PAD patients and non-PAD participants (RR = 1.70, 95% CI = 1.25–2.29, P = 0.01). There was also a significant difference in number of missing teeth between PAD patients and non-PAD participants (WMD = 3.75, 95% CI = 1.31–6.19, P = 0.003). No significant difference was found in clinical attachment loss between PAD patients and non-PAD participants (WMD = − 0.05, 95% CI = − 0.03–0.19, P = 0.686). Conclusion In conclusion, the results of this meta-analysis revealed a significant relationship between periodontitis and PAD. Moreover, our study indicated that PAD patients had more missing teeth than control subjects did. Further high-quality and well-designed studies with specific inclusion and exclusion criteria are required to strengthen the conclusions of this study. Electronic supplementary material The online version of this article (10.1186/s12872-018-0879-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shuo Yang
- Department of Stomatology, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Li Sheng Zhao
- Department of Stomatology, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Chuan Cai
- Department of Stomatology, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Quan Shi
- Department of Stomatology, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Ning Wen
- Department of Stomatology, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, China.
| | - Juan Xu
- Department of Stomatology, Chinese People's Liberation Army General Hospital, 28 Fuxing Road, Beijing, 100853, China.
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Srivaratharajah K, Abramson BL. Women and Peripheral Arterial Disease: A Review of Sex Differences in Epidemiology, Clinical Manifestations, and Outcomes. Can J Cardiol 2018; 34:356-361. [DOI: 10.1016/j.cjca.2018.01.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 01/11/2018] [Accepted: 01/11/2018] [Indexed: 11/17/2022] Open
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Wang SH, Chien WC, Chung CH, Lin FH, Peng CK, Chian CF, Shen CH. Tuberculosis increases the risk of peripheral arterial disease: A nationwide population-based study. Respirology 2017; 22:1670-1676. [PMID: 28681508 DOI: 10.1111/resp.13117] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 05/14/2017] [Accepted: 05/19/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND OBJECTIVE According to several studies, tuberculosis (TB) may be involved in the pathogenesis of cardiovascular disease. However, the relationship between TB and peripheral arterial disease (PAD) has not been studied. The aim of this study was to investigate whether patients with TB exhibit an increased risk of developing PAD. METHODS The data assessed in this national population-based cohort study were obtained from the Taiwan National Health Insurance Database from 2000 to 2010. Patients with newly diagnosed TB were selected using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. The non-TB cohort was randomly frequency-matched to the TB cohort at a ratio of 2:1 according to age, sex and index year. Cox's proportional hazards regression models were used to analyse the risk of PAD. RESULTS We enrolled 14 350 patients with TB and 28 700 controls in this study. The risk of PAD was 3.93-fold higher in the patients with TB than in the non-TB controls after adjusting for age, sex, co-morbidities and socio-economic status. Based on the subgroup analysis, the TB cohort exhibited an increased risk of developing PAD compared with the non-TB cohort, regardless of age, sex, co-morbidities and socio-economic status. Patients with TB had a higher risk of developing PAD than healthy control subjects after 1 year of follow-up. CONCLUSION Patients with TB have a significantly higher risk of developing PAD than patients without TB. TB should be considered when evaluating a patient's risk of developing PAD.
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Affiliation(s)
- Sheng-Huei Wang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chi-Hsiang Chung
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Fu-Huang Lin
- School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Chung-Kan Peng
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Institute of Undersea and Hyperbaric Medicine, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Feng Chian
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chih-Hao Shen
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Chiu CH, Lin CL, Lee FY, Wang YC, Kao CH. Leptospirosis and Peripheral Artery Occlusive Disease: A Nationwide Cohort Analysis. Medicine (Baltimore) 2016; 95:e3127. [PMID: 26986166 PMCID: PMC4839947 DOI: 10.1097/md.0000000000003127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Data on the association between peripheral artery occlusive disease (PAOD) and leptospirosis are limited. We conducted a retrospective cohort study for determining whether leptospirosis is one of the possible risk factors for PAOD. Patients diagnosed with leptospirosis by using 2000 to 2010 data from the Taiwan National Health Insurance Research Database. Patients with leptospirosis without a history of PAOD were selected. For each leptospirosis patient, 4 controls without a history of leptospirosis and PAOD were randomly selected and frequency-matched for sex, age, the year of the index date, and comorbidity diseases. The follow-up period was from the time of the initial diagnosis of leptospirosis to the diagnosis date of PAOD, or December 31, 2011. The Cox proportional hazard regression models were used for analyzing the risk of PAOD. During the follow-up period, the cumulative incidence of PAOD was higher among the patients from the leptospirosis cohort than among the nonleptospirosis cohort (log-rank test, P < 0.001). In total, 29 patients with PAOD from the leptospirosis cohort and 81 from the nonleptospirosis cohort were observed with the incidence rates of 2.1 and 1.3 per 1000 person-years, respectively, yielding a crude hazards ratio (HR) of 1.62 (95% confidence interval [CI] = 1.44-1.81) and adjusted HR (aHR) of 1.75 (95% CI = 1.58-1.95).The risk of PAOD was 1.75-fold higher in the patients with leptospirosis than in the general population.
