Ankle Brachial Index: quick reference guide for clinicians

Soluble CD14 Levels in the Jackson Heart Study: Associations With Cardiovascular Disease Risk and Genetic Variants

[Figure: see text].

Sex-influenced association of metabolic syndrome with lower extremity arterial disease in type 2 diabetes

AIM

The present study is undertaken to investigate the relationship between metabolic syndrome (MS) and lower extremity arterial disease (LEAD) in type 2 diabetes mellitus (T2DM) patients.

METHODS

A multi-center cross-sectional study was conducted on 8374 T2DM patients (4521 males and 3853 females) from 30 hospitals across China from June 2016 to January 2017. The odds ratios (ORs) and 95% confidence intervals (CIs) were presented to show the association between MS and LEAD. The univariate and multiple logistic analyses were performed to examine the association between MS and the prevalence of LEAD. Furthermore, the relationship was analyzed in different sex groups. Subgroup analysis was performed based on the number and individual of MS components.

RESULTS

Finally, 1809(21.60%) T2DM patients meet the diagnostic criteria of LEAD. Of the 3853 female subjects, 841(21.83%) patients were in the LEAD group and of the 4521 male subjects, 968(21.41%) patients were in the LEAD group. When adjusting for confounding variables, MS was significantly associated with the prevalence of LEAD in all enrolled T2DM patients (OR = 1.22, 95%CI: 1.09-1.37, P = 0.001). However, upon analyzing LEAD in different sex groups, the significant association remained in females (OR = 1.33, 95%CI: 1.12-1.58, P < 0.001), but not in males (OR = 1.11, 95%CI: 0.95-1.29, P = 0.202).

CONCLUSIONS

Our results suggest that MS is specifically associated with an increased risk of LEAD in female T2DM patients. However, MS may not be a significant factor in the prevalence of LEAD in male T2DM patients.

Comparison between central and ambulatory blood pressure measurements in early detection of end organ damage: a single-center prospective non-randomized controlled trial

Background

Both ambulatory blood pressure (AMBP) and non-invasive central blood pressure (NCBP) monitoring could be used as predictors for early detection of hypertensive end organ damage (EOD). However, the comparison between these two methods needs more clarification. Our cross-sectional study included 100 hypertensive patients with a mean age of 47.52 ± 8.35 years on regular antihypertensive treatment for ≥ 1 year (50 controlled, 50 uncontrolled). We compared associations, sensitivity, and specificity of EOD parameters with office, AMBP, and NCBP measurements. We measured left ventricular mass index (LVMI), carotid intimal medial thickness (CIMT), ankle-brachial index (ABI), serum creatinine, glomerular filtration rate (GFR), and pulse wave velocity (PWV).

Results

We found a significant relation between SBP of NCBP, AMBP and LVMI, and CIMT, PWV, and GFR respectively (P < 0.05) while office SBP showed no significant relation. Systolic AMBP showed a high sensitivity to ABI (98%) and CIMT (92%) while systolic NCBP had 92% specificity and DBP showed 90% sensitivity for ABI.

Conclusion

AMBP and NCBP show a significant relation to LVMI, CIMT, PWV, and GFR with little superiority of central BP while office BP does not. Systolic ABPM has high sensitivity to ABI and CIMT and systolic NCBP has a high sensitivity and specificity to ABI.

ABPI reporting and compression recommendations in global clinical practice guidelines on venous leg ulcer management: A scoping review

Clinical practice guidelines (CPGs) for venous leg ulcer (VLU) management recommend below-knee compression to improve healing outcomes after calculating the ankle-brachial pressure index (ABPI) to rule out significant arterial disease. This systematic scoping review aimed to complete a qualitative and quantitative content analysis of international CPGs for VLU management to determine if consensus existed in relation to recommendations for compression application based on an ABPI reading and clinical assessment. Our review shows that there is a lack of consensus across 13 VLU CPGs and a lack of clear guidance in relation to the specific ABPI range of compression therapy that can be safely applied. An area of uncertainty and disagreement exists in relation to an ABPI between 0.6 and 0.8, with some guidelines advocating that compression is contraindicated and others that there should be reduced compression. This has implications in clinical practice, including when it is safe to apply compression. In addition, the inconsistency in the levels of evidence and the grades of recommendation makes it difficult to compare across various guidelines.

Higher Serum Calcium Levels Are Associated with Preclinical Peripheral Arterial Disease among the Apparently Healthy Individuals

Background

Epidemiological studies suggest that serum calcium levels correlate with cardiovascular events. An ankle-brachial index (ABI) between 0.9 and 1.00 is a surrogate estimation of preclinical peripheral arterial disease (PAD). Prior studies have shown that an ABI of 0.9–1.0 is also associated with endothelial dysfunction. Therefore, we sought to investigate the relationship between serum calcium levels and preclinical PAD in apparently healthy Korean individuals.

