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Abraham AT, Mojaddedi S, Loseke IH, Bray C. Hypertension in Patients With Peripheral Artery Disease: An Updated Literature Review. Cureus 2024; 16:e62246. [PMID: 39006738 PMCID: PMC11245047 DOI: 10.7759/cureus.62246] [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] [Accepted: 06/12/2024] [Indexed: 07/16/2024] Open
Abstract
Peripheral artery disease (PAD), a condition where there is reduced blood flow due to narrowing or blockage of the arteries of the peripheral vasculature, is an epidemic that currently affects eight million people in the United States alone and is a major risk equivalent to having active coronary artery disease (CAD). However, it is commonly underdiagnosed in the general population. Hypertension is a common cardiovascular condition characterized by elevated blood pressure levels. There are several mitigating risk factors that can reduce the risk of complications of PAD, with hypertension playing a major role. This literature review aims to explore the relationship between hypertension and PAD, including their shared risk factors, pathophysiological mechanisms, and management strategies. In addition, we will analyze how this impacts major cardiovascular outcomes, such as critical limb ischemia, vascular amputation, myocardial infarction (MI), ischemic stroke, and cardiovascular-related death by examining relevant studies, current guidelines, and evidence. This literature review is intended to guide practitioners on ideal blood pressure parameters and evidence-based anti-hypertensives that provide overall cardiovascular benefit in both the primary care and hospital-based setting. By understanding the association between hypertension and PAD and the underlying pathophysiological mechanisms, healthcare professionals can improve diagnosis, treatment, and management strategies for affected individuals.
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Affiliation(s)
- Andrew T Abraham
- Graduate Medical Education/North Florida Regional Medical Center, University of Central Florida College of Medicine, Gainesville, USA
| | - Sanaullah Mojaddedi
- Graduate Medical Education/North Florida Regional Medical Center, University of Central Florida College of Medicine, Gainesville, USA
| | - Isaac H Loseke
- Graduate Medical Education/North Florida Regional Medical Center, University of Central Florida College of Medicine, Gainesville, USA
| | - Christopher Bray
- Graduate Medical Education/North Florida Regional Medical Center, University of Central Florida College of Medicine, Gainesville, USA
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Bulum T, Brkljačić N, Tičinović Ivančić A, Čavlović M, Prkačin I, Tomić M. In Association with Other Risk Factors, Smoking Is the Main Predictor for Lower Transcutaneous Oxygen Pressure in Type 2 Diabetes. Biomedicines 2024; 12:381. [PMID: 38397984 PMCID: PMC10886561 DOI: 10.3390/biomedicines12020381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 02/01/2024] [Accepted: 02/05/2024] [Indexed: 02/25/2024] Open
Abstract
Type 2 diabetes mellitus (T2DM) significantly increases the risk of peripheral artery disease (PAD), and diabetes is the leading cause of nontraumatic amputations. This study investigated the risk factors for transcutaneous oxygen pressure (TcPO2) in T2DM, a noninvasive method to quantify skin oxygenation and the underlying microvascular circulation. The study included 119 T2DM patients (91 male/28 female). TcPO2 measurements were conducted with the Tina TCM4 Series transcutaneous monitor (Radiometer, Copenhagen, Sweden) and skin electrodes. Patients with TcPO2 < 40 mmHg were younger (p = 0.001), had significantly higher systolic blood pressure (SBP) (p = 0.023), glycated hemoglobin (HbA1c) (p = 0.013), fasting plasma glucose (fPG) (p = 0.038), total cholesterol (p = 0.006), LDL cholesterol (p = 0.004), and had more frequent smoking habits (p = 0.001) than those with TcPO2 ≥ 40 mmHg. The main predictors for the TcPO2 value (R2 = 0.211) obtained via stepwise regression analysis were age, smoking, SBP, HbA1c, fPG, and total and LDL cholesterol. Among all the listed predictors, smoking, HbA1c, and LDL cholesterol were found to be the most significant, with negative parameter estimates of -3.051310 (p = 0.0007), -2.032018 (p = 0.0003), and -2.560353 (p = 0.0046). The results of our study suggest that in association with other risk factors, smoking is the main predictor for lower TcPO2 in T2DM.
