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Okamura T, Tsukamoto K, Arai H, Fujioka Y, Ishigaki Y, Koba S, Ohmura H, Shoji T, Yokote K, Yoshida H, Yoshida M, Deguchi J, Dobashi K, Fujiyoshi A, Hamaguchi H, Hara M, Harada-Shiba M, Hirata T, Iida M, Ikeda Y, Ishibashi S, Kanda H, Kihara S, Kitagawa K, Kodama S, Koseki M, Maezawa Y, Masuda D, Miida T, Miyamoto Y, Nishimura R, Node K, Noguchi M, Ohishi M, Saito I, Sawada S, Sone H, Takemoto M, Wakatsuki A, Yanai H. Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2022. J Atheroscler Thromb 2024; 31:641-853. [PMID: 38123343 DOI: 10.5551/jat.gl2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Affiliation(s)
- Tomonori Okamura
- Preventive Medicine and Public Health, Keio University School of Medicine
| | | | | | - Yoshio Fujioka
- Faculty of Nutrition, Division of Clinical Nutrition, Kobe Gakuin University
| | - Yasushi Ishigaki
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, Iwate Medical University
| | - Shinji Koba
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Hirotoshi Ohmura
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine
| | - Tetsuo Shoji
- Department of Vascular Medicine, Osaka Metropolitan University Graduate school of Medicine
| | - Koutaro Yokote
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine
| | - Hiroshi Yoshida
- Department of Laboratory Medicine, The Jikei University Kashiwa Hospital
| | | | - Juno Deguchi
- Department of Vascular Surgery, Saitama Medical Center, Saitama Medical University
| | - Kazushige Dobashi
- Department of Pediatrics, School of Medicine, University of Yamanashi
| | | | | | - Masumi Hara
- Department of Internal Medicine, Mizonokuchi Hospital, Teikyo University School of Medicine
| | - Mariko Harada-Shiba
- Cardiovascular Center, Osaka Medical and Pharmaceutical University
- Department of Molecular Pathogenesis, National Cerebral and Cardiovascular Center Research Institute
| | - Takumi Hirata
- Institute for Clinical and Translational Science, Nara Medical University
| | - Mami Iida
- Department of Internal Medicine and Cardiology, Gifu Prefectural General Medical Center
| | - Yoshiyuki Ikeda
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Shun Ishibashi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jichi Medical University, School of Medicine
- Current affiliation: Ishibashi Diabetes and Endocrine Clinic
| | - Hideyuki Kanda
- Department of Public Health, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
| | - Shinji Kihara
- Medical Laboratory Science and Technology, Division of Health Sciences, Osaka University graduate School of medicine
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women's Medical University Hospital
| | - Satoru Kodama
- Department of Prevention of Noncommunicable Diseases and Promotion of Health Checkup, Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine
| | - Masahiro Koseki
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Yoshiro Maezawa
- Department of Endocrinology, Hematology and Gerontology, Chiba University Graduate School of Medicine
| | - Daisaku Masuda
- Department of Cardiology, Center for Innovative Medicine and Therapeutics, Dementia Care Center, Doctor's Support Center, Health Care Center, Rinku General Medical Center
| | - Takashi Miida
- Department of Clinical Laboratory Medicine, Juntendo University Graduate School of Medicine
| | | | - Rimei Nishimura
- Department of Diabetes, Metabolism and Endocrinology, The Jikei University School of Medicine
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University
| | - Midori Noguchi
- Division of Public Health, Department of Social Medicine, Graduate School of Medicine, Osaka University
| | - Mitsuru Ohishi
- Department of Cardiovascular Medicine and Hypertension, Graduate School of Medical and Dental Sciences, Kagoshima University
| | - Isao Saito
- Department of Public Health and Epidemiology, Faculty of Medicine, Oita University
| | - Shojiro Sawada
- Division of Metabolism and Diabetes, Faculty of Medicine, Tohoku Medical and Pharmaceutical University
| | - Hirohito Sone
- Department of Hematology, Endocrinology and Metabolism, Niigata University Faculty of Medicine
| | - Minoru Takemoto
- Department of Diabetes, Metabolism and Endocrinology, International University of Health and Welfare
| | | | - Hidekatsu Yanai
- Department of Diabetes, Endocrinology and Metabolism, National Center for Global Health and Medicine Kohnodai Hospital
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Xu Y, Pouncey AL, Zhou Z, Woodward M, Harris K. Smoking as a risk factor for lower extremity peripheral artery disease in women compared to men: A systematic review and meta-analysis. PLoS One 2024; 19:e0300963. [PMID: 38656947 PMCID: PMC11042699 DOI: 10.1371/journal.pone.0300963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/07/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND To investigate whether the relationship between smoking and peripheral artery disease (PAD) differs by sex (PROSPERO CRD42022352318). METHODS PubMed, EMBASE, and CINAHL were searched (3 March 2024) for studies reporting associations between smoking and PAD in both sexes, at least adjusted for age. Data were pooled using random effects. Between-study heterogeneity was examined using I2 statistic and Cochran's Q test. Newcastle-Ottowa Scale was adopted for quality assessment. RESULTS Four cohort studies (n = 2,117,860, 54.4% women) and thirteen cross-sectional studies (n = 230,436, 59.9% women) were included. In cohort studies, former and current smokers had higher risk of PAD than never smokers. Compared to those who never or previously smoked, women current smokers (relative risk (RR) 5.30 (95% confidence interval 3.17, 8.87)) had higher excess risk of PAD than men (RR 3.30 (2.46, 4.42)), women-to-men ratio of RR 1.45 (1.30, 1.62)(I2 = 0%, p = 0.328). In cross-sectional studies, risk of PAD was higher among former and current compared to never smokers, more so in men, women-to-men ratios of odds ratio: 0.64 (0.46, 0.90)(I2 = 30%, p = 0.192), 0.63 (0.50, 0.79)(I2 = 0%, p = 0.594), respectively. For both sexes, risk of PAD was higher among current smokers compared to those who were not currently smoking. Cohort studies and five cross-sectional studies were of good quality, scoring 6 to 8 of a possible maximum 9 points. Eight cross-sectional studies scored 2 to 5. DISCUSSIONS Further research is required to elucidate sex differences in the relationships between smoking and PAD, as the current evidence is limited and mixed. Tobacco-control programs should consider both sexes.