Methods

We evaluated the association between serum calcium levels and preclinical PAD in 596 participants (334 males, 262 females) in a health examination program. Preclinical PAD was defined by an ABI of 0.9–1.0. Multiple logistic regression analysis was used to determine whether the serum calcium level was an independent determinant of preclinical PAD.

Results

The overall prevalence of preclinical PAD was 14.3%. The mean age was 44.0±12.5 years in the non-PAD group and 48.3±11.4 years in the preclinical PAD group (P=0.001). After adjusting for age, gender, systolic blood pressure, fasting plasma glucose, high-density lipoprotein cholesterol, triglycerides, C-reactive protein, g-glutamyltransferase, uric acid, hypertension medication, diabetes medication, and hyperlipidemia medication, the odds ratio (95% confidence intervals) for preclinical PAD was 2.28 (1.02–5.11) with a 1-mg/dL increase in the serum calcium.

Conclusion

These findings suggest that increased serum calcium is independently and positively associated with preclinical PAD regardless of the presence of classic cardiovascular risk factors.

Epidemiological characteristics of lower extremity arterial disease in Chinese diabetes patients at high risk: a prospective, multicenter, cross-sectional study

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.

Assessment of ulceration risk in diabetic individuals

ABSTRACT Objective: To identify the risk factors for foot ulceration through the tracing of diabetic peripheral neuropathy and peripheral arterial disease in individuals with type I and II diabetes, who were assisted in reference centers of the Federal District, Brazil. Method: a cross-sectional and analytical study, with the assessment of 117 individuals in outpatient clinics of the Federal District. Continuous variables were compared through Mann-Whitney test, and categorized variables, through Chi-square test for univariate analysis and Logistics regression test for multivariate analysis. Results: painful diabetic peripheral neuropathy was present in 37 (75.5%) of the individuals with neuropathy. Deformities and loss of protective plant sensibility were related to neuropathy (p=0.014 and p=0.001, respectively). Of the 40 (34.2%) individuals in the sample who presented peripheral arterial disease, 26 (65%) presented calcification risk. Conclusion: signs of painful peripheral polyneuropathy, peripheral arterial disease, deformities, loss of protective plantar sensibility, and dry skin were identified as risk factors for ulceration.

The Validity and Reliability between Automated Oscillometric Measurement of Ankle-Brachial Index and Standard Measurement by Eco-Doppler in Diabetic Patients with or without Diabetic Foot

OBJECTIVE

To evaluate the concordance between oscillometric ABI and standard Doppler ABI in diabetic Chinese patients with or without diabetic foot.

METHODS

230 consecutive diabetic patients (n = 459 limbs) were included. The right and left ABIs were determined with both devices by the same investigator. The concordance and agreement were assessed by kappa index and the Bland-Altman method.

RESULTS

The average Doppler ABI was 1.003 ± 0.286 on the right and 0.990 ± 0.287 on the left, while oscillometric ABI was 1.002 ± 0.332 and 0.993 ± 0.319, which had no significance. The average time for oscillometric ABI was 8.600 versus 16.980 minutes for Doppler ABI (p < 0.001). There was good agreement between the two measurements, with a kappa value of 0.869 on the right and 0.919 on the left. Regarding the Doppler ABI as the gold standard, the accuracy, sensitivity, specificity, +LR, and -LR of oscillometric ABI reached 95.22%, 94.34%, 95.48%, 20.873%, and 0.059% on the right. For the left, it was 96.94%, 96.43%, 97.11%, 33.364%, and 0.036%.

CONCLUSIONS

The oscillometric measurement is a reliable, convenient, and less time-consuming alternative to standard Doppler ABI in patients. It should be widely used for PAD detection.

Compression for Primary Prevention, Treatment, and Prevention of Recurrence of Venous Leg Ulcers: An Evidence-and Consensus-Based Algorithm for Care Across the Continuum

Chronic venous insufficiency is a prevalent disease that frequently leads to development of venous leg ulcers. While a number of evidence-based clinical practice guidelines have been developed that provide guidance for clinicians when caring for patients with chronic venous insufficiency, they lack adequate detail concerning selection and application of compression for prevention and management of venous leg ulcers. In order to address this need, the WOCN Society appointed a task force to develop an algorithm for compression for primary prevention, treatment, and prevention of recurrent venous leg ulcers in persons with chronic venous insufficiency. The task force used findings from a scoping literature review to identify current best evidence needed to support decision points and pathways within the algorithm. In addition, the task force convened a panel of 20 clinicians and researchers with expertise in lower extremity venous disorders in order to establish consensus around pathways and decision points within the algorithm lacking robust evidence. Following initial construction of the algorithm, a second interdisciplinary group of expert clinicians established content validity and provided additional qualitative feedback used to complete final revisions of the algorithm. This article reviews the process used to create this landmark algorithm, including generation of the evidence- and consensus-based statements used in its construction, the various pathways, and rich supplemental materials embedded within the algorithm, and the process used to establish content validity.