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Affiliation(s)
- Tomislav Bulum
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, 10000 Zagreb, Croatia
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | - Neva Brkljačić
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, 10000 Zagreb, Croatia
| | | | - Maja Čavlović
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, 10000 Zagreb, Croatia
| | - Ingrid Prkačin
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
- Department of Internal Medicine, Merkur University Hospital, 10000 Zagreb, Croatia
| | - Martina Tomić
- Vuk Vrhovac University Clinic for Diabetes, Endocrinology and Metabolic Diseases, Merkur University Hospital, 10000 Zagreb, Croatia
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何 爱, 丁 心, 黄 佳, 罗 祥, 孟 健, 曹 瑛, 高 方, 邹 梦. [Clinical characteristics and risk factors of lower extremity arterial disease in patients with diabetic foot ulcer]. NAN FANG YI KE DA XUE XUE BAO = JOURNAL OF SOUTHERN MEDICAL UNIVERSITY 2022; 42:604-609. [PMID: 35527498 PMCID: PMC9085592 DOI: 10.12122/j.issn.1673-4254.2022.04.18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To investigate the clinical characteristics of lower extremity arterial disease (LEAD) and its risk factors in patients with diabetic foot ulcer (DFU). METHODS We retrospectively collected the clinical and follow-up data of 650 patients with DFU treated in the Department of Endocrinology and Metabolism of Nanfang Hospital between January, 2017 and December, 2019. We compared the data between patients who had LEAD and those without LEAD and used a multivariate logistic regression model to analyze the risk factors of LEAD in DFU patients. RESULTS Among the 650 DFU patients, 470 (72.4%) had LEAD. The patients were followed up for a mean of 3.5 months, and the mean healing time of DFU was 2.55 months; healing of DFU occurred in 453 patients and 183 patients received amputation. The patients with LEAD and those without LEAD differed significantly in age, hospitalization costs, diastolic blood pressure (DBP), glycated hemoglobin, blood lipid levels, disease course, ankle brachial index, healing time, smoking history, clinical outcomes, Wagner grade and imaging results (P < 0.05). Multivariate logistic regression analysis identified age (OR=1.070, 95% CI: 1.049-1.091), smoking history (OR= 2.013, 95% CI: 1.268-3.195), and a decreased DBP (OR=0.980, 95% CI: 0.963-0.997) as independent risk factors for LEAD in DFU patients. A prolonged healing time was a prominent clinical feature of DFU complicated by LEAD. CONCLUSION DFU patients have a high incidence of LEAD, which leads to high rates of disability and mortality and is associated with an advanced age, high smoking rate and longer healing time. A decreased DBP is also a risk factor for LEAD in DFU patients.
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Affiliation(s)
- 爱萍 何
- 南方医科大学南方医院内分泌代谢科,广东 广州 510515Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 心怡 丁
- 南方医科大学公共卫生学院职业卫生与职业医学系,广东 广州 510515Department of Occupational Health and Medicine, School of Public Health, Southern Medical University, Guangzhou 510515, China
| | - 佳利 黄
- 南方医科大学南方医院内分泌代谢科,广东 广州 510515Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 祥蓉 罗
- 南方医科大学南方医院内分泌代谢科,广东 广州 510515Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 健夫 孟
- 南方医科大学南方医院内分泌代谢科,广东 广州 510515Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 瑛 曹
- 南方医科大学南方医院内分泌代谢科,广东 广州 510515Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 方 高
- 南方医科大学南方医院内分泌代谢科,广东 广州 510515Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | - 梦晨 邹
- 南方医科大学南方医院内分泌代谢科,广东 广州 510515Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
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Busch L, Heinen Y, Stern M, Wolff G, Özaslan G, Tzetou K, Sansone R, Heiss C, Kelm M. Angioplasty of Flow-Limiting Stenosis Reduces Aortic and Brachial Blood Pressure in Patients With Peripheral Artery Disease. J Am Heart Assoc 2021; 10:e019724. [PMID: 34227407 PMCID: PMC8483469 DOI: 10.1161/jaha.120.019724] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 04/14/2021] [Indexed: 01/22/2023]
Abstract
Background Arterial hypertension affects cardiovascular outcome in patients with peripheral artery disease (PAD). We hypothesized that angioplasty of peripheral arterial stenoses decreases aortic (aBP) and brachial blood pressure (bBP). Methods and Results In an index cohort (n=30), we simultaneously measured aBP, bBP, augmentation index (AIx), and aortic pulse wave velocity (PWV) before and after angioplasty of the iliac and femoropopliteal arteries; diagnostic angiography served as a control. In an all-comer registry cohort (n=381), we prospectively measured bBP in patients scheduled for angioplasty of the iliac, femoral, and crural arteries or diagnostic angiography. Systolic aBP decreased after iliac (Δ-25 mmHg; 95% CI, -30 to -20; P<0.0001) and femoropopliteal angioplasty (Δ-12 mmHg; 95% CI, -17 to -5; P<0.0001) as compared with diagnostic angiography. Diastolic aBP decreased after iliac (Δ-9 mmHg; 95% CI, -13 to -1; P=0.01) but not femoropopliteal angioplasty. In parallel, AIx significantly dropped, whereas PWV remained stable. In the registry cohort, systolic bBP decreased after angioplasty of the iliac (Δ-17 mmHg; 95% CI, -31 to -8; P=0.0005) and femoropopliteal arteries (Δ-10 mmHg; 95% CI, -23 to -1; P=0.04) but not the crural arteries, as compared with diagnostic angiography. Diastolic bBP decreased after iliac (Δ-10 mmHg; 95% CI, -17 to -2; P=0.01) and femoropopliteal angioplasty (Δ-9 mmHg; 95% CI, -15 to -1; P=0.04). Multivariate analysis identified baseline systolic bBP and site of lesion as determinants of systolic bBP drop after endovascular treatment. Conclusions Angioplasty of flow-limiting stenoses in patients with peripheral artery disease lowers aortic and brachial blood pressure with more pronounced effects at more proximal lesion sites and elevated baseline systolic blood pressure. These data indicate a role of endovascular treatment to acutely optimize blood pressure in patients with peripheral artery disease. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02728479.
