1
|
Nordanstig J, Behrendt CA, Baumgartner I, Belch J, Bäck M, Fitridge R, Hinchliffe R, Lejay A, Mills JL, Rother U, Sigvant B, Spanos K, Szeberin Z, van de Water W, Antoniou GA, Björck M, Gonçalves FB, Coscas R, Dias NV, Van Herzeele I, Lepidi S, Mees BME, Resch TA, Ricco JB, Trimarchi S, Twine CP, Tulamo R, Wanhainen A, Boyle JR, Brodmann M, Dardik A, Dick F, Goëffic Y, Holden A, Kakkos SK, Kolh P, McDermott MM. Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Asymptomatic Lower Limb Peripheral Arterial Disease and Intermittent Claudication. Eur J Vasc Endovasc Surg 2024; 67:9-96. [PMID: 37949800 DOI: 10.1016/j.ejvs.2023.08.067] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 11/12/2023]
|
2
|
Antignani PL, Gargiulo M, Gastaldi G, Jawien A, Mansilha A, Poredos P. Lower extremity arterial disease perspective: IUA consensus document on "lead management". Part 1. INT ANGIOL 2023; 42:382-395. [PMID: 37822195 DOI: 10.23736/s0392-9590.23.05110-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
Atherosclerotic cardiovascular disease (ASCVD) is defined as coronary heart disease (CHD), cerebrovascular disease, or lower extremity arterial disease (LEAD) also named peripheral arterial disease (PAD). ASCVD is considered to be of atherosclerotic origin and is the leading cause of morbidity and mortality mainly for individuals with diabetes mellitus (DM). In this consensus document of the International Union of Angiology the authors discuss epidemiology, risk factors, primary and secondary prophylaxis, the correlation between diabetes mellitus and LEAD, conservative and surgical treatment.
Collapse
Affiliation(s)
| | - Mauro Gargiulo
- Section of Vascular Surgery, Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna School of Medicine, S. Orsola and Maggiore Polyclinic Hospitals, Bologna, Italy
| | - Giacomo Gastaldi
- DiaCenTRE, Hirslanden Grangettes SA, Diabetology Unit, Geneva University Hospital, Geneva, Switzerland
| | - Arkadiusz Jawien
- Department of Vascular Surgery and Angiology, L. Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Torun, Poland
| | - Armando Mansilha
- Faculty of Medicine of the University of Porto, Department of Angiology and Vascular Surgery, S. João Hospital, Porto, Portugal
| | - Pavel Poredos
- University Clinical Center Ljubljana, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| |
Collapse
|
3
|
Makowski L, Engelbertz C, Köppe J, Dröge P, Ruhnke T, Günster C, Gerß J, Freisinger E, Malyar N, Reinecke H, Feld J. Contemporary Treatment and Outcome of Patients with Ischaemic Lower Limb Amputation: A Focus on Sex Differences. Eur J Vasc Endovasc Surg 2023; 66:550-559. [PMID: 37355161 DOI: 10.1016/j.ejvs.2023.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 05/04/2023] [Accepted: 06/19/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE Chronic limb threatening ischaemia (CLTI) has a devastating prognosis with high rates of lower limb amputation (LLA) and deaths. This is an illustration of contemporary management and the long term fate of patients after ischaemic LLA, particularly with respect to sex, using real world data. METHODS This was a multisectoral cross sectional and longitudinal analysis of health claims data from the largest German health insurance database (AOK). Data of 39 796 propensity score matched patients hospitalised for ischaemic LLA between 2010 and 2018 were analysed for cardiovascular comorbidities, treatment, and for subsequent cardiovascular and limb events, with a distinct focus on sex. Matching was performed, to ensure that the rate of major amputations and the age distribution were equal in both groups (in both sexes). An observation period of two years before index and a follow up (FU) period until 2019 were included. RESULTS Before index amputation, 68% of patients had received any kind of peripheral revascularisation. The use of statins (37.0% vs. 42.6%) and antithrombotic substances (54.9% vs. 61.8%) was lower in women than in men (p < .001). During two year FU, cardiovascular and limb events occurred among women and men as follows: limb re-amputation (26.7% vs. 31.2%), myocardial infarction (10.9% vs. 14.5%), stroke (20.8% vs. 20.7%), and death from any cause (51.0% vs. 53.3%, p < .001 except for stroke). After adjustment for cardiovascular comorbidities and vascular procedures, female sex was associated with a higher probability of death (HR 1.04, 95% CI 1.04 - 1.04). CONCLUSION Patients undergoing ischaemic LLA still have a poor prognosis marked by high rates of recurrent cardiovascular and limb events resulting in a > 50% mortality rate within two years. The continuous lack of guideline recommended therapies, particularly in women, may be associated with the persisting poor outcome, necessitating urgent further investigation.