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Affiliation(s)
- Chun-Hsiang Chiu
- From the Division of Infectious Diseases and Tropical Medicine (C-HC), Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center; Institute of Clinical Medicine (C-HC), School of Medicine, National Yang-Ming University; Management Office for Health Data (C-LL), China Medical University Hospital; College of Medicine, China Medical University(C-LL); Department of Emergency Medicine (F-YL), Taichung Tzu Chi Hospital, Taichung; Department of Family Medicine (Y-CW), Tri-Service General Hospital, National Defense Medical Center; Graduate Institute of Clinical Medical Science and School of Medicine (C-HK), College of Medicine, China Medical University; and Department of Nuclear Medicine and PET Center (C-HK), China Medical University Hospital, Taichung, Taiwan
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Amrock SM, Weitzman M. Multiple biomarkers for mortality prediction in peripheral arterial disease. Vasc Med 2016; 21:105-12. [DOI: 10.1177/1358863x15621797] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Few studies have assessed which biomarkers influence mortality risk among those with peripheral arterial disease (PAD). We analyzed data from 556 individuals identified to have PAD (i.e. ankle–brachial index ⩽0.9) with available measurements of C-reactive protein, the neutrophil-to-lymphocyte ratio (NLR), homocysteine, and the urinary albumin-to-creatinine ratio (UACR) in the 1999–2004 National Health and Nutrition Examination Survey. We investigated whether a combination of these biomarkers improved the prediction of all-cause and cardiovascular mortality beyond conventional risk factors. During follow-up (median, 8.1 years), 277 of 556 participants died; 63 deaths were attributed to cardiovascular disease. After adjusting for conventional risk factors, Cox proportional-hazards models showed the following to be most strongly associated with all-cause mortality (each is followed by the adjusted hazard ratio [HR] per 1 standard deviation increment in the log values): homocysteine (1.31), UACR (1.21), and NLR (1.20). UACR alone significantly predicted cardiovascular mortality (1.53). Persons in the highest quintile of multimarker scores derived from regression coefficients of significant biomarkers had elevated risks of all-cause mortality (adjusted HR, 2.45; 95% CI, 1.66–3.62; p for trend, <0.001) and cardiovascular mortality (adjusted HR, 2.20; 95% CI, 1.02–4.71; p for trend, 0.053) compared to those in the lowest two quintiles. The addition of continuous multimarker scores to conventional risk factors improved risk stratification of all-cause mortality (integrated discrimination improvement [IDI], 0.162; p<0.00001) and cardiovascular mortality (IDI, 0.058; p<0.00001). In conclusion, the addition of a continuous multimarker score to conventional risk factors improved mortality prediction among patients with PAD.
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Affiliation(s)
- Stephen M Amrock
- Department of Medicine, Oregon Health & Science University, Portland, OR, USA
| | - Michael Weitzman
- Department of Pediatrics, New York University School of Medicine, New York, NY, USA
- Department of Environmental Medicine, New York University School of Medicine, New York, NY, USA
- College of Global Public Health, New York University, New York, NY, USA
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Abstract
New data on the epidemiology of peripheral artery disease (PAD) are available, and they should be integrated with previous data. We provide an updated, integrated overview of the epidemiology of PAD, a focused literature review was conducted on the epidemiology of PAD. The PAD results were grouped into symptoms, diagnosis, prevalence, and incidence both in the United States and globally, risk factors, progression, coprevalence with other atherosclerotic disease, and association with incident cardiovascular morbidity and mortality. The most common symptom of PAD is intermittent claudication, but noninvasive measures, such as the ankle-brachial index, show that asymptomatic PAD is several times more common in the population than intermittent claudication. PAD prevalence and incidence are both sharply age-related, rising >10% among patients in their 60s and 70s. With aging of the global population, it seems likely that PAD will be increasingly common in the future. Prevalence seems to be higher among men than women for more severe or symptomatic disease. The major risk factors for PAD are similar to those for coronary and cerebrovascular disease, with some differences in the relative importance of factors. Smoking is a particularly strong risk factor for PAD, as is diabetes mellitus, and several newer risk markers have shown independent associations with PAD. PAD is strongly associated with concomitant coronary and cerebrovascular diseases. After adjustment for known cardiovascular disease risk factors, PAD is associated with an increased risk of incident coronary and cerebrovascular disease morbidity and mortality.