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Affiliation(s)
- Lucas Busch
- Department of Cardiology, Pulmonology, and Vascular MedicineUniversity DuesseldorfMedical FacultyDuesseldorfGermany
| | - Yvonne Heinen
- Department of Cardiology, Pulmonology, and Vascular MedicineUniversity DuesseldorfMedical FacultyDuesseldorfGermany
| | - Manuel Stern
- Department of Cardiology, Pulmonology, and Vascular MedicineUniversity DuesseldorfMedical FacultyDuesseldorfGermany
| | - Georg Wolff
- Department of Cardiology, Pulmonology, and Vascular MedicineUniversity DuesseldorfMedical FacultyDuesseldorfGermany
| | - Göksen Özaslan
- Department of Cardiology, Pulmonology, and Vascular MedicineUniversity DuesseldorfMedical FacultyDuesseldorfGermany
| | - Konstantina Tzetou
- Department of Cardiology, Pulmonology, and Vascular MedicineUniversity DuesseldorfMedical FacultyDuesseldorfGermany
| | - Roberto Sansone
- Department of Cardiology, Pulmonology, and Vascular MedicineUniversity DuesseldorfMedical FacultyDuesseldorfGermany
| | - Christian Heiss
- Department of Cardiology, Pulmonology, and Vascular MedicineUniversity DuesseldorfMedical FacultyDuesseldorfGermany
- Department of Clinical and Experimental MedicineUniversity of SurreyFaculty of Health and Medical SciencesGuildfordUnited Kingdom
| | - Malte Kelm
- Department of Cardiology, Pulmonology, and Vascular MedicineUniversity DuesseldorfMedical FacultyDuesseldorfGermany
- Cardiovascular Research Institute Duesseldorf (CARID)DuesseldorfGermany
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Alsaigh T, Di Bartolo BA, Mulangala J, Figtree GA, Leeper NJ. Bench-to-Bedside in Vascular Medicine: Optimizing the Translational Pipeline for Patients With Peripheral Artery Disease. Circ Res 2021; 128:1927-1943. [PMID: 34110900 PMCID: PMC8208504 DOI: 10.1161/circresaha.121.318265] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Peripheral arterial disease is a growing worldwide problem with a wide spectrum of clinical severity and is projected to consume >$21 billion per year in the United States alone. While vascular researchers have brought several therapies to the clinic in recent years, few of these approaches have leveraged advances in high-throughput discovery screens, novel translational models, or innovative trial designs. In the following review, we discuss recent advances in unbiased genomics and broader omics technology platforms, along with preclinical vascular models designed to enhance our understanding of disease pathobiology and prioritize targets for additional investigation. Furthermore, we summarize novel approaches to clinical studies in subjects with claudication and ischemic ulceration, with an emphasis on streamlining and accelerating bench-to-bedside translation. By providing a framework designed to enhance each aspect of future clinical development programs, we hope to enrich the pipeline of therapies that may prevent loss of life and limb for those with peripheral arterial disease.