Collapse
Affiliation(s)
- Lena Makowski
- University Hospital Muenster, Cardiology, Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany.
| | - Christiane Engelbertz
- University Hospital Muenster, Cardiology, Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - Jeanette Köppe
- University of Muenster, Institute of Biostatistics and Clinical Research, Muenster, Germany
| | | | | | | | - Joachim Gerß
- University of Muenster, Institute of Biostatistics and Clinical Research, Muenster, Germany
| | - Eva Freisinger
- University Hospital Muenster, Cardiology, Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - Nasser Malyar
- University Hospital Muenster, Cardiology, Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - Holger Reinecke
- University Hospital Muenster, Cardiology, Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany
| | - Jannik Feld
- University of Muenster, Institute of Biostatistics and Clinical Research, Muenster, Germany
| |
Collapse
|
4
|
Helmer M, Scheurig-Muenkler C, Brandt V, Tesche C, Bette S, Schwarz F, Kroencke T, Decker JA. Coronary Artery Disease in Patients Hospitalized for Peripheral Artery Disease: A Nationwide Analysis of 1.8 Million Patients. Diagnostics (Basel) 2023; 13:diagnostics13061163. [PMID: 36980471 PMCID: PMC10047185 DOI: 10.3390/diagnostics13061163] [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: 02/16/2023] [Revised: 03/15/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
PURPOSE Coronary artery disease (CAD) and peripheral artery disease (PAD) are highly prevalent in society. This nationwide analysis aimed to evaluate the trends of in-hospital treatment of patients admitted due to PAD with and without concomitant CAD, to determine the prevalence and risk factors of concomitant CAD in patients with PAD. METHODS Using data from the German Federal Statistical Office, we included all admissions for PAD (with and without concomitant CAD) in Germany between 2009 and 2018. Baseline patient characteristics, outcomes and comorbidities were analyzed. Elixhauser comorbidity groups and the linear van Walraven comorbidity score (vWs) were calculated to assess the comorbidity burden. RESULTS Of all 1,793,517 patients hospitalized for PAD, a total of 21.8% (390,259) had concomitant CAD, increasing from 18.6% in 2009 to 24.4% in 2018. Patients with accompanying CAD showed higher in-hospital mortality (3.7 vs. 2.6%), more major amputations (9.0 vs. 7.7%) and more comorbidities (Elixhauser score: 4.2 vs. 3.2 and vWs: 9.1 vs. 6.1), resulting in higher costs (median: EUR 4541 vs. EUR 4268 per case). More advanced stages of PAD were associated with multi-vessel CAD (10% of all patients with PAD Fontaine IV showed 3-vessel CAD) and the prevalence of multi-vessel CAD increased predominantly in patients with advanced PAD. CONCLUSION One in four patients hospitalized for PAD had concomitant CAD, showing an increase over time with an additional medical and economic burden for hospitals compared with patients without CAD.