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Affiliation(s)
- Michael H Criqui
- From the Division of Preventive Medicine, Department of Family and Preventive Medicine, Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, CA (M.H.C.); Department of Cardiology, Dupuytren University Hospital, Limoges, France (V.A.); and INSERM 1094, Tropical Neuroepidemiology, Limoges School of Medicine, Limoges, France (V.A.).
| | - Victor Aboyans
- From the Division of Preventive Medicine, Department of Family and Preventive Medicine, Division of Cardiology, Department of Medicine, University of California, San Diego, La Jolla, CA (M.H.C.); Department of Cardiology, Dupuytren University Hospital, Limoges, France (V.A.); and INSERM 1094, Tropical Neuroepidemiology, Limoges School of Medicine, Limoges, France (V.A.)
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Rein P, Saely CH, Silbernagel G, Vonbank A, Mathies R, Drexel H, Baumgartner I. Systemic inflammation is higher in peripheral artery disease than in stable coronary artery disease. Atherosclerosis 2015; 239:299-303. [DOI: 10.1016/j.atherosclerosis.2015.01.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Revised: 01/08/2015] [Accepted: 01/14/2015] [Indexed: 12/01/2022]
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15
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Vijayvergiya R, Vadivelu R. Role of Helicobacter pylori infection in pathogenesis of atherosclerosis. World J Cardiol 2015; 7:134-143. [PMID: 25810813 PMCID: PMC4365310 DOI: 10.4330/wjc.v7.i3.134] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 12/01/2014] [Indexed: 02/06/2023] Open
Abstract
Though a century old hypothesis, infection as a cause for atherosclerosis is still a debatable issue. Epidemiological and clinical studies had shown a possible association but inhomogeneity in the study population and study methods along with potential confounders have yielded conflicting results. Infection triggers a chronic inflammatory state which along with other mechanisms such as dyslipidemia, hyper-homocysteinemia, hypercoagulability, impaired glucose metabolism and endothelial dysfunction, contribute in pathogenesis of atherosclerosis. Studies have shown a positive relations between Cytotoxic associated gene-A positive strains of Helicobacter pylori and vascular diseases such as coronary artery disease and stroke. Infection mediated genetic modulation is a new emerging theory in this regard. Further large scale studies on infection and atherosclerosis focusing on multiple pathogenetic mechanisms may help in refining our knowledge in this aspect.
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16
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Bartova J, Sommerova P, Lyuya-Mi Y, Mysak J, Prochazkova J, Duskova J, Janatova T, Podzimek S. Periodontitis as a risk factor of atherosclerosis. J Immunol Res 2014; 2014:636893. [PMID: 24741613 PMCID: PMC3987959 DOI: 10.1155/2014/636893] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 01/29/2014] [Accepted: 02/17/2014] [Indexed: 11/24/2022] Open
Abstract
Over the last two decades, the amount of evidence corroborating an association between dental plaque bacteria and coronary diseases that develop as a result of atherosclerosis has increased. These findings have brought a new aspect to the etiology of the disease. There are several mechanisms by which dental plaque bacteria may initiate or worsen atherosclerotic processes: activation of innate immunity, bacteremia related to dental treatment, and direct involvement of mediators activated by dental plaque and involvement of cytokines and heat shock proteins from dental plaque bacteria. There are common predisposing factors which influence both periodontitis and atherosclerosis. Both diseases can be initiated in early childhood, although the first symptoms may not appear until adulthood. The formation of lipid stripes has been reported in 10-year-old children and the increased prevalence of obesity in children and adolescents is a risk factor contributing to lipid stripes development. Endothelium damage caused by the formation of lipid stripes in early childhood may lead to bacteria penetrating into blood circulation after oral cavity procedures for children as well as for patients with aggressive and chronic periodontitis.