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Affiliation(s)
- Tom Alsaigh
- Department of Surgery, Division of Vascular Surgery, Stanford University School of Medicine, Stanford, California, United States of America
| | - Belinda A. Di Bartolo
- Cardiothoracic and Vascular Health, Kolling Institute and Department of Cardiology, Royal North Shore Hospital, Northern Sydney Local Health District, Australia
| | | | - Gemma A. Figtree
- Cardiothoracic and Vascular Health, Kolling Institute and Department of Cardiology, Royal North Shore Hospital, Northern Sydney Local Health District, Australia
| | - Nicholas J. Leeper
- Department of Surgery, Division of Vascular Surgery, Stanford University School of Medicine, Stanford, California, United States of America
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Rinfret F, Lambert F, Youmbissi JT, Arcand JF, Turcot R, Bessette MA, Bourque S, Moreau V, Tousignant K, Deschênes D, Cloutier L. Cross-Sectional Assessment of Achievement of Therapeutic Goals in a Canadian Multidisciplinary Clinic for Patients With Advanced Chronic Kidney Disease. Can J Kidney Health Dis 2018; 5:2054358118775097. [PMID: 29785274 PMCID: PMC5954580 DOI: 10.1177/2054358118775097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 02/14/2018] [Indexed: 11/17/2022] Open
Abstract
Background The implementation of advanced chronic kidney disease (CKD) multidisciplinary clinics has now demonstrated their effectiveness in delaying and even avoiding dialysis for patients with CKD. However, very little has been documented on the management and achievement of targets for a number of parameters in this context. Objective Our goal was to assess our multidisciplinary clinic therapy performance in relation to the targets for hypertension, anemia, and calcium phosphate assessment. Methods Design and setting A cross-sectional descriptive study was conducted with a cohort including all patients followed up in our multidisciplinary clinic in July 2014. Measurements Comorbidity, laboratory, and clinical data were collected and compared with the recommendations of scientific organizations. Results The cohort included 128 patients, 37.5% of whom were women. Mean follow-up time was 26.6 ± 25.1 months and mean estimated glomerular filtration rate (eGFR) was 14.0 ± 4.7 mL/min/1.73 m2. A total of 24.2% of patients with diabetes achieved blood pressure targets of <130/80 mm Hg, while 56.5% of patients without diabetes achieved targets of <140/90 mm Hg. Hemoglobin of patients treated with erythropoiesis-stimulating agents was 100 to 110 g/L in 36.2% of the patients, below 100 for 39.7% of them, and above 110 for 24.1%, whereas 67.2% were within the acceptable limits of 95 to 115 g/L. In addition, 63.4% of patients had a serum phosphate of <1.5 mmol/L, and 90.9% of patients had total serum calcium <2.5 mmol/L. Limitations Our study is a single center study with the majority of our patients being Caucasian. This limits the generalizability of our findings. Conclusion The control rates of various parameters were satisfactory given the difficult clinical context, but could be optimized. We publish these data in the hope that they are helpful to others engaged in quality improvement in their own programs or more generally.
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Affiliation(s)
- Félix Rinfret
- Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - France Lambert
- Centre intégré universitaire de santé et services sociaux de la Mauricie-et-du-Centre-du-Québec, Trois-Rivières, Canada
| | - Joseph Tchetagni Youmbissi
- Centre intégré universitaire de santé et services sociaux de la Mauricie-et-du-Centre-du-Québec, Trois-Rivières, Canada
| | - Jean-François Arcand
- Centre intégré universitaire de santé et services sociaux de la Mauricie-et-du-Centre-du-Québec, Trois-Rivières, Canada
| | - Richard Turcot
- Centre intégré universitaire de santé et services sociaux de la Mauricie-et-du-Centre-du-Québec, Trois-Rivières, Canada
| | - Maral Alimardani Bessette
- Centre intégré universitaire de santé et services sociaux de la Mauricie-et-du-Centre-du-Québec, Trois-Rivières, Canada
| | - Solange Bourque
- Centre intégré universitaire de santé et services sociaux de la Mauricie-et-du-Centre-du-Québec, Trois-Rivières, Canada
| | - Vincent Moreau
- Centre intégré universitaire de santé et services sociaux de la Mauricie-et-du-Centre-du-Québec, Trois-Rivières, Canada
| | - Karine Tousignant
- Centre intégré universitaire de santé et services sociaux de la Mauricie-et-du-Centre-du-Québec, Trois-Rivières, Canada
| | - Diane Deschênes
- Centre intégré universitaire de santé et services sociaux de la Mauricie-et-du-Centre-du-Québec, Trois-Rivières, Canada
| | - Lyne Cloutier
- Université du Québec à Trois-Rivières, Trois-Rivières, Canada
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Zhang X, Ran X, Xu Z, Cheng Z, Shen F, Yu Y, Gao L, Chai S, Wang C, Liu J, Liu J, Sun Z, Zhao J, Ji L. Epidemiological characteristics of lower extremity arterial disease in Chinese diabetes patients at high risk: a prospective, multicenter, cross-sectional study. J Diabetes Complications 2018; 32:150-156. [PMID: 29191431 DOI: 10.1016/j.jdiacomp.2017.10.003] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 10/07/2017] [Accepted: 10/10/2017] [Indexed: 02/05/2023]
Abstract
AIMS To determine the epidemiological characteristics of lower extremity arterial disease (LEAD) in high-risk patients and identify practical gaps in LEAD management. METHODS This cross-sectional study consecutively enrolled 10681 patients with type 2 diabetes from 30 hospitals across China from June 2016 to January 2017. All patients were assessed for LEAD by the Ankle-Brachial Index in conjunction with lower limb ultrasonography according to local guidelines. RESULTS The mean age of patients was 64.2 years, and the median duration of diabetes was 9.0 years. The overall prevalence of LEAD was 21.2%, with 10.6% of patients diagnosed with LEAD before enrollment and 11.8% newly diagnosed at the present visit. Patients with older age, hypertension and dyslipidemia as well as those who smoked were at higher risk of developing LEAD. Only 55.0%, 28.2%, and 42.5% of participating patients reached the guideline-recommended goals for glycemic, blood pressure, and lipid control, respectively. Anti-hypertensive agents, lipid lowering therapies, anti-platelet agents, and vasodilators were underused, especially in newly diagnosed LEAD patients (44.1%, 46.2%, 35.3%, and 31.7%, respectively). CONCLUSIONS Despite the high prevalence of LEAD, it was still found to be underdiagnosed and undertreated in Chinese diabetes patients. More efforts should be directed at encouraging awareness of early LEAD and achieving guideline-recommended goals in type 2 diabetes patients.