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Affiliation(s)
- Ying Xu
- Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Faculty of Medicine, Australian Institute of Health Innovation, Centre for Health Systems and Safety Research, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Anna Louise Pouncey
- Faculty of Medicine, Department of Vascular Surgery, Division of Surgery and Cancer, Imperial College London, QEQM, St Mary’s Hospital, London, United Kingdom
| | - Zien Zhou
- Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Mark Woodward
- Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Katie Harris
- Faculty of Medicine, The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
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Prem Senthil M, Kurban C, Thuy Nguyen N, Nguyen AP, Chakraborty R, Delaney C, Clark R, Anand S, Bhardwaj H. Role of noninvasive ocular imaging as a biomarker in peripheral artery disease (PAD): A systematic review. Vasc Med 2024; 29:215-222. [PMID: 38054219 PMCID: PMC11010562 DOI: 10.1177/1358863x231210866] [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] [Indexed: 12/07/2023]
Abstract
This study aimed to review the current literature exploring the utility of noninvasive ocular imaging for the diagnosis of peripheral artery disease (PAD). Our search was conducted in early April 2022 and included the databases Medline, Scopus, Embase, Cochrane, and others. Five articles were included in the final review. Of the five studies that used ocular imaging in PAD, two studies used retinal color fundus photography, one used optical coherence tomography (OCT), and two used optical coherence tomography angiography (OCTA) to assess the ocular changes in PAD. PAD was associated with both structural and functional changes in the retina. Structural alterations around the optic disc and temporal retinal vascular arcades were seen in color fundus photography of patients with PAD compared to healthy individuals. The presence of retinal hemorrhages, exudates, and microaneurysms in color fundus photography was associated with an increased future risk of PAD, especially the severe form of the disease. The retinal nerve fiber layer (RNFL) was significantly thinner in the nasal quadrant in patients with PAD compared to age-matched healthy individuals in OCT. Similarly, the choroidal thickness in the subfoveal region was significantly thinner in patients with PAD compared to controls. Patients with PAD also had a significant reduction in the retinal and choroidal circulation in OCTA compared to healthy controls. As PAD causes thinning and ischemic changes in retinal vessels, examination of the retinal vessels using retinal imaging techniques can provide useful information about early microvascular damage in PAD. Ocular imaging could potentially serve as a biomarker for PAD. PROSPERO ID: CRD42022310637.
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Affiliation(s)
- Mallika Prem Senthil
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Chroran Kurban
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Ngoc Thuy Nguyen
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Anh-Phuong Nguyen
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Ranjay Chakraborty
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Christopher Delaney
- Department of Vascular and Endovascular Surgery, Flinders Medical Centre, Adelaide, SA, Australia
| | - Robyn Clark
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Saumya Anand
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, SA, Australia
| | - Heena Bhardwaj
- College of Nursing and Health Sciences, Caring Futures Institute, Flinders University, Adelaide, SA, Australia
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Acitelli E, Guedon AF, De Liguori S, Gallo A, Maranghi M. Peripheral artery disease: an underdiagnosed condition in familial hypercholesterolemia? A systematic review. Endocrine 2024:10.1007/s12020-024-03763-x. [PMID: 38457056 DOI: 10.1007/s12020-024-03763-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 02/25/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE Familial hypercholesterolemia (FH) is one of the most common inherited diseases characterized by elevated LDL-cholesterol levels, leading to early-onset atherosclerosis. While the association between FH and coronary and carotid artery disease is well-established, its association with peripheral artery disease (PAD) is less robust. This systematic review aims at exploring existing evidence on PAD prevalence and incidence in FH individuals. METHODS A comprehensive search was conducted on MEDLINE and Embase databases, for studies published between January 2013 and December 2023, evaluating prevalence and incidence of PAD in FH patients. Literature reviews, case reports, responses to editors and non-English language articles were excluded. RESULTS The initial research provided 53 results. After article screening, 28 articles were fully reviewed and 24 were finally included in the analysis. Among these, 19 reported PAD prevalence, while 5 PAD incidence over a mean follow-up time of 8.7 years. PAD prevalence and incidence ranged from 0.3 to 60% and from 0.5 to 4.2% respectively, probably reflecting the heterogeneity in PAD definition criteria. CONCLUSION This systematic review sheds light on the limited number of studies on PAD in FH patients. Particularly, considering the potential positive effects of newly available lipid-lowering strategies on PAD outcomes, addressing this research gap is pivotal for a more comprehensive understanding of peripheral vascular manifestations in FH patients and for optimal management of this population.
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Affiliation(s)
- Elisa Acitelli
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Alexis F Guedon
- Département Hospitalo-Universitaire Inflammation Immunopathologie Biothérapie (DMUi3), Sorbonne Université, APHP, Service de Médecine Interne, Paris, France
| | - Sara De Liguori
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Antonio Gallo
- Department of Nutrition, APHP, Hôpital Pitié-Salpètriêre, Sorbonne Université, INSERM UMR1166, Lipidology and cardiovascular prevention Unit, 47/83 boulevard de l'Hôpital, F-75013, Paris, France
| | - Marianna Maranghi
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy.
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Reddy KR, Freeman AM. Lifestyle Medicine: An Antidote to Cardiovascular Diseases. Am J Lifestyle Med 2024; 18:216-232. [PMID: 38559785 PMCID: PMC10979734 DOI: 10.1177/15598276221130684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
Despite numerous advances in basic understanding of cardiovascular disease pathophysiology, pharmacology, therapeutic procedures, and systems improvement, there hasn't been much decline in heart disease related mortality in the US since 2010. Hypertension and diet induced risk continue to be the leading causes of cardiovascular morbidity. Even with the excessive mortality associated with the COVID-19 pandemic, in 2020, heart disease remained the leading cause of death. Given the degree of disease burden, morbidity, and mortality, there is an urgent need to redirect medical professionals' focus towards prevention through simple and cost effective lifestyle strategies. However, current practice paradigm and financial compensation systems are mainly centered disease management and not health promotion. For example, the financial value placed on 3-10 min smoking cessation counseling (.24RVUs) is 47-fold lower than an elective PCI (11.21 RVUs). The medical community seems to be enamored with the latest and greatest technology, new devices, and surgical procedures. What if the greatest technology of all was simply the way we live every day? Perhaps when this notion is known by enough, we will switch to this lifestyle medicine technology to prevent disease in the first place.