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Affiliation(s)
- Jirina Bartova
- Institute of Clinical and Experimental Dental Medicine, First Faculty of Medicine and General University Hospital, Charles University, Karlovo Namesti 32, 12000 Prague, Czech Republic
| | - Pavla Sommerova
- Institute of Clinical and Experimental Dental Medicine, First Faculty of Medicine and General University Hospital, Charles University, Karlovo Namesti 32, 12000 Prague, Czech Republic
| | - Yelena Lyuya-Mi
- Institute of Clinical and Experimental Dental Medicine, First Faculty of Medicine and General University Hospital, Charles University, Karlovo Namesti 32, 12000 Prague, Czech Republic
| | - Jaroslav Mysak
- Institute of Clinical and Experimental Dental Medicine, First Faculty of Medicine and General University Hospital, Charles University, Karlovo Namesti 32, 12000 Prague, Czech Republic
| | - Jarmila Prochazkova
- Institute of Clinical and Experimental Dental Medicine, First Faculty of Medicine and General University Hospital, Charles University, Karlovo Namesti 32, 12000 Prague, Czech Republic
| | - Jana Duskova
- Institute of Clinical and Experimental Dental Medicine, First Faculty of Medicine and General University Hospital, Charles University, Karlovo Namesti 32, 12000 Prague, Czech Republic
| | - Tatjana Janatova
- Institute of Clinical and Experimental Dental Medicine, First Faculty of Medicine and General University Hospital, Charles University, Karlovo Namesti 32, 12000 Prague, Czech Republic
| | - Stepan Podzimek
- Institute of Clinical and Experimental Dental Medicine, First Faculty of Medicine and General University Hospital, Charles University, Karlovo Namesti 32, 12000 Prague, Czech Republic
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17
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SIGNORELLI SALVATORESANTO, FIORE VALERIO, MALAPONTE GRAZIA. Inflammation and peripheral arterial disease: The value of circulating biomarkers (Review). Int J Mol Med 2014; 33:777-83. [DOI: 10.3892/ijmm.2014.1657] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 01/10/2014] [Indexed: 11/06/2022] Open
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Abstract
Hyperhomocysteinemia is considered a risk factor for atherosclerosis. Methyltetrahydrofolate reductase (MTHFR) gene mutation and low level of plasma vitamin B12 and folate could take part in the etiology of peripheral arterial disease (PAD). We examined whether plasma vitamin B12 and folate levels and MTHFR-C677T polymorphism are associated with the risk of PAD. The study comprised 293 patients (107 females, 186 males, mean age of 66 ± SEM0.7 years) and 293 sex-matched control subjects (mean age of 62 ± SEM0.8 years). We also determined plasma lipid profile, hs-CRP, creatinine, vitamin B12, folate and total homocysteine (tHcy) for all patients and controls. Odds ratios were non-significant for different genotypes of MTHFR-C677T polymorphism. There was a significant lower level of vitamin B12 in PAD patients. 43 and 25 % of patient and control populations were in the lowest quartile of vitamin B12 (<188 pmol/L), respectively. Plasma level of vitamin B12 in the lowest quartile significantly increased tHcy level in PAD patients, and it was independent of plasma folate level. Low level of plasma vitamin B12 was independently associated with hyperhomocysteinemia in PAD patients. The prevalence of the MTHFR-C677T mutation was not significantly different in patients with PAD compared with controls.
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19
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Possible translocation of periodontal pathogens into the lymph nodes draining the oral cavity. J Microbiol 2012; 50:827-36. [PMID: 23124752 DOI: 10.1007/s12275-012-2030-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Accepted: 06/19/2012] [Indexed: 01/03/2023]
Abstract
Numerous publications have reported the presence of periodontopathogenic bacteria in peripheral and central vascular lesions. However, it is unclear how this bacterial translocation occurs. The objective of this study was to investigate whether periodontopathic bacteria are translocated to lymph nodes proximal to the oral cavity. Obtaining lymph node samples is not ethically feasible unless they are excised as part of the surgical management of patients with cancer. This study analyzed formalin-fixed and paraffin-embedded lymph nodes, histologically negative for cancer cell invasion, that were excised from 66 patients with histories of head and neck cancer. Real-time PCR was performed to amplify the 16S ribosomal DNA fragments from Porphyromonas gingivalis, Treponema denticola, Aggregatibacter actinomycetemcomitans, Tannerella forsythia, and Prevotella intermedia. The relationship between bacterial detection and cancer severity, gender, and the use of anti-cancer therapy was examined by Fisher's exact test. P. gingivalis, T. forsythia, and P. intermedia were present in 17%, 8%, and 8% of the samples of submandibular and submental lymph nodes, respectively. There were no significant relationships between bacterial detection and the cancer disease status, patient gender or use of anticancer therapy. According to these data, it appears that the translocation of periodontopathic bacteria may occur via lymphatic drainage, irrespective of the cancer disease status, gender or anticancer therapy.