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Affiliation(s)
- Xiaomei Zhang
- Department of Endocrinology, Peking University International Hospital, Beijing 102206, China
| | - Xingwu Ran
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Zhangrong Xu
- Diabetes Center, Department of Endocrinology, The 306th Hospital of PLA, Beijing, China
| | - Zhifeng Cheng
- Department of Endocrinology, The Fourth Hospital of Harbin Medical University, Harbin 150006, China
| | - Feixia Shen
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
| | - Yanmei Yu
- Department of Endocrinology, Mudanjiang Diabetes Hospital, Mudanjiang 157011, China
| | - Lin Gao
- Department of Endocrinology, Affiliated Hospital of Zunyi Medical College, Zunyi 563000, China
| | - Sanbo Chai
- Department of Endocrinology, Peking University International Hospital, Beijing 102206, China
| | - Changjiang Wang
- Department of Endocrinology, The First Affiliated Hospital of Anhui Medical University, Hefei 230000, China
| | - Jianying Liu
- Department of Endocrinology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, China
| | - Jing Liu
- Department of Endocrinology and Metabolism, Gansu Provincial Hospital, Lanzhou 730000, China
| | - Zilin Sun
- Department of Endocrinology, Zhongda Hospital Southeast University, Nanjing 210008, China
| | - Jiajun Zhao
- Department of Endocrinology, Shandong Provincial Hospital, Jinan 250021, China
| | - Linong Ji
- Department of Endocrinology, Peking University International Hospital, Beijing 102206, China; Department of Endocrinology and Metabolism, Peking University People's Hospital, Beijing 100044, China.
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Gökgöl C, Diehm N, Nezami FR, Büchler P. Nitinol Stent Oversizing in Patients Undergoing Popliteal Artery Revascularization: A Finite Element Study. Ann Biomed Eng 2015; 43:2868-80. [PMID: 26101031 DOI: 10.1007/s10439-015-1358-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 06/09/2015] [Indexed: 11/26/2022]
Abstract
Nitinol stent oversizing is frequently performed in peripheral arteries to ensure a desirable lumen gain. However, the clinical effect of mis-sizing remains controversial. The goal of this study was to provide a better understanding of the structural and hemodynamic effects of Nitinol stent oversizing. Five patient-specific numerical models of non-calcified popliteal arteries were developed to simulate the deployment of Nitinol stents with oversizing ratios ranging from 1.1 to 1.8. In addition to arterial biomechanics, computational fluid dynamics methods were adopted to simulate the physiological blood flow inside the stented arteries. Results showed that stent oversizing led to a limited increase in the acute lumen gain, albeit at the cost of a significant increase in arterial wall stresses. Furthermore, localized areas affected by low Wall Shear Stress increased with higher oversizing ratios. Stents were also negatively impacted by the procedure as their fatigue safety factors gradually decreased with oversizing. These adverse effects to both the artery walls and stents may create circumstances for restenosis. Although the ideal oversizing ratio is stent-specific, this study showed that Nitinol stent oversizing has a very small impact on the immediate lumen gain, which contradicts the clinical motivations of the procedure.
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Affiliation(s)
- Can Gökgöl
- Institute for Surgical Technology & Biomechanics, University of Bern, Bern, Switzerland
| | - Nicolas Diehm
- Clinical and Interventional Angiology, Kantonsspital Aarau, Tellstrasse, Aarau, 5001, Switzerland.