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Affiliation(s)
- Koushik R. Reddy
- Division of Cardiology, Department of Medicine, James A. Haley VA Medical Center and University of South Florida, Tampa, FL, USA (KRR); and Division of Cardiology, Department of Medicine, National Jewish Health, Denver, CO, USA (AMF)
| | - Andrew M. Freeman
- Division of Cardiology, Department of Medicine, James A. Haley VA Medical Center and University of South Florida, Tampa, FL, USA (KRR); and Division of Cardiology, Department of Medicine, National Jewish Health, Denver, CO, USA (AMF)
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Al Hamid A, Beckett R, Wilson M, Jalal Z, Cheema E, Al-Jumeily Obe D, Coombs T, Ralebitso-Senior K, Assi S. Gender Bias in Diagnosis, Prevention, and Treatment of Cardiovascular Diseases: A Systematic Review. Cureus 2024; 16:e54264. [PMID: 38500942 PMCID: PMC10945154 DOI: 10.7759/cureus.54264] [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: 02/14/2024] [Indexed: 03/20/2024] Open
Abstract
Cardiovascular disease (CVDs) has been perceived as a 'man's disease', and this impacted women's referral to CVD diagnosis and treatment. This study systematically reviewed the evidence regarding gender bias in the diagnosis, prevention, and treatment of CVDs. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were followed. We searched CINAHL, PubMed, Medline, Web of Science, British Nursing Index, Scopus, and Google Scholar. The included studies were assessed for quality using risk bias tools. Data extracted from the included studies were exported into Statistical Product and Service Solutions (SPSS, v26; IBM SPSS Statistics for Windows, Armonk, NY), where descriptive statistics were applied. A total of 19 studies were analysed. CVDs were less reported among women who either showed milder symptoms than men or had their symptoms misdiagnosed as gastrointestinal or anxiety-related symptoms. Hence, women had their risk factors under-considered by physicians (especially by male physicians). Subsequently, women were offered fewer diagnostic tests, such as coronary angiography, ergometry, electrocardiogram (ECG), and cardiac enzymes, and were referred to less to cardiologists and/or hospitalisation. Furthermore, if hospitalised, women were less likely to receive a coronary intervention. Similarly, women were prescribed cardiovascular medicines than men, with the exception of antihypertensive and anti-anginal medicines. When it comes to the perception of CVD, women considered themselves at lower risk of CVDs than men. This systematic review showed that women were offered fewer diagnostic tests for CVDs and medicines than men and that in turn influenced their disease outcomes. This could be attributed to the inadequate knowledge regarding the differences in manifestations among both genders.
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Affiliation(s)
| | - Rachel Beckett
- Forensic Science, Liverpool John Moores University, Liverpool, GBR
| | - Megan Wilson
- Forensic Science, Liverpool John Moores University, Liverpool, GBR
| | - Zahra Jalal
- Pharmacology and Therapeutics, Birmingham University, Birmingham, GBR
| | - Ejaz Cheema
- Pharmacy, University of Management and Technology, Lahore, PAK
| | - Dhiya Al-Jumeily Obe
- Computer Science and Mathematics, Liverpool John Moores University, Liverpool, GBR
| | - Thomas Coombs
- Toxicology, British American Tobacco, Southampton, GBR
| | | | - Sulaf Assi
- Pharmacy, Liverpool John Moores University, Liverpool, GBR
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Prasad A, Choh AC, Gonzalez ND, Garcia M, Lee M, Watt G, Maria Vasquez L, Laing S, Wu S, McCormick JB, Fisher-Hoch S. A high burden of diabetes and ankle brachial index abnormalities exists in Mexican Americans in South Texas. Prev Med Rep 2024; 38:102604. [PMID: 38375159 PMCID: PMC10874877 DOI: 10.1016/j.pmedr.2024.102604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 01/06/2024] [Accepted: 01/08/2024] [Indexed: 02/21/2024] Open
Abstract
Ethnic differences exist in the United States in the interrelated problems of diabetes (DM), peripheral arterial disease (PAD), and leg amputations. The purpose of this study was to determine the prevalence and risk factor associations for subclinical PAD in a population sample of Mexican Americans using the ankle brachial (ABI) index. The ABI-High (higher of the two ankle pressures/highest brachial pressure) and ABI-Low (lower of the two ankle pressures/highest brachial pressure) were calculated to define PAD. Toe brachial index (TBI) was also calculated. 746 participants were included with an age of 53.4 ± 0.9 years, 28.3 % had diabetes mellitus (DM), 12.6 % were smokers, and 51.2 % had hypertension (HTN). Using ABI-High ≤ 0.9, the prevalence of PAD was 2.7 %. This rose to 12.7 % when an ABI-Low ≤ 0.9 was used; 4.0 % of the population had an ABI-High > 1.4. The prevalence of TBI < 0.7 was 3.9 %. DM was a significant risk factor for ABI-High ≤ 0.9 and ABI-High > 1.4, and TBI < 0.7. Increased age, HTN, smoking was associated with ABI-High ≤ 0.9, while being male was associated with ABI-High > 1.4. Increased age, smoking, and lower education were all associated with abnormal TBI. Despite relatively younger mean age than other studied Hispanic cohorts, the present population has a high burden of ABI abnormalities. DM was a consistent risk factor for PAD. These abnormalities indicate an important underlying substrate of vascular and metabolic disease that may predispose this population to the development of symptomatic PAD and incident amputations.