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Joseph R, Nath SG, Joseraj MG. Elevated plasma homocysteine levels in chronic periodontitis: a hospital-based case-control study. J Periodontol 2010; 82:439-44. [PMID: 20831374 DOI: 10.1902/jop.2010.100271] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Plasma homocysteine (Hcy), a novel risk factor for cardiovascular disease, has been found to be increased in inflammatory diseases, such as rheumatoid arthritis. Our study investigates the association between chronic periodontitis and plasma Hcy. METHODS This case-control study involves 85 age- and sex-matched subjects with chronic periodontitis and 91 healthy controls. Patients were grouped into moderate and severe periodontitis. Plaque index, calculus component of simplified oral hygiene index, and modified gingival index were recorded. Body mass index, fasting blood sugar, total cholesterol, triglycerides, high-density lipoprotein, low-density lipoprotein, very-low-density lipoprotein, and plasma Hcy were also assessed. RESULTS Case and control groups had similar levels of fasting blood sugar, lipid profile, and body mass index. The mean plasma Hcy was found to be 19.22 ± 8.27 and 10.27 ± 2.50 μmol/L for cases and controls, respectively. A significant elevation in plasma Hcy levels was observed in cases (P <0.05). No significant differences were observed in plasma Hcy levels between moderate and severe chronic periodontitis (P = 0.722). CONCLUSIONS Elevated levels of plasma Hcy were observed in patients with chronic periodontitis. Future research should be directed on the effect of periodontal therapy on plasma Hcy levels.
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Affiliation(s)
- Rosamma Joseph
- Department of Periodontics, Government Dental College, Medical College Post Office, Calicut, Kerala, India.
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22
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Abstract
Peripheral arterial disease (PAD), a relatively common manifestation of atherosclerotic vascular disease, is associated with significant morbidity and mortality. Although conventional risk factors contribute to the onset and progression of PAD, the role of 'novel' biomarkers in pathways of inflammation, thrombosis, lipoprotein metabolism, and oxidative stress in determining susceptibility to PAD is being increasingly recognized. Validation of novel risk factors for PAD may allow earlier detection, an improved understanding of disease etiology and progression, and the development of new therapies. In this review, we discuss available evidence for associations between novel circulating markers and several aspects of PAD including disease susceptibility, progression, functional limitation, and adverse outcomes.
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Affiliation(s)
- Farhan J Khawaja
- Department of Medicine, Division of Cardiovascular Diseases and the Gonda Vascular Center, Mayo Clinic College of Medicine, Rochester, MN 55905, USA
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23
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Friedewald VE, Kornman KS, Beck JD, Genco R, Goldfine A, Libby P, Offenbacher S, Ridker PM, Van Dyke TE, Roberts WC. The American Journal of Cardiology and Journal of Periodontology editors' consensus: periodontitis and atherosclerotic cardiovascular disease. J Periodontol 2009; 80:1021-32. [PMID: 19563277 DOI: 10.1902/jop.2009.097001] [Citation(s) in RCA: 169] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
ACKNOWLEDGMENT This Editors' Consensus is supported by an educational grant from Colgate-Palmolive, Inc., New York, New York, and is based on a meeting of the authors held in Boston, Massachusetts, on January 9, 2009. DISCLOSURE Dr. Friedewald has received honoraria for speaking from Novartis, East Hanover, New Jersey. Dr. Kornman is a full-time employee and shareholder of Interleukin Genetics, Waltham, Massachusetts, which owns patents on genetic biomarkers for chronic inflammatory diseases. Dr. Genco is a consultant to Merck, Whitehouse Station, New Jersey. Dr. Ridker has received research support from AstraZeneca, Wilmington, Delaware; Novartis; Pfizer, New York, New York; Roche, Nutley, New Jersey; Sanofi-Aventis, Bridgewater, New Jersey; and Abbott Laboratories, Abbott Park, Illinois. Dr. Ridker has received non-financial research support from Amgen, Thousand Oaks, California. Dr. Ridker is a co-inventor on patents held by Brigham and Women's Hospital that relate to the use of inflammatory biomarkers in cardiovascular disease. Dr. Ridker is a research consultant for Schering-Plough, Kenilworth, New Jersey; Sanofi-Aventis; AstraZeneca; Isis, Carlsbad, California; Novartis; and Vascular Biogenics, Tel Aviv, Israel. Dr. Van Dyke is a co-inventor on patents held by Boston University, Boston, Massachusetts, that relate to inflammation control, including consulting fees. Dr. Roberts has received honoraria for speaking from Merck, Schering-Plough, AstraZeneca, and Novartis. All other individuals in a position to control content disclosed no relevant financial relationships.
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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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25
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Callens S, Florence E, Philippe M, Van Der Planken M, Colebunders R. Mixed Arterial and Venous Thromboembolism in a Person with HIV Infection. ACTA ACUST UNITED AC 2009; 35:907-8. [PMID: 14723381 DOI: 10.1080/00365540310017014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
People with human immunodeficiency virus (HIV) infection are more susceptible to thromboembolic events. Venous thromboembolism (VTE) occurs frequently in HIV infected persons but arterial thrombosis has only rarely been reported. We describe a case of a person with HIV infection who developed an arterial thrombosis and 3 months later an extensive VTE. Several non-HIV and HIV related thrombogenic factors were identified.