Collapse
Affiliation(s)
- Magnus Helmer
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, 86156 Augsburg, Germany
| | - Christian Scheurig-Muenkler
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, 86156 Augsburg, Germany
| | - Verena Brandt
- Department of Cardiology, German Heart Centre Munich, 80636 Munich, Germany
| | - Christian Tesche
- Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, 80377 Munich, Germany
- Department of Cardiology, Augustinum Clinic Munich, 81375 Munich, Germany
| | - Stefanie Bette
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, 86156 Augsburg, Germany
| | - Florian Schwarz
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, 86156 Augsburg, Germany
- Medical Faculty, Ludwig-Maximilians-University Munich, 80336 Munich, Germany
| | - Thomas Kroencke
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, 86156 Augsburg, Germany
- Centre for Advanced Analytics and Predictive Sciences (CAAPS), University of Augsburg, 86159 Augsburg, Germany
| | - Josua A Decker
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, 86156 Augsburg, Germany
| |
Collapse
|
5
|
Sartipy F, Garcia Pereira Filho AJ, Lundin F, Wahlberg E, Sigvant B. Presence of asymptomatic Peripheral Arterial Disease in combination with common risk factors elevates the cardiovascular risk Substantially. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2022; 13:200130. [PMID: 35493293 PMCID: PMC9043415 DOI: 10.1016/j.ijcrp.2022.200130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/10/2022] [Accepted: 03/21/2022] [Indexed: 12/24/2022]
Abstract
Background and aims This study evaluates the risks for adverse cardiovascular (CV) events in Asymptomatic Peripheral Arterial Disease (APAD) combined with different traditional CV risk factors. Methods A population-based observational study of 8000 subjects, identified 559 subjects as having APAD through ankle-brachial index (ABI) measurements and questionnaires regarding limb symptoms. This cohort and subgroups classified by presence of different traditional CV risk factors at baseline were assessed for 10 years on CV outcome. The recorded endpoints were all-cause mortality, CV mortality and non-fatal CV events. Results Before subdividing the APAD subjects, the CV mortality incidence was 28.5 deaths per 1000 person-years as compared to 8.7 deaths for references without APAD. For subjects with hypertension at baseline the CV mortality incidence was 35.4 when combined with APAD and 11.7 without. In women with hypertension but without other risk factors, presence of APAD increased the age-adjusted Hazard Ratio (HR) for fatal and non-fatal CV events by 1.86 [CI 1.54,2.24, p < 0.001]. Conclusions ABI measurements should be considered an important indication for aggressive multifactorial risk factor reduction in populations with any other prevalent CV risk factor. In hypertension, diabetes mellitus and a smoking history, coexisting APAD contributes significantly to the increased age-adjusted CV risk.
Collapse
Affiliation(s)
- Fredrik Sartipy
- Section of Vascular Surgery, Department of Clinical Science and Education, Karolinska Institutet at Södersjukhuset, Kirurgkliniken, Sjukhusbacken 10, 118 83, Stockholm, Sweden
| | | | - Fredrik Lundin
- Centre of Clinical Research, County Council of Värmland, Älvgatan 49, 652 30, Karlstad, Sweden
| | - Eric Wahlberg
- Department of Medicine and Health, Linköping University, Linkoping University Hospital, SE 581-53, Linköping, Sweden
| | - Birgitta Sigvant
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| |
Collapse
|
6
|
Lin J, Chen Y, Jiang N, Li Z, Xu S. Burden of Peripheral Artery Disease and Its Attributable Risk Factors in 204 Countries and Territories From 1990 to 2019. Front Cardiovasc Med 2022; 9:868370. [PMID: 35498034 PMCID: PMC9039520 DOI: 10.3389/fcvm.2022.868370] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/22/2022] [Indexed: 11/26/2022] Open
Abstract
Background Data on burden of peripheral artery disease (PAD) and its attributable risk factors are valuable for policymaking. We aimed to estimate the burden and risk factors for PAD from 1990 to 2019. Methods We extracted the data on prevalence, incidence, death, years lived with disability (YLDs), and years of life lost (YLLs) from the Global Burden of Disease Study 2019 to measure PAD burden. Moreover, the attributable burden to PAD risk factors was also estimated. Results Globally, in 2019, 113,443,017 people lived with PAD and 10,504,092 new cases occurred, resulting in 74,063 deaths, 500,893 YLDs, and 1,035,487 YLLs. The absolute numbers of PAD prevalent and incident cases significantly increased between 1990 and 2019, contrasting with the decline trends in age-standardized prevalence and incidence rates. However, no statistically significant changes were detected in the global age-standardized death or YLL rates. The burden of PAD and its temporal trends varied significantly by location, gender, age group, and social-demographic status. Among all potentially modifiable risk factors, age-standardized PAD deaths worldwide were primarily attributable to high fasting plasma glucose, followed by high systolic blood pressure, tobacco, kidney dysfunction, diet high in sodium, and lead exposure. Conclusion PAD remained a serious public health problem worldwide. More strategies aimed at implementing cost-effective interventions and addressing modifiable risk factors should be carried out, especially in regions with high or increasing burden.