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Affiliation(s)
- Anand Prasad
- The University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Audrey C. Choh
- University of Texas School of Public Health Brownsville Regional Campus, USA
| | - Nelson D. Gonzalez
- University of Texas School of Public Health Brownsville Regional Campus, USA
| | - Marlene Garcia
- The University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Miryoung Lee
- University of Texas School of Public Health Brownsville Regional Campus, USA
| | - Gordon Watt
- Memorial Sloan Kettering Cancer Center, Department of Epidemiology and Biostatistics, India
| | | | - Susan Laing
- The University of Texas Health Science Center at Houston, USA
| | - Shenghui Wu
- The University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Joseph B. McCormick
- University of Texas School of Public Health Brownsville Regional Campus, USA
| | - Susan Fisher-Hoch
- University of Texas School of Public Health Brownsville Regional Campus, USA
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Schlueter DJ, Sulieman L, Mo H, Keaton JM, Ferrara TM, Williams A, Qian J, Stubblefield O, Zeng C, Tran TC, Bastarache L, Dai J, Babbar A, Ramirez A, Goleva SB, Denny JC. Systematic replication of smoking disease associations using survey responses and EHR data in the All of Us Research Program. J Am Med Inform Assoc 2023; 31:139-153. [PMID: 37885303 PMCID: PMC10746325 DOI: 10.1093/jamia/ocad205] [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: 01/06/2023] [Revised: 05/04/2023] [Accepted: 10/12/2023] [Indexed: 10/28/2023] Open
Abstract
OBJECTIVE The All of Us Research Program (All of Us) aims to recruit over a million participants to further precision medicine. Essential to the verification of biobanks is a replication of known associations to establish validity. Here, we evaluated how well All of Us data replicated known cigarette smoking associations. MATERIALS AND METHODS We defined smoking exposure as follows: (1) an EHR Smoking exposure that used International Classification of Disease codes; (2) participant provided information (PPI) Ever Smoking; and, (3) PPI Current Smoking, both from the lifestyle survey. We performed a phenome-wide association study (PheWAS) for each smoking exposure measurement type. For each, we compared the effect sizes derived from the PheWAS to published meta-analyses that studied cigarette smoking from PubMed. We defined two levels of replication of meta-analyses: (1) nominally replicated: which required agreement of direction of effect size, and (2) fully replicated: which required overlap of confidence intervals. RESULTS PheWASes with EHR Smoking, PPI Ever Smoking, and PPI Current Smoking revealed 736, 492, and 639 phenome-wide significant associations, respectively. We identified 165 meta-analyses representing 99 distinct phenotypes that could be matched to EHR phenotypes. At P < .05, 74 were nominally replicated and 55 were fully replicated. At P < 2.68 × 10-5 (Bonferroni threshold), 58 were nominally replicated and 40 were fully replicated. DISCUSSION Most phenotypes found in published meta-analyses associated with smoking were nominally replicated in All of Us. Both survey and EHR definitions for smoking produced similar results. CONCLUSION This study demonstrated the feasibility of studying common exposures using All of Us data.
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Affiliation(s)
- David J Schlueter
- Precision Health Informatics Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
- Department of Health and Society, University of Toronto, Scarborough, Toronto, ON, Canada
| | - Lina Sulieman
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Huan Mo
- Precision Health Informatics Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
- The Cohort Analytics Core (CAC), Center for Precision Health Research, National Human Genome Research Institute, Bethesda, MD, USA
| | - Jacob M Keaton
- Precision Health Informatics Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
| | - Tracey M Ferrara
- Precision Health Informatics Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
| | - Ariel Williams
- Precision Health Informatics Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
| | - Jun Qian
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Onajia Stubblefield
- Precision Health Informatics Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
| | - Chenjie Zeng
- Precision Health Informatics Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
| | - Tam C Tran
- Precision Health Informatics Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
- The Cohort Analytics Core (CAC), Center for Precision Health Research, National Human Genome Research Institute, Bethesda, MD, USA
| | - Lisa Bastarache
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Jian Dai
- Precision Health Informatics Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
| | - Anav Babbar
- Precision Health Informatics Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
| | - Andrea Ramirez
- Precision Health Informatics Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Slavina B Goleva
- Precision Health Informatics Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
| | - Joshua C Denny
- Precision Health Informatics Section, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD, United States
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Mandaglio-Collados D, Marín F, Rivera-Caravaca JM. Peripheral artery disease: Update on etiology, pathophysiology, diagnosis and treatment. Med Clin (Barc) 2023; 161:344-350. [PMID: 37517924 DOI: 10.1016/j.medcli.2023.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 08/01/2023]
Abstract
Peripheral artery disease (PAD) is a condition related to atherosclerosis affecting >200 million people worldwide, and it increases cardiovascular morbidity (mainly from myocardial infarction and stroke) and mortality. Indeed, PAD patients are classified as patients at very high cardiovascular risk. The most common manifestation of PAD is intermittent claudication, which is associated with reduced mobility and leg pain. Nevertheless, asymptomatic PAD is the most frequent form of PAD worldwide; therefore, it remains underdiagnosed and undertreated. The major risk factors for PAD are smoking, diabetes mellitus, hyperlipidemia, hypertension, overweight/obesity, age, male sex, and black race. Hence, the first and most relevant approach in PAD treatment is lifestyle management, with measures such as smoking cessation, healthy diet, weight loss, and regular physical exercise. This should also be supported by an optimal pharmacological approach including lipid-lowering drugs, antihypertensive drugs, antidiabetic agents, and antithrombotics.
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Affiliation(s)
- Darío Mandaglio-Collados
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - Francisco Marín
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain
| | - José Miguel Rivera-Caravaca
- Department of Cardiology, Hospital Clínico Universitario Virgen de la Arrixaca, University of Murcia, Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CIBERCV, Murcia, Spain; Faculty of Nursing, University of Murcia, Murcia, Spain.
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Xu Y, Harris K, Pouncey AL, Carcel C, Low G, Peters SAE, Woodward M. Sex differences in risk factors for incident peripheral artery disease hospitalisation or death: Cohort study of UK Biobank participants. PLoS One 2023; 18:e0292083. [PMID: 37851596 PMCID: PMC10584119 DOI: 10.1371/journal.pone.0292083] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 09/12/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Women with peripheral artery disease (PAD) often have atypical symptoms, late hospital presentations, and worse prognosis. Risk factor identification and management are important. We assessed sex differences in associations of risk factors with PAD. METHODS 500,207 UK Biobank participants (54.5% women, mean age 56.5 years) without prior hospitalisation of PAD at baseline were included. Examined risk factors included blood pressure, smoking, diabetes, lipids, adiposity, history of stroke or myocardial infarction (MI), socioeconomic status, kidney function, C-reactive protein, and alcohol consumption. Poisson and Cox regressions were used to estimate sex-specific incidence of PAD hospitalisation or death, hazard ratios (HRs), and women-to-men ratios of HRs (RHR) with confidence intervals (CIs). RESULTS Over a median of 12.6 years, 2658 women and 5002 men had a documented PAD. Age-adjusted incidence rates were higher in men. Most risk factors were associated with a higher risk of PAD in both sexes. Compared with men, women who were smokers or had a history of stroke or MI had a greater excess risk of PAD (relative to those who never smoked or had no history of stroke or MI): RHR 1.18 (95%CI 1.04, 1.34), 1.26 (1.02, 1.55), and 1.50 (1.25, 1.81), respectively. Higher high-density lipoprotein cholesterol (HDL-C) was more strongly associated with a lower risk of PAD in women than men, RHR 0.81 (0.68, 0.96). Compared to HDL-C at 40 to 60 mg/dL, the lowest level of HDL-C (≤40 mg/dL) was related to greater excess risk in women, RHR 1.20 (1.02, 1.41), whereas the highest level of HDL-C (>80 mg/dL) was associated with lower risk of PAD in women, but higher risk in men, RHR 0.50 (0.38, 0.65). CONCLUSIONS While the incidence of PAD was higher in men, smoking and a history of stroke or MI were more strongly associated with a higher risk of PAD in women than men. HDL-C was more strongly associated with a lower risk of PAD in women than men.