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Affiliation(s)
- Steven Callens
- Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
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26
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Friedewald VE, Kornman KS, Beck JD, Genco R, Goldfine A, Libby P, Offenbacher S, Ridker PM, Van Dyke TE, Roberts WC. The American Journal of Cardiology and Journal of Periodontology Editors' Consensus: periodontitis and atherosclerotic cardiovascular disease. Am J Cardiol 2009; 104:59-68. [PMID: 19576322 DOI: 10.1016/j.amjcard.2009.05.002] [Citation(s) in RCA: 155] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2009] [Accepted: 05/06/2009] [Indexed: 11/16/2022]
Affiliation(s)
- Vincent E Friedewald
- The American Journal of Cardiology, University of Notre Dame, Notre Dame, IN, USA.
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Paraskevas S, Huizinga JD, Loos BG. A systematic review and meta-analyses on C-reactive protein in relation to periodontitis. J Clin Periodontol 2008; 35:277-90. [PMID: 18294231 DOI: 10.1111/j.1600-051x.2007.01173.x] [Citation(s) in RCA: 479] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
AIM Elevated plasma C-reactive protein (CRP) is regarded as a risk predictor for cardiovascular diseases. This systematic review explored the robustness of observations that CRP is elevated in periodontitis. Similarly, the effect of periodontal therapy on CRP levels was investigated. MATERIAL AND METHODS Selection of publications was based on: (1) cross-sectional (case-control) studies; (2) longitudinal (treatment) studies; (3) high-sensitivity CRP measurement; (4) median and/or mean (+/-SD) values presented; and (5) subjects with no systemic disorders. RESULTS Screening of the initially 448 identified studies and reference checking resulted in 18 suitable papers. The majority of the studies showed that CRP levels are higher in patients than in controls. Often, studies showed that patients had CRP levels >2.1 mg/l. A meta-analysis of 10 cross-sectional studies showed that the weighted mean difference (WMD) of CRP between patients and controls was 1.56 mg/l (p<0.00001). Evidence from available treatment studies (n=6) showed lower levels of CRP after periodontal therapy. Eligible treatment studies in a meta-analysis demonstrated a WMD of reductions of CRP after therapy of 0.50 mg/L (95% CI 0.08-0.93) (p=0.02). CONCLUSIONS There is strong evidence from cross-sectional studies that plasma CRP in periodontitis is elevated compared with controls. There is modest evidence on the effect of periodontal therapy in lowering the levels of CRP.
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Affiliation(s)
- Spiros Paraskevas
- Department of Periodontology, Academic Centre for Dentistry Amsterdam (ACTA), University of Amsterdam and Vrije University, Amsterdam, The Netherlands.
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28
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Garofolo L, Barros N, Miranda F, D'Almeida V, Cardien LC, Ferreira SR. Association of Increased Levels of Homocysteine and Peripheral Arterial Disease in a Japanese-Brazilian Population. Eur J Vasc Endovasc Surg 2007; 34:23-8. [PMID: 17482486 DOI: 10.1016/j.ejvs.2007.02.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2006] [Accepted: 02/13/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Our aim was to evaluate the possible association between homocysteine levels and peripheral arterial disease (PAD) in a population-based study of Japanese-Brazilians. MATERIALS AND METHODS This cross-sectional study was derived from a population-based survey on the prevalence of diabetes and associated diseases conducted in Japanese-Brazilians. A total of 1330 male and female subjects aged>or=30 years were submitted to clinical examination and laboratory procedures including homocysteine measurement. The ankle-brachial index (ABI) was calculated; subjects with ABI values <0.9 were diagnosed with PAD. The evaluable population included 1008 subjects. Logistic regression was used taking PAD as the dependent variable. RESULTS Mean age of the population was 56.5 years and overall prevalence of PAD was 20%. A worse cardiovascular profile was found in male patients, including significantly higher homocysteine levels (11.9+/-1.8 vs. 9.1+/-1.1micromol/L, p<0.001). Men with PAD had higher prevalence rates of hyperhomocysteinemia compared to women (22.7% vs 7.6%). Univariate analysis showed an odds ratio of hyperhomocysteinemia for PAD of 1.51 [1.02-2.25] in men and 1.69 [1.06-2.68] in women. After adjustment for other cardiovascular risk factors, higher levels of homocysteine were only significantly related to PAD in men. CONCLUSION In a Japanese-Brazilian population, elevated levels of homocysteine are associated with PAD in men. Prospective studies are necessary to confirm this finding.
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Affiliation(s)
- L Garofolo
- Post-Graduation Course on Cardiac, Vascular and Thoracic Surgery, Surgery Department, Federal University of Sao Paulo, Sao Paulo, Brazil.