- University of Applied Sciences Furtwangen, Villingen-Schwenningen, Germany.
| | - Farhad Rikhtegar Nezami
- Institute for Surgical Technology & Biomechanics, University of Bern, Bern, Switzerland
- Harvard-MIT Biomedical Engineering Center, Massachusetts Institute of Technology, Cambridge, MA, 02139, USA
| | - Philippe Büchler
- Institute for Surgical Technology & Biomechanics, University of Bern, Bern, Switzerland
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Pal M, Ferk P, Leskošek B, Krajnc I, Pajntar M. Prevalence of isolated systolic hypertension (ISH) in Slovene hypertensive patients: insights from the "Quality of Healthcare in Slovenia" project. Wien Klin Wochenschr 2015; 127 Suppl 5:S247-54. [PMID: 25787214 DOI: 10.1007/s00508-015-0765-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2013] [Accepted: 02/04/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The aim of the present study was mainly to evaluate age- and gender-dependent isolated systolic hypertension (ISH) prevalence before and during antihypertensive treatment, and to evaluate pulse pressure (PP) distributions during antihypertensive treatment in almost 20,000 Slovene hypertensive patients. METHODS The study was conducted as part of the "Quality of Healthcare in Slovenia" project, in agreement with the National Medical Ethics Committee of the Republic of Slovenia. Appropriate statistical analyses and evaluations were performed. RESULTS The prevalence of ISH before the treatment was 19.6 % (17.0 % for men and 21.4 % for women) and it was significantly (p < 0.001) higher during the treatment (29.6 %; 26.4 % for men and 31.9 % for women). The mean PP before the treatment for the whole study patient sample was (71.2 ± 16.9) mmHg and was significantly (p < 0.001) reduced during the treatment to (57.4 ± 12.5) mmHg. CONCLUSION With regard to high ISH in treated Slovene hypertensive patients, quality of ISH control may not be optimal and should be improved. On the other hand, the adequate arterial hypertension (AH) control (systolic blood pressure (SBP) < 140 mmHg and diastolic blood pressure (DBP) < 90 mmHg) was achieved in 55.6 % of patients. Our observations may have useful therapeutic implications in the management of AH, particularly ISH in the elderly.
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Affiliation(s)
- Marjetka Pal
- Faculty of Medicine, Department of Pharmacology and Experimental Toxicology, University of Maribor, Slomškov trg 15, 2000, Maribor, Slovenia
| | - Polonca Ferk
- Faculty of Medicine, Department of Pharmacology and Experimental Toxicology, University of Maribor, Slomškov trg 15, 2000, Maribor, Slovenia.
| | - Brane Leskošek
- Faculty of Medicine, Institute for Biostatistics and Medical Informatics, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
| | - Ivan Krajnc
- Faculty of Medicine, Department of Internal Medicine, University of Maribor, Slomškov trg 15, 2000, Maribor, Slovenia
| | - Marjan Pajntar
- Medical Chamber of Slovenia, Dunajska 162, 1000, Ljubljana, Slovenia
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Strauss E, Oszkinis G, Staniszewski R. SEPP1 gene variants and abdominal aortic aneurysm: gene association in relation to metabolic risk factors and peripheral arterial disease coexistence. Sci Rep 2014; 4:7061. [PMID: 25395084 PMCID: PMC4231327 DOI: 10.1038/srep07061] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 10/29/2014] [Indexed: 11/09/2022] Open
Abstract
An inadequate selenium level is supposed to be a risk factor for cardiovascular diseases. However little is known about variation of the genes encoding selenium-containing proteins that would confirm the causality in these diseases. The aim of this study was to analyze the relationships between two functional variants of selenoprotein P gene (SEPP1 rs3877899G>A, rs7579G>A) and the occurrence of abdominal aortic aneurysm (AAA) and aortoiliac occlusive disease (AIOD), as well as their metabolic risk factors. In AAA, the rs3877899A allele was associated with higher systolic blood (P < .003) and pulse pressure (P < .003) values (recessive model), and with coexistence of peripheral arterial disease (PAD; carriers: P = .033). The other SEPP1 variants were associated with BMI values and influenced the risk of aortic diseases, depending on body weight. The strongest associations in the case-control analysis was found between the presence of the rs3877899G-rs7579G haplotype and development of AAA in overweight and obese subjects (OR = 1.80, 95%CI = 1.16-2.79, P = .008). The higher BMI values were correlated with lower age of AAA patients and larger size of aneurysm. Our results suggests the potential role of the selenoprotein P in pathogenesis of AAA. Future studies should consider the role of the rs3877899G-rs7579G haplotype as a risk factor for aggressive-growing AAAs.