Collapse
Affiliation(s)
- Jinfeng Lin
- Department of Neurosurgery, Jieyang People's Hospital, Jieyang, China
| | - Yangbo Chen
- Department of Cardiology, Jieyang People's Hospital, Jieyang, China
| | - Nan Jiang
- Department of Neurosurgery, Jieyang People's Hospital, Jieyang, China
| | - Zuoshi Li
- Department of Neurosurgery, Jieyang People's Hospital, Jieyang, China
| | - Shangbo Xu
- Department of Cardiology, Jieyang People's Hospital, Jieyang, China
| |
Collapse
|
7
|
Differences in Symptom Presentation in Women and Men with Confirmed Lower Limb Peripheral Artery Disease: A Systematic Review and Meta-Analysis. Eur J Vasc Endovasc Surg 2022; 63:602-612. [DOI: 10.1016/j.ejvs.2021.12.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 12/07/2021] [Accepted: 12/28/2021] [Indexed: 01/15/2023]
|
8
|
Timmis A, Vardas P, Townsend N, Torbica A, Katus H, De Smedt D, Gale CP, Maggioni AP, Petersen SE, Huculeci R, Kazakiewicz D, de Benito Rubio V, Ignatiuk B, Raisi-Estabragh Z, Pawlak A, Karagiannidis E, Treskes R, Gaita D, Beltrame JF, McConnachie A, Bardinet I, Graham I, Flather M, Elliott P, Mossialos EA, Weidinger F, Achenbach S. European Society of Cardiology: cardiovascular disease statistics 2021. Eur Heart J 2022; 43:716-799. [PMID: 35016208 DOI: 10.1093/eurheartj/ehab892] [Citation(s) in RCA: 352] [Impact Index Per Article: 176.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 12/07/2021] [Accepted: 12/16/2021] [Indexed: 12/13/2022] Open
Abstract
AIMS This report from the European Society of Cardiology (ESC) Atlas Project updates and expands upon the widely cited 2019 report in presenting cardiovascular disease (CVD) statistics for the 57 ESC member countries. METHODS AND RESULTS Statistics pertaining to 2019, or the latest available year, are presented. Data sources include the World Health Organization, the Institute for Health Metrics and Evaluation, the World Bank, and novel ESC sponsored data on human and capital infrastructure and cardiovascular healthcare delivery. New material in this report includes sociodemographic and environmental determinants of CVD, rheumatic heart disease, out-of-hospital cardiac arrest, left-sided valvular heart disease, the advocacy potential of these CVD statistics, and progress towards World Health Organization (WHO) 2025 targets for non-communicable diseases. Salient observations in this report: (i) Females born in ESC member countries in 2018 are expected to live 80.8 years and males 74.8 years. Life expectancy is longer in high income (81.6 years) compared with middle-income (74.2 years) countries. (ii) In 2018, high-income countries spent, on average, four times more on healthcare than middle-income countries. (iii) The median PM2.5 concentrations in 2019 were over twice as high in middle-income ESC member countries compared with high-income countries and exceeded the EU air quality standard in 14 countries, all middle-income. (iv) In 2016, more than one in five adults across the ESC member countries were obese with similar prevalence in high and low-income countries. The prevalence of obesity has more than doubled over the past 35 years. (v) The burden of CVD falls hardest on middle-income ESC member countries where estimated incidence rates are ∼30% higher compared with high-income countries. This is reflected in disability-adjusted life years due to CVD which are nearly four times as high in middle-income compared with high-income countries. (vi) The incidence of calcific aortic valve disease has increased seven-fold during the last 30 years, with age-standardized rates four times as high in high-income compared with middle-income countries. (vii) Although the total number of CVD deaths across all countries far exceeds the number of cancer deaths for both sexes, there are 15 ESC member countries in which cancer accounts for more deaths than CVD in males and five-member countries in which cancer accounts for more deaths than CVD in females. (viii) The under-resourced status of middle-income countries is associated with a severe procedural deficit compared with high-income countries in terms of coronary intervention, ablation procedures, device implantation, and cardiac surgical procedures. CONCLUSION Risk factors and unhealthy behaviours are potentially reversible, and this provides a huge opportunity to address the health inequalities across ESC member countries that are highlighted in this report. It seems clear, however, that efforts to seize this opportunity are falling short and present evidence suggests that most of the WHO NCD targets for 2025 are unlikely to be met across ESC member countries.