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Abdellaoui A, Al-Khaffaf H. C-Reactive Protein (CRP) as a Marker in Peripheral Vascular Disease. Eur J Vasc Endovasc Surg 2007; 34:18-22. [PMID: 17296319 DOI: 10.1016/j.ejvs.2006.10.040] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2006] [Accepted: 10/25/2006] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To review the role of CRP as a marker for the prediction of development of Peripheral Vascular Disease (PVD) and as a prognostic indicator. METHODS Search of the Cochrane Vascular Group Control Trials Register, Medline and Embase for all published studies on the role of CRP as a marker in peripheral vascular disease was undertaken.13 prospective studies were found. RESULTS 12 of the 13 prospective studies showed a strong association between CRP and PVD. Three population studies involving 16,561 people, over a period of 6.5 to 12 years, revealed that high CRP levels approximately tripled the risk of developing PVD, independently of all other risk factors. Three case-control studies found that hsCRP was much higher in patients with PVD. Four other studies, which covered 2337 people, demonstrated that CRP levels were associated inversely with lower ankle brachial pressure index. One study conducted on 384 people failed to show a link between hsCRP and progression of ABPI. Two further small studies showed that raised pre and post intervention hsCRP were associated with restenosis after angioplasty. CONCLUSIONS CRP appears to be a strong predictor and marker of severity of PVD and also may predict the risk of restenosis after angioplasty.
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Affiliation(s)
- A Abdellaoui
- East Lancashire Hospitals NHS Trust, General/Vascular Surgery, Burnley General Hospital, Casterton Avenue, Burnley, Lancashire BB10 2PQ, United Kingdom
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Khawaja FJ, Bailey KR, Turner ST, Kardia SL, Mosley TH, Kullo IJ. Association of novel risk factors with the ankle brachial index in African American and non-Hispanic white populations. Mayo Clin Proc 2007; 82:709-16. [PMID: 17550751 DOI: 10.4065/82.6.709] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To investigate whether novel risk factors, including C-reactive protein (CRP), fibrinogen, lipoprotein(a) [Lp(a)], and homocysteine levels, are associated with the ankle brachial index (ABI) in African American and non-Hispanic white populations and whether novel risk factors account for ethnic differences in peripheral arterial disease (PAD). PARTICIPANTS AND METHODS Between December 2000 and October 2004, original participants in the Genetic Epidemiology Network of Arteriopathy study returned for a second study visit to undergo measurement of risk factors and ABI. The CRP, Lp(a), and homocysteine levels were log transformed to reduce skewness. Multivariable regression analyses were used to assess whether a novel risk factor was associated with ABI after adjustment for conventional risk factors and whether ethnicity was associated with PAD (ABI, <or=0.95) after adjustment for conventional and novel risk factors. RESULTS Of 2229 study participants, the ABI was determined in 1395 African American participants (mean +/- SD age, 63 +/- 9 years; 71% women) and 834 white participants (mean +/- SD age, 58 +/- 9 years; 62% women) who belonged to hypertensive sibships. The mean ABI was lower in African American than in white individuals (0.99 +/- 0.1 vs 1.13 +/- 0.1; P < .001). In both ethnic groups, higher levels of CRP, fibrinogen, and homocysteine were each associated with a lower ABI after adjustment for conventional risk factors. In African American participants, the Lp(a) level was also significantly associated with the ABI. African American ethnicity was associated with the presence of PAD after adjustment for conventional risk factors (men: odds ratio [OR], 3.04; 95% confidence interval [CI], 1.80-5.15; women: OR, 2.82; 95% CI, 1.85-4.29), but the risk was significantly attenuated after additional adjustment for novel risk factors (men: OR, 2.11; 95% CI, 1.21-3.70; women: OR, 1.98; 95% CI, 1.26-3.11). CONCLUSION Novel risk factors are associated with interindividual variation in ABI in African American and non-Hispanic white populations and partly account for the increased risk of PAD associated with African American ethnicity.
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Affiliation(s)
- Farhan J Khawaja
- Department of Internal Medicine, College of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905, USA
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Abstract
Peripheral vascular disease (PVD) is very prevalent in the United States and is part of a global vascular problem. PVD patients have a heightened inflammatory state and are at high risk of death from acute cardiovascular problems rather than from progression of PVD. Modifiable risk factors for PVD include smoking, hypertension, diabetes, hyperlipidemia, elevated high sensitivity C-reactive protein, obesity, and the metabolic syndrome. Symptomatic treatment of claudication includes smoking cessation, exercise, cilostazol, statins, and revascularization with percutaneous or surgical therapy. Antithrombotic therapy with aspirin or clopidogrel is important to reduce cardiovascular events but does not affect symptoms of claudication. Patients with rest limb ischemia or ulceration should be revascularized to minimize the chance of limb loss. Percutaneous revascularization is not without significant complications, however, and future research needs to focus on inflammation, thrombosis, and restenosis in the PVD patient. Finally, new devices that tackle difficult lesions, drug-eluting stents, and pharmacologic agents that reduce global atherosclerosis are on the horizon and are likely to become critical components in the management of the PVD patient.