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Affiliation(s)
- Ying Xu
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University, Sydney, Australia
| | - Katie Harris
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Anna Louise Pouncey
- Department of Vascular Surgery, Division of Surgery and Cancer, Faculty of Medicine, Imperial College London, QEQM, St Mary`s Hospital, London, United Kingdom
| | - Cheryl Carcel
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Gary Low
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Research Operations, Nepean Hospital, Nepean Blue Mountain Local Health District, Kingswood, New South Wales, Australia
- Sydney Medical School, Faculty of Medicine and Health, University of Sydney, Camperdown, New South Wales, Australia
| | - Sanne A. E. Peters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- The George Institute for Global Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Mark Woodward
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, School of Public Health, Imperial College London, London, United Kingdom
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Ardiana M, Santoso A, Hermawan HO, Nugraha RA, Pikir BS, Suryawan IGR. Acute effects of cigarette smoke on Endothelial Nitric Oxide synthase, vascular cell adhesion molecule 1 and aortic intima media thickness. F1000Res 2023; 10:396. [PMID: 38046985 PMCID: PMC10690037 DOI: 10.12688/f1000research.28375.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2023] [Indexed: 12/05/2023] Open
Abstract
Background. Cigarette smoking could induce endothelial dysfunction and the increase of circulating markers of inflammation by activation of monocytes. This can lead to increased intima media thickness (IMT) of entire blood vessels and result in acceleration of the atherosclerosis process. However, to our knowledge, little is known about the role of cigarette smoking in this atherosclerotic inflammatory process. The aim of this study is to explore the link between cigarette smoking and its effect on endothelial nitric oxide synthase (e-NOS) and vascular cell adhesion molecule 1 (VCAM-1). Methods. An experimental study with a post-test only controlled group design was used. We used 18 Wistar rats ( Rattus norvegicus) randomly subdivided into two groups: group K (-) were not exposed to tobacco smoke, whereas group K (+) were exposed to smoke equivalent of more than 40 cigarettes for 28 days daily. After 28 days, samples were analyzed for e-NOS, VCAM-1 and aortic IMT. Results . Our results indicate that tobacco smoke can enhance the expression of VCAM-1 on rat cardiac vascular endothelial cells, resulting in a decreased expression of e-NOS level and increase of aortic IMT. Linear regression model found that eNOS level negatively correlated wiith aortic IMT ( r 2 = 0.584, β = -0.764, p < 0.001), whereas VCAM-1 expression did not correlate with aortic IMT ( r 2 = 0.197, p = 0.065). Conclusion. Low e-NOS level and high VCAM-1 level observed after cigarette smoke exposure which may increase aortic IMT.
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Affiliation(s)
- Meity Ardiana
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, East Java, 60272, Indonesia
| | - Anwar Santoso
- Department of Cardiology and Vascular Medicine, Faculty of Medicine University of Indonesia - National Cardiovascular Centre Harapan Kita Hospital, Jakarta, DKI Jakarta, 11420, Indonesia
| | - Hanestya Oky Hermawan
- Department of Biomedicine, Faculty of Medicine, Universitas Brawijaya, Malang, East Java, 65145, Indonesia
| | - Ricardo Adrian Nugraha
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, East Java, 60272, Indonesia
| | - Budi Susetyo Pikir
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, East Java, 60272, Indonesia
| | - I. Gde Rurus Suryawan
- Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Airlangga - Dr. Soetomo General Academic Hospital, Surabaya, East Java, 60272, Indonesia
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Zhang J, Tan LJ, Jung H, Jung J, Lee J, Lee G, Park S, Moon B, Choi K, Shin S. Association of smoking and dietary polycyclic aromatic hydrocarbon exposure on the prevalence of metabolic syndrome in Korean adults. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2023; 33:831-839. [PMID: 37019984 DOI: 10.1038/s41370-023-00541-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 03/14/2023] [Accepted: 03/15/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Polycyclic aromatic hydrocarbons (PAHs) are environmental pollutants that are potentially hazardous to human health. Dietary exposure is recognized as one of the major pathways of exposure to PAHs among humans. While some PAH exposures have been associated with metabolic syndrome (MetS) in the general population, most epidemiological studies are based on urinary metabolites of a few noncarcinogenic PAHs. OBJECTIVE To investigate the association between estimates of dietary exposure to major carcinogenic PAHs and MetS in Korean adults. METHODS Multi-cycle Korean National Health and Nutrition Examination Survey (KNHANES) database (n = 16,015) and PAH measurement data from the total diet survey were employed to estimate daily PAH intake for each participating adult. After adjusting for potential confounders, multinomial logistic regression analysis was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) between PAHs and MetS of the participating adults. RESULTS Benzo(a)pyrene exposure was associated with an increased risk of MetS in men (OR = 1.30; 95% Cl: 1.03-1.63; P-trend = 0.03). In women, however, only chrysene and low high-density lipoprotein (HDL-c) were positively associated with an increased risk of MetS (OR = 1.24; 95% CI: 1.03-1.48; P-trend = 0.0172). Among men, smokers were at an increased risk for MetS, regardless of whether they were exposed to low or high total PAHs and benzo(a)pyrene levels. SIGNIFICANCE Our findings suggested that PAHs are associated with the risk of MetS and MetS components in Korean adults. In particular, it was confirmed that smoking may influence the relationship between PAH exposure and MetS.Further prospective cohort studies are required to confirm the causal relationship between PAHs and MetS. IMPACT STATEMENT Epidemiological studies on PAH exposure are often hampered by a lack of reliable exposure estimates, as biomonitoring of urine does not capture exposure to more toxic PAHs. Using multi-cycle KNHANES data and the measurement data from a total diet survey of Korea, we could develop a personalized PAH intake estimate for each participating adult and assessed the association with MetS.