Collapse
Affiliation(s)
- Adam Timmis
- William Harvey Research Institute, Queen Mary University London, London, UK
| | - Panos Vardas
- Hygeia Hospitals Group, HHG, Athens, Greece
- European Heart Agency, European Society of Cardiology, Brussels, Belgium
| | | | - Aleksandra Torbica
- Centre for Research on Health and Social Care Management (CERGAS), Bocconi University, Milan, Italy
| | - Hugo Katus
- Department of Internal Medicine and Cardiology, University of Heidelberg, Heidelberg, Germany
| | | | - Chris P Gale
- Medical Research Council Bioinformatics Centre, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Aldo P Maggioni
- Research Center of Italian Association of Hospital Cardiologists (ANMCO), Florence, Italy
| | - Steffen E Petersen
- William Harvey Research Institute, Queen Mary University London, London, UK
| | - Radu Huculeci
- European Heart Agency, European Society of Cardiology, Brussels, Belgium
| | | | | | - Barbara Ignatiuk
- Division of Cardiology, Ospedali Riuniti Padova Sud, Monselice, Italy
| | | | - Agnieszka Pawlak
- Mossakowski Medical Research Centre Polish Academy of Sciences, Warsaw, Poland
| | - Efstratios Karagiannidis
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Roderick Treskes
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Dan Gaita
- Universitatea de Medicina si Farmacie Victor Babes, Institutul de Boli Cardiovasculare, Timisoara, Romania
| | - John F Beltrame
- University of Adelaide, Central Adelaide Local Health Network, Basil Hetzel Institute, Adelaide, Australia
| | - Alex McConnachie
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, UK
| | | | - Ian Graham
- Tallaght University Hospital, Dublin, Ireland
| | - Marcus Flather
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Perry Elliott
- Institute of Cardiovascular Science, University College London, London, UK
| | | | - Franz Weidinger
- Department of Internal Medicine and Cardiology, Klinik Landstrasse, Vienna, Austria
| | - Stephan Achenbach
- Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| |
Collapse
|
9
|
Decker JA, Varga-Szemes A, Schoepf UJ, Emrich T, Schwarz F, Kroencke TJ, Scheurig-Muenkler C. In-patient care trends in peripheral artery disease in the German healthcare system over the past decade. Eur Radiol 2021; 32:1697-1708. [PMID: 34647176 DOI: 10.1007/s00330-021-08285-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/04/2021] [Accepted: 08/19/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To analyze trends of in-hospital treatment of patients admitted due to peripheral artery disease (PAD) from 2009 to 2018 with special focus on comorbidities, revascularization procedures, resulting costs, and outcome. METHODS Using data from the research data center of the German Federal Statistical Office, we included all hospitalizations due to PAD Fontaine stage IIb or higher from 2009 to 2018. To analyze comorbidities, Elixhauser diagnostic groups and linear van Walraven score (vWS) were assessed. RESULTS A total of 1.8 million hospitalizations resulting in €10.3 billion in reimbursement costs were included. From 2009 to 2018, the absolute number of hospitalizations due to PAD increased by 13.3% (163,547 to 185,352). The average cost per hospitalization increased by 20.8% from €5,261 to €6,356. The overall in-hospital mortality decreased from 3.1 to 2.6%. Median vWS of all PAD cases increased by 3 points (2 to 5). The number of percutaneous transluminal angioplasties (PTA) increased by 