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Affiliation(s)
- Nicolas W Shammas
- Midwest Cardiovascular Research Foundation, Cardiovascular Medicine, PC, 1236 East Rusholme, Suite 300, Davenport, IA 52803, USA.
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32
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Hashimoto K, Kasayama S, Yamamoto H, Kurebayashi S, Kawase I, Koga M. Strong association of C-reactive protein with body mass index and 2-h post-challenge glucose in non-diabetic, non-smoker subjects without hypertension. Diabet Med 2004; 21:581-5. [PMID: 15154943 DOI: 10.1111/j.1464-5491.2004.01212.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS Increases in C-reactive protein (CRP) levels have been shown to be associated with cardiovascular diseases as well as asymptomatic atherosclerosis and to be closely related to traditional cardiovascular risk factors. The aim of this study was to determine the clinical and biochemical characteristics associated with CRP in non-diabetic, non-smoker subjects without hypertension. METHODS A 75-g oral glucose tolerance test was performed on 305 Japanese subjects aged 40-70 years who were undergoing health examinations. We recruited non-diabetic, non-smoker subjects without hypertension. Subjects with known cardiovascular diseases, chronic or acute inflammation, malignant diseases, or autoimmune disorders were excluded. Plasma high-sensitivity CRP was measured in 125 subjects who satisfied the admission criteria. RESULTS Plasma CRP levels were significantly higher in the 28 subjects with impaired glucose tolerance (IGT) than that in the 97 subjects with normal glucose tolerance (NGT) (median 0.53, range 0.18-1.10 mg/l vs. median 0.32, range 0.17-0.49 mg/l; P = 0.032). There was a positive correlation of CRP with body mass index (BMI), triglycerides, uric acid, fasting glucose, oral glucose tolerance test (OGTT) 1-h glucose, OGTT 2-h glucose, and a negative correlation with HDL cholesterol. Multivariate regression analysis identified BMI (F = 8.57, P = 0.004) and OGTT 2-h glucose (F = 5.96, P = 0.016) as independent predictors for CRP. CONCLUSIONS BMI and OGTT 2-h glucose are the most important predictors for plasma CRP in non-diabetic, non-smoker subjects without hypertension.
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Affiliation(s)
- K Hashimoto
- Department of Internal Medicine, Kinki Central Hospital, Itami, Hyogo, Japan
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Ciccarone E, Di Castelnuovo A, Assanelli D, Archetti S, Ruggeri G, Salcuni N, Donati MB, Capani F, Iacoviello L. Homocysteine levels are associated with the severity of peripheral arterial disease in Type 2 diabetic patients. J Thromb Haemost 2003; 1:2540-7. [PMID: 14675090 DOI: 10.1111/j.1538-7836.2003.00500.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Homocysteine levels are positively associated with the risk of cardiovascular disease. They might be determined by both MTHFR677C-->T polymorphisms and folate or B-vitamin status. OBJECTIVES To investigate the possible association between plasma homocysteine levels and its genetic or environmental determinants and either the presence or the severity of peripheral arterial disease (PAD), in Type 2 diabetic patients. METHODS From a cohort of 944 patients with Type 2 diabetes, 135 patients with PAD were selected, and frequency-matched for age and sex with 219 Type 2 diabetic control patients without macrovascular complications. According to the increasing severity of the disease, patients were divided into PAD1 (only diffuse calcifications of the arteries without any stenosis or occlusion), PAD2 (one or two stenosis or occlusions) and PAD3 (three or more). RESULTS Homocysteine levels were similar in control and case patients (10.3 micromol L-1 vs. 10.7 micromol L-1, P = 0.53); however, a significant increase was found in PAD3 patients: odds ratio = 2.77 (95% confidence interval 1.14, 6.72) for patients with homocysteine levels above the median vs. those under the median in multivariate analysis. Although all significantly associated with homocysteine levels, neither MTHFR genotype nor folic acid or vitamin B12 levels were associated with severity of PAD. A significant interaction (P < 0.05) was found between folic acid and MTHFR polymorphism in determining the levels of homocysteine. CONCLUSIONS In Type 2 diabetes, homocysteine was associated with the angiographic severity of PAD, but neither the genotypes nor vitamin levels contributed to this association.
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Affiliation(s)
- E Ciccarone
- Angela Valenti Laboratory of Genetic and Environmental Risk Factors for Thrombotic Disease, Consorzio Mario Negri Sud, Santa Maria Imbaro, Italy
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