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Affiliation(s)
- Jiaqi Zhang
- Department of Food and Nutrition, Chung-Ang University, Gyeonggi-do, 17546, Republic of Korea
| | - Li-Juan Tan
- Department of Food and Nutrition, Chung-Ang University, Gyeonggi-do, 17546, Republic of Korea
| | - Hyein Jung
- Department of Food and Nutrition, Chung-Ang University, Gyeonggi-do, 17546, Republic of Korea
| | - Jongseok Jung
- Department of Food and Nutrition, Chung-Ang University, Gyeonggi-do, 17546, Republic of Korea
| | - JiYun Lee
- Department of Food and Nutrition, Chung-Ang University, Gyeonggi-do, 17546, Republic of Korea
| | - Gowoon Lee
- Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Suhyun Park
- Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - BoKyung Moon
- Department of Food and Nutrition, Chung-Ang University, Gyeonggi-do, 17546, Republic of Korea
| | - Kyungho Choi
- Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Sangah Shin
- Department of Food and Nutrition, Chung-Ang University, Gyeonggi-do, 17546, Republic of Korea.
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Baretella O, Buser L, Andres C, Häberli D, Lenz A, Döring Y, Baumgartner I, Schindewolf M. Association of sex and cardiovascular risk factors with atherosclerosis distribution pattern in lower extremity peripheral artery disease. Front Cardiovasc Med 2023; 10:1004003. [PMID: 37441701 PMCID: PMC10333498 DOI: 10.3389/fcvm.2023.1004003] [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: 07/26/2022] [Accepted: 04/24/2023] [Indexed: 07/15/2023] Open
Abstract
Objective Atherosclerosis expression varies across not only coronary, cerebrovascular, and peripheral arteries but also within the peripheral vascular tree. The underlying pathomechanisms of distinct atherosclerosis phenotypes in lower extremity peripheral artery disease (PAD) is poorly understood. We investigated the association of cardiovascular risk factors (CVRFs) and atherosclerosis distribution in a targeted approach analyzing symptomatic patients with isolated anatomic phenotypes of PAD. Methods In a cross-sectional analysis of consecutive patients undergoing first-time endovascular recanalization for symptomatic PAD, data of patients with isolated anatomic phenotypes of either proximal (iliac) or distal (infrageniculate) atherosclerosis segregation were extracted. We performed a multivariable logistic regression model with backward elimination to investigate the association of proximal and distal PAD with CVRFs. Results Of the 637 patients (29% females) with endovascular recanalization, 351 (55%) had proximal and 286 (45%) had distal atherosclerosis. Female sex [odds ratio (OR) 0.33, 95% confidence interval (CI) 0.20-0.54, p = 0.01], active smoking (OR 0.16, 95% CI 0.09-0.28, p < 0.001), and former smoking (OR 0.33, 95% CI 0.20-0.57, p < 0.001) were associated with proximal disease. Diabetes mellitus (DM) (OR 3.25, 95% CI 1.93-5.46, p < 0.001), chronic kidney disease (CKD) (OR 1.18, 95% CI 1.08-1.28, p < 0.001), and older age (OR 1.31, 95% CI 1.06-1.61, p = 0.01) were associated with distal disease. Conclusion Female sex, particularly in the context of smoking, is associated with clinically relevant, proximal atherosclerosis expression. Our additional findings that distal atherosclerosis expression is associated with DM, CKD, and older age suggest that PAD has at least two distinct atherosclerotic phenotypes with sex-specific and individual susceptibility to atherogenic risk factors.
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Affiliation(s)
- Oliver Baretella
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Laura Buser
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Claudine Andres
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Dario Häberli
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Armando Lenz
- Clinical Trials Unit Bern, University of Bern, Bern, Switzerland
| | - Yvonne Döring
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximilians-Universität (LMU) München, Munich, Germany
- German Centre for Cardiovascular Research (DZHK), Partner site Munich Heart Alliance, Munich, Germany
- Department for BioMedical Research (DBMR), Bern University Hospital, University of Bern, Bern, Switzerland
| | - Iris Baumgartner
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marc Schindewolf
- Division of Angiology, Swiss Cardiovascular Center, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Abstract
Peripheral artery disease (PAD) is a common type of atherosclerotic disease of the lower extremities associated with reduced quality of life and ambulatory capacity. Major adverse cardiovascular events and limb amputations are the leading cause of morbidity and mortality in this population. Optimal medical therapy is therefore critical in these patients to prevent adverse events. Risk factor modifications, including blood pressure control and smoking cessation, in addition to antithrombotic agents, peripheral vasodilators, and supervised exercise therapy are key pillars of medical therapy. Revascularization procedures represent key touch points between patients and health care providers and serve as opportunities to optimize medical therapy and improve long-term patency rates and outcomes. This review summarizes the aspects of medical therapy that all providers should be familiar with when caring for patients with PAD in the peri-revascularization period.
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Affiliation(s)
| | - Joshua A. Beckman
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee
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15
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Wang X, Yang Y, Zhang J, Zang S. Development and validation of a prediction model for the prolonged length of stay in Chinese patients with lower extremity atherosclerotic disease: a retrospective study. BMJ Open 2023; 13:e069437. [PMID: 36759024 PMCID: PMC9923290 DOI: 10.1136/bmjopen-2022-069437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVES This study aims to develop and internally validate a prediction model, which takes account of multivariable and comprehensive factors to predict the prolonged length of stay (LOS) in patients with lower extremity atherosclerotic disease (LEAD). DESIGN This is a retrospective study. SETTING China. PARTICIPANTS, PRIMARY AND SECONDARY OUTCOMES Data of 1694 patients with LEAD from a retrospective cohort study between January 2014 and November 2021 were analysed. We selected nine variables and created the prediction model using the least absolute shrinkage and selection operator (LASSO) regression model after dividing the dataset into training and test sets in a 7:3 ratio. Prediction model performance was evaluated by calibration, discrimination and Hosmer-Lemeshow test. The effectiveness of clinical utility was estimated using decision curve analysis. RESULTS LASSO regression analysis identified age, gender, systolic blood pressure, Fontaine classification, lesion site, surgery, C reactive protein, prothrombin time international normalised ratio and fibrinogen as significant predictors for predicting prolonged LOS in patients with LEAD. In the training set, the prediction model showed good discrimination using a 500-bootstrap analysis and good calibration with an area under the receiver operating characteristic of 0.750. The Hosmer-Lemeshow goodness of fit test for the training set had a p value of 0.354. The decision curve analysis showed that using the prediction model both in training and tests contributes to clinical value. CONCLUSION Our prediction model is a valuable tool using easily and routinely obtained clinical variables that could be used to predict prolonged LOS in patients with LEAD and help to better manage these patients in routine clinical practice.