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Affiliation(s)
- Ewa Strauss
- 1] Institute of Human Genetics, Polish Academy of Sciences, Strzeszynska 32, 60-479 Poznan, Poland [2] Department of General and Vascular Surgery, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Grzegorz Oszkinis
- Department of General and Vascular Surgery, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
| | - Ryszard Staniszewski
- Department of General and Vascular Surgery, Poznan University of Medical Sciences, Dluga 1/2, 61-848 Poznan, Poland
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11
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Skoglund PH, Arpegård J, Ostergren J, Svensson P. Amino-terminal pro-B-type natriuretic peptide and high-sensitivity C-reactive protein but not cystatin C predict cardiovascular events in male patients with peripheral artery disease independently of ambulatory pulse pressure. Am J Hypertens 2014; 27:363-71. [PMID: 24470529 DOI: 10.1093/ajh/hpt278] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Patients with peripheral arterial disease (PAD) are at high risk for cardiovascular (CV) events. We have previously shown that ambulatory pulse pressure (APP) predicts CV events in PAD patients. The biomarkers amino-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hs-CRP), and cystatin C are related to a worse outcome in patients with CV disease, but their predictive values have not been studied in relation to APP. METHODS Blood samples and 24-hour measurements of ambulatory blood pressure were examined in 98 men referred for PAD evaluation during 1998-2001. Patients were followed for a median of 71 months. The outcome variable was CV events defined as either CV mortality or any hospitalization for myocardial infarction, stroke, or coronary revascularization. The predictive values of log(NT-proBNP), log(hs-CRP), and log(cystatin C) alone and together with APP were assessed by multivariable Cox regression. Area under the curve (AUC) and net reclassification improvement (NRI) were calculated compared with a model containing other significant risk factors. RESULTS During follow-up, 36 patients had at least 1 CV event. APP, log(NT-proBNP), and log(hs-CRP) all predicted CV events in univariable analysis, whereas log(cystatin C) did not. In multivariable analysis log(NT-proBNP) (hazard ratio (HR) = 1.62; 95% confidence interval (CI) = 1.05-2.51) and log(hs-CRP) (HR = 1.63; 95% CI = 1.19-2.24) predicted events independently of 24-hour PP. The combination of log(NT-proBNP), log(hs-CRP), and average day PP improved risk discrimination (AUC = 0.833 vs. 0.736; P < 0.05) and NRI (37%; P < 0.01) when added to other significant risk factors. CONCLUSIONS NT-proBNP and hs-CRP predict CV events independently of APP and the combination of hs-CRP, NT-proBNP, and day PP improves risk discrimination in PAD patients.
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Affiliation(s)
- Per H Skoglund
- Karolinska Institutet, Department of Medicine, Solna, Internal Medicine Unit and Emergency Department, Karolinska University Hospital Solna, Stockholm, Sweden
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12
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Skoglund PH, Östergren J, Svensson P. Ambulatory pulse pressure predicts cardiovascular events in patients with peripheral arterial disease. Blood Press 2012; 21:227-32. [PMID: 22553945 DOI: 10.3109/00365599.2012.676755] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Patients with peripheral arterial disease (PAD) are at high risk of cardiovascular (CV) events and often have hypertension with a high pulse pressure (PP). We studied the prognostic value of ambulatory blood pressure (ABP) in PAD patients with special reference to PP. METHODS 98 consecutive males with PAD had 24-h ABP measurements. The mean age was 68 years and CV comorbidity was prevalent. The outcome variable was CV events defined as CV mortality or any hospitalization for myocardial infarction, stroke or coronary revascularization. The predictive value of ABP variables was assessed by Cox regression. 90 age-matched men free of CV disease served as controls. RESULTS During follow-up (median 71 months), 36 patients and seven controls had at least one CV event. In PAD patients, 24-h PP (hazard ratios, HR, 1.48 (95% confidence interval, CI, 1.14-1.92), p <0.01) predicted CV events. Office PP did not predict events in PAD patients (HR 1.15 (0.97-1.38), ns). In multivariate analysis, 24-h PP (HR 1.48 (1.12-1.95), p <0.01) remained a predictor of CV events. CONCLUSIONS Ambulatory PP predicts CV events in patients with PAD. ABP measurement may be indicated for better risk stratification in PAD patients.
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Affiliation(s)
- Per H Skoglund
- Karolinska University Hospital Solna, Department of Emergency Medicine, Stockholm, Sweden.