43.9% while some surgical procedures such as bypasses and embolectomies decreased by 30.8% and 6.8%, respectively. Many revascularization procedures showed a disproportionate increase of those performed in vessels below the knee for example in PTA (+ 68.5%) or in endarterectomies (+ 38.8%). CONCLUSIONS This decade-long nationwide analysis shows a rising number of hospitalizations due to PAD with more comorbid patients resulting in increasing reimbursement costs. Interventions are shifting from surgical to endovascular approaches with a notable trend towards interventions in smaller vessels below the knee. KEY POINTS • The number of hospitalizations due to peripheral artery disease is rising and it is associated with increasing reimbursement costs. • Admitted patients are older and show an increasing number of comorbidities while overall in-hospital mortality is decreasing. • Revascularization procedures are shifting from surgical to endovascular approaches and show a trend towards intervention in smaller vessels below the knee. • Major amputations are decreasing while the number of minor amputations is increasing.
Collapse
Affiliation(s)
- Josua A Decker
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany.,Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA
| | - Akos Varga-Szemes
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA
| | - U Joseph Schoepf
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA.
| | - Tilman Emrich
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, USA.,Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany.,German Centre for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Germany
| | - Florian Schwarz
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
| | - Thomas J Kroencke
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
| | | |
Collapse
|
10
|
Dahle N, Skau E, Leppert J, Ärnlöv J, Hedberg P. Poorly controlled ambulatory blood pressure in outpatients with peripheral arterial disease. Ups J Med Sci 2021; 126:7609. [PMID: 33995892 PMCID: PMC8098705 DOI: 10.48101/ujms.v126.7609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 03/29/2021] [Accepted: 03/29/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Patients with peripheral arterial disease (PAD) are generally less intensively managed than patients with coronary heart disease (CHD), despite that their risk of complications is believed to be equivalent. Identification of PAD patients at risk of poorly controlled blood pressure (BP) could lead to improved treatment, thus lowering the risk of cardiovascular (CV) complications. We aimed to describe the prevalence of poorly controlled cardiovascular (CV) risk factors, focusing on BP, in outpatients with PAD diagnosed in a vascular ultrasound laboratory. METHODS Consecutive outpatients with carotid and/or lower extremity PAD were included (n = 402) and examined with blood sampling, clinical BP, and 24-h ambulatory BP measurements. A poorly controlled clinical BP was defined as ≥140/90 mmHg, ambulatory BP ≥130/80 mmHg, low-density lipoprotein (LDL)-cholesterol level ≥2.5 mmol/L, and glycated hemoglobin (HbA1c) level >53 mmol/mol in those with diabetes. RESULTS Most of the patients had poorly controlled clinical (76.6%) and ambulatory BP (51.7%) profiles. Antihypertensive medications were prescribed in 84% of the patients. However, >40% of them used only 0-1 medication, and <25% of them used three or more agents. Clinical BP, a low number of medications, body mass index, and the presence of diabetes independently predicted a poorly controlled ambulatory BP. Nearly one-third of the patients were smokers, and most of the cohort had an LDL-cholesterol level of ≥2.5 mmol/L. An HbA1c level of >53 mmol/mol was present in 55% of diabetic patients. CONCLUSION Poorly controlled clinical and ambulatory systolic BP profiles were common. In addition, suboptimal control of other important CV risk factors was detected. The findings of this study highlight the need for better preventive efforts against CV risk factors in outpatients with PAD.