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Affiliation(s)
- Xue Wang
- Department of Community Nursing, School of Nursing, China Medical University, Shenyang, Liaoning, China
| | - Yu Yang
- Department of Vascular Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Jian Zhang
- Department of Vascular Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Shuang Zang
- Department of Community Nursing, School of Nursing, China Medical University, Shenyang, Liaoning, China
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Luna P, Harris K, Castro-Dominguez Y, Algara M, Severiche-Mena C, Smolderen KG, Mena-Hurtado C. Risk profiles, access to care, and outcomes in Hispanics hospitalized for lower extremity peripheral artery disease. J Vasc Surg 2023; 77:216-224.e15. [PMID: 36037965 DOI: 10.1016/j.jvs.2022.08.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 08/17/2022] [Accepted: 08/19/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Previous studies have shown that Hispanics have worse clinical outcomes for lower extremity peripheral artery disease (PAD) than non-Hispanic White (NHWs). Using a national database, this study aimed to document the contemporary burden of PAD in Hispanics by evaluating their risk profiles, access to care, and outcomes compared with NHWs. METHODS Hospitalizations of Hispanics and NHWs with a primary diagnosis of PAD were identified using 2011-2017 National Inpatient Sample data. Patient sociodemographic characteristics, comorbidities, whether the admission was through the emergency department (ED) or elective, length of stay, and costs accrued were compared by ethnicity. Temporal trends in revascularizations, amputations, and ED admissions by year were evaluated with the Cochran-Mantel-Haenszel test and stratified by ethnicity. Data were combined across years and multivariable logistic regression was used to evaluate the association of ethnicity with inpatient revascularization, amputation, and mortality, adjusting for sociodemographic and cardiovascular risk factors. RESULTS From 2011 to 2017, there were a total of 1,018,220 PAD hospitalizations among Hispanics (13.9%) and NHWs (86.1%) between 2011 and 2017. Hispanics were more often low income and uninsured and presented with higher burden of comorbidities including diabetes, renal failure, prior amputations, and chronic limb-threatening ischemia compared with NHWs. Most Hispanics were admitted via the ED compared with NHWs (58.0% vs 36.7%; d = 0.48), and median length of stay was almost a day longer (4.5 days vs 3.7 days). Hispanic ethnicity was associated with lower odds of surgical (odds ratio [OR], 0.62; 95% confidence interval [CI], 0.57-0.67) and endovascular revascularization (OR, 0.94; 95% CI, 0.89-0.996) and mortality (OR, 0.83; 95% CI, 0.75-0.93), but higher odds of minor (OR, 1.25; 95% CI, 1.20-1.31) and major (OR, 1.08; 95% CI, 1.03-1.14) amputation. CONCLUSIONS Two tiers of health care consumption for inpatient PAD care and outcomes manifested among Hispanics and NHWs. First, Hispanics with PAD had a more vulnerable socioeconomic profile and presented with more severe PAD than NHWs. Second, they sought care more disproportionately through the ED and underwent more amputations than NHWs. To eradicate these inequities in PAD care and risk, strategies that improve access to outpatient care and expand health care coverage, as well as targeted management of risk factors in these vulnerable minority groups are needed.
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Affiliation(s)
- Paulina Luna
- Yale University School of Medicine, New Haven, CT; Weill Cornell Medicine, New York, NY
| | | | - Yulanka Castro-Dominguez
- Yale University School of Medicine, New Haven, CT; Case Western Reserve University, Cleveland, OH
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Joly M, Gillois P, Satger B, Blaise S, Pernod G. Comparative evaluation of socioeconomic insecurity in peripheral and coronary artery disease patients. JOURNAL DE MEDECINE VASCULAIRE 2022; 47:220-227. [PMID: 36464416 DOI: 10.1016/j.jdmv.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/30/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND Cardiovascular disease represents the leading cause of death worldwide. Socioeconomic deprivation is a risk factor for cardiovascular disease. We have previously shown that precariousness was more frequent in symptomatic peripheral artery disease (PAD) patients than in the general population. According to a previous study, coronary artery disease (CAD) patients have a higher level of education than CAD with PAD, but no study directly compared the level of precariousness in PAD and CAD patients. AIM To measure and compare the level of socioeconomic insecurity in patients suffering from symptomatic PAD with those suffering from isolated CAD, i.e without symptomatic PAD. METHODS We conducted an observational, cohort, prospective, multicenter study. Patients suffering from symptomatic PAD or CAD were recruited through the medical or surgical vascular or cardiology departments, or the vascular rehabilitation center. The EPICES score and the INSEE parameters were used for analysis. The individual is considered precarious when his or her score is greater than or equal to 30. Cardiovascular risk factors and peripheral arterial disease stages were also collected. RESULTS In total, 230 patients were included. According to the EPICES score, 47.8% [95%CI, 38.7-56.7] of patients with symptomatic PAD were in a precarious situation compared to 17.4% [95%CI, 10.5-24.3] of patients suffering from isolated CAD (P<0.001). The mean EPICES score was 33.3 (SD 22.5) in the PAD and 16.9 (SD 17.02) in the CAD population, respectively (P<0.001). In the PAD population, the level of education was low, with an under-representation of patients with a baccalaureate or higher education degree: 21.7% [95%CI, 14.2-29.3] vs. 41.7% [95%CI, 32.7-50.7] in the PAD and CAD populations, respectively. There was also an under-representation of executives and intellectual and intermediate professions in the PAD population, 18.3% [95%CI, 11.2-25.3], compared to the CAD population, 31.3% [95%CI, 22.8-39.8]. CONCLUSION PAD patients are more precarious than patients suffering from CAD. A better detection of socioeconomic deprivation in patients suffering from peripheral arterial disease could allow comprehensive care and thus hope for an improvement in terms of morbidity and mortality.
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Affiliation(s)
- Marion Joly
- Department of Vascular Medicine, University Hospital Grenoble-Alpes, Grenoble, France
| | - Pierre Gillois
- Department of Public Health, University Hospital Grenoble-Alpes, Grenoble, France; Université Grenoble-Alpes, CNRS/TIMC-IMAG UMR 5525/Themas, Grenoble, France
| | - Bernadette Satger
- Department of Vascular Medicine, University Hospital Grenoble-Alpes, Grenoble, France
| | - Sophie Blaise
- Department of Vascular Medicine, University Hospital Grenoble-Alpes, Grenoble, France
| | - Gilles Pernod
- Department of Vascular Medicine, University Hospital Grenoble-Alpes, Grenoble, France; Université Grenoble-Alpes, CNRS/TIMC-IMAG UMR 5525/Themas, Grenoble, France.