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13
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Cockcroft JR, Pedersen ME. β-blockade: benefits beyond blood pressure reduction? J Clin Hypertens (Greenwich) 2012; 14:112-120. [PMID: 22277144 PMCID: PMC8108973 DOI: 10.1111/j.1751-7176.2011.00553.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Revised: 09/07/2011] [Accepted: 09/15/2011] [Indexed: 12/20/2022]
Abstract
Hypertension is a major cardiovascular (CV) risk factor, but several other common conditions, including chronic obstructive pulmonary disease (COPD), osteoporosis, and peripheral arterial disease (PAD), have been shown to independently increase the risk of CV events and death. The physiological basis for an increased CV risk in those conditions probably lies in the augmentations of oxidative stress, endothelial dysfunction, systemic inflammation, and arterial stiffness, which all are also hallmarks of hypertension. β-Blockers have been used for the treatment of hypertension for more than 40 years, but a number of meta-analyses have demonstrated that treatment with these agents may be associated with an increased risk of CV events and mortality. However, the majority of primary prevention β-blocker trials employed atenolol, an earlier-generation β(1) -selective blocker whose mechanism of action is based on a reduction of cardiac output. Available evidence suggests that vasodilatory β-blockers may be free of the deleterious effects of atenolol. The purpose of this review is to summarize pathophysiologic mechanisms thought to be responsible for the increased CV risk associated with COPD, osteoporosis, and PAD, and examine the possible benefits of vasodilatory β-blockade in those conditions. Our examination focused on nebivolol, a β(1) -selective agent with vasodilatory effects most likely mediated via β(3) activation.
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Affiliation(s)
- John R. Cockcroft
- From the Department of Cardiology, University of Cardiff, University Hospital, Cardiff, UK;
and the
Royal Brompton Hospital, London, UK
| | - Michala E. Pedersen
- From the Department of Cardiology, University of Cardiff, University Hospital, Cardiff, UK;
and the
Royal Brompton Hospital, London, UK
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14
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Affiliation(s)
- Denis L. Clement
- From the University of Ghent, Faculty of Medicine and Health Sciences, Ghent, Belgium
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15
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Abstract
Arterial aging can be attributed to two different pathophysiological changes--increase in arterial stiffness and disturbed wave reflections. The capacity of the aorta to absorb the force exerted by the left ventricular ejection and dampen pulsatile flow becomes diminished with advancing age, owing to the progressive hardening of the arterial wall. These changes contribute to increase blood pressure, mainly systolic blood pressure and pulse pressure, which can trigger cardiovascular events. Understanding the pulsatile arterial hemodynamics that elevate cardiovascular risk has led to the use of pharmacological therapies, which prevent arterial stiffness and reduce wave reflections, and improve cardiovascular morbidity and mortality. Antifibrotic agents, such as those that block the renin-angiotensin-aldosterone pathway, are often given in association with diuretics, calcium-channel blockers, or both, but not with standard beta-blockers. Consistent reductions in cardiovascular outcomes obtained using these agents can be predicted through noninvasive measurements of central systolic blood pressure and pulse pressure.
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Affiliation(s)
- Michel E Safar
- Diagnosis Center, Hôpital Hôtel-Dieu, 1 Place du Parvis Notre-Dame, 75181 Paris Cedex 04, France
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16
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Kiernan TJ, Hynes BG, Ruggiero NJ, Yan BP, Jaff MR. Comprehensive evaluation and medical management of infrainguinal peripheral artery disease: "when to treat, when not to treat". Tech Vasc Interv Radiol 2010; 13:2-10. [PMID: 20123428 DOI: 10.1053/j.tvir.2009.10.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Peripheral artery disease (PAD) is a highly prevalent atherosclerotic syndrome associated with significant morbidity and mortality. PAD is defined by atherosclerotic obstruction of the arteries to the legs that reduce arterial flow during exercise or at rest, and is associated with systemic atherosclerosis. The clinical presentation of PAD is quite varied, including patients with atypical leg symptoms, classic intermittent claudication, and critical limb ischemia. Clinical assessment of these patients includes a comprehensive history, physical examination, and noninvasive and invasive vascular studies. The major risk factors for PAD include diabetes mellitus, tobacco abuse, hyperlipidemia, hypertension, and advanced age. Because of the presence of these risk factors, the systemic nature of atherosclerosis, and the high risk of ischemic events, patients with PAD should be candidates for comprehensive secondary prevention strategies, including aggressive glycemic control, all attempts at tobacco cessation, lipid lowering and antihypertensive treatment, antiplatelet therapy, and thorough foot care. This article reviews the comprehensive diagnostic algorithm and medical treatment strategies for patients with infrainguinal PAD.
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Affiliation(s)
- Thomas J Kiernan
- Section of Vascular Medicine, Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
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