Collapse
Affiliation(s)
- Nina Dahle
- Centre for Clinical Research, Uppsala University, Falun, Sweden
- Primary Health Care Center Britsarvet-Grycksbo, County of Dalarna, Falun, Sweden
| | - Emma Skau
- Centre for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås, Sweden
- Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden
| | - Jerzy Leppert
- Centre for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås, Sweden
| | - Johan Ärnlöv
- Division of Family Medicine and Primary Care, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- School of Health and Social Studies, Dalarna University, Falun, Sweden
| | - Pär Hedberg
- Centre for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås, Sweden
- Department of Clinical Physiology, Västmanland County Hospital, Västerås, Sweden
| |
Collapse
|
11
|
Volis I, Saliba W, Jaffe R, Eitan A, Zafrir B. Effect of Cerebrovascular and/or Peripheral Artery Disease With or Without Attainment of Lipid Goals on Long-Term Outcomes in Patients With Coronary Artery Disease. Am J Cardiol 2020; 128:28-34. [PMID: 32650921 DOI: 10.1016/j.amjcard.2020.04.043] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/19/2020] [Accepted: 04/27/2020] [Indexed: 12/24/2022]
Abstract
Involvement of atherosclerosis in extracardiac vascular territories may identify coronary artery disease (CAD) patients at higher risk for adverse events. We investigated the long-term prognostic implications of polyvascular disease in patients with CAD, and further analyzed lipid goal attainment and its relation to patient outcomes. The study was a retrospective analysis of 10,297 patients who underwent coronary revascularization, categorized as having CAD alone (83.1%) or with multisite artery disease (MSAD) (16.9%) including cerebrovascular disease (CBVD) and/or peripheral artery disease (PAD). Incidence rates and hazard ratios (HR) for major adverse cardiovascular events (MACE) (myocardial infarction, ischemic stroke, or all-cause death) according to vascular territories involved, and in relation to most-recent lipid levels attained, were analyzed. Patients with MSAD were older with higher burden of co-morbidities. The rate of MACE (myocardial infarction, ischemic stroke, or all-cause death) and its individual components increased with the number of affected vascular beds. Adjusted HR (95% confidence interval) for MACE was 1.41 (1.24 to 1.59) in patients with CAD and CBVD, 1.46 (1.33 to 1.62) in CAD and PAD, and 1.69 (1.49 to 1.92) in those with CAD and CBVD and PAD, compared with CAD alone. Most-recent low-density lipoprotein cholesterol (LDL-C) levels <55 mg/dl and <70 mg/dl were attained by 21.8% and 44.6% of patients with CAD alone, in comparison to 22.7% and 43.3% in MSAD. Compared with patients with most-recent LDL-C > 100 mg/dl, attaining LDL-C < 70 mg/dl had an adjusted HR for MACE of 0.52 (0.47 to 0.57) in CAD only patients and 0.66 (0.57 to 0.78) in MSAD patients. In conclusion, the presence of CBVD and/or PAD in patients with CAD is associated with higher burden of co-morbidities and progressive increase in long-term MACE. More than half of CAD patients with or without MSAD do not achieve lipid goals, which are associated with a significantly lower risk for adverse events.
Collapse
|
12
|
Ricco JB. Why have cardiovascular events in peripheral arterial disease patients failed to decline: lessons from a 10-year registry. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2019; 5:279-280. [PMID: 31495873 DOI: 10.1093/ehjqcco/qcz048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Jean-Baptiste Ricco
- Department of Clinical Research, University Hospital of Poitiers, Bât. Agora, 2 rue de la Milétrie, Poitiers Cedex, France
| |
Collapse
|