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Cha S, Grace SL, Han K, Kim B, Paik NJ, Kim WS. Editor's Choice - Effect of Physical Activity and Tobacco Use on Mortality and Morbidity in Patients with Peripheral Arterial Disease After Revascularisation: A Korean Nationwide Population Based Cohort Study. Eur J Vasc Endovasc Surg 2022; 64:417-426. [PMID: 35671938 DOI: 10.1016/j.ejvs.2022.05.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 05/16/2022] [Accepted: 05/29/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To investigate the effects of physical activity (PA) and tobacco use on adverse clinical outcomes after revascularisation for peripheral arterial disease (PAD) in the Western Pacific region, where PAD cases and tobacco use are among the highest in the world. METHODS This was a retrospective cohort study using the Korean National Health Insurance Service (NHIS) database and included patients who had received revascularisation for PAD between 2010 and 2015. They were categorised as active or inactive based on the number of days per week they engaged in PA and as current or non-tobacco users (self report). The primary outcome was all cause mortality. Secondary outcomes included major adverse outcome (a composite of all cause mortality, myocardial infarction, and stroke) and major adverse limb event (MALE, a composite of amputation and recurrent revascularisation). RESULTS The relatively healthy cohort comprised 8 324 patients (mean age 64.7 years; 76.9% male) following revascularisation for PAD. Among them, 32.7% were inactive and 26.4% were tobacco users. Active patients had better outcomes than inactive patients (all cause mortality adjusted hazard ratio [adjHR] 0.766; 95% CI 0.685 - 0.855, major adverse outcome adjHR 0.795; 95% CI 0.719 - 0.878, MALE adjHR 0.858; 95% CI 0.773 - 0.953). Tobacco users had poorer outcomes than non-users (all cause mortality adjHR 1.279; 95% CI 1.124 - 1.456, major adverse outcome adjHR 1.263; 95% CI 1.124 - 1.418, MALE adjHR 1.291; 95% CI 1.143 - 1.458). CONCLUSION Even after receiving revascularisation for PAD, a sizable proportion of patients were physically inactive and used tobacco, leading to adverse clinical outcomes such as death, cardiovascular morbidity, and amputation in Korea. These modifiable risk factors should be addressed systematically, and a comprehensive approach including supervised exercise programmes and tobacco cessation is needed in patients with PAD.
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Affiliation(s)
- Seungwoo Cha
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sherry L Grace
- York University & the University Health Network, Toronto, Canada
| | - Kyungdo Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Bongseong Kim
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea
| | - Nam-Jong Paik
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Won-Seok Kim
- Department of Rehabilitation Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
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Mortality and Conversion to Transfemoral Amputation After Transtibial Amputation in the Veterans Affairs Health System. J Am Acad Orthop Surg 2022; 30:798-807. [PMID: 35858478 DOI: 10.5435/jaaos-d-22-00262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 05/25/2022] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Transtibial below-knee amputation (BKA) is associated with considerable morbidity, particularly in the vasculopathic population. The purpose of this study was to determine the cumulative probability of undergoing transfemoral above-knee amputation (AKA) conversion within 5 years of BKA and associated risk factors while accounting for the competing risk of death. METHODS This is a retrospective, national database study with structured query of the Veterans Affairs (VA) database for patients who underwent BKA from 1999 to 2020, identified by Current Procedural Terminology codes. Above-knee amputation conversion was identified using Current Procedural Terminology codes in combination with natural language processing to match procedure laterality. After internally validating our patient identification method, risk factors were collected. Competing risk analysis estimated the cumulative incidence rate of AKA conversion and associated risk factors with death as a competing risk. RESULTS Our query yielded 19,875 patients (19,640 men, 98.8%) who underwent BKA with a median age of 66 years (interquartile range, 60 to 73). The median follow-up was 951 days (interquartile range, 275 to 2,026). The crude cumulative probabilities of AKA conversion and death at 5 years were 15.4% (95% confidence interval [CI], 14.9% to 16.0%) and 47.7% (95% CI, 46.9% to 48.4%), respectively. In the Fine and Gray subdistribution hazard model, peripheral vascular disease had the highest AKA conversion risk (hazard ratio [HR] 2.66; 95% CI, 2.22 to 3.20; P < 0.001). Other factors independently associated with AKA conversion included urgent operation (HR 1.32; 95% CI, 1.23 to 1.42), cerebrovascular disease (HR 1.19; 95% CI, 1.11 to 1.28), chronic obstructive pulmonary disease (HR 1.15; 95% CI, 1.07 to 1.24), and previous myocardial infarction (HR 1.10; 95% CI, 1.02 to 1.19) (All P < 0.02). DISCUSSION Within this predominantly male, VA population, BKA carries a high risk of conversion to AKA within 5 years, without reaching a steady risk of AKA conversion within 5 years. Peripheral vascular disease, chronic obstructive pulmonary disease, cerebrovascular disease, previous myocardial infarction, and urgent BKA increase the risk of AKA conversion. LEVEL OF EVIDENCE Level III.
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Swedish snuff (snus) dipping, cigarette smoking, and risk of peripheral artery disease: a prospective cohort study. Sci Rep 2022; 12:12139. [PMID: 35840660 PMCID: PMC9287299 DOI: 10.1038/s41598-022-16467-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 07/11/2022] [Indexed: 11/08/2022] Open
Abstract
Tobacco smoking is an important risk factor for peripheral artery disease (PAD), but it remains unknown whether smokeless tobacco, such as Swedish snuff (snus), is also associated with this disease. We used data from the Cohort of Swedish Men including 24,085 men. Individuals were grouped into never, past, and current snus dippers as well as never, past quitting ≥ 10 years, past, quitting < 10 years, and current smokers. Incident PAD cases were defined by linkage of the cohort with the Swedish National Patient Register. Cox proportional hazards regression was used to analyze the data. Over a mean follow-up period of 9.1 years (from July 1, 2009 to December 31, 2019), 655 incident PAD cases were ascertained. Cigarette smoking but not Swedish snus dipping was associated with an increased risk of PAD. Compared with never snus dippers, the hazard ratio of PAD was 0.95 (95% confidence interval [CI] 0.73–1.24) for past snus dippers and 0.88 (95% CI 0.66–1.17) for current snus dippers. Compared to never smokers, the hazard ratio of PAD was 1.38 (95% CI 1.14–1.68) for past smoker who stopped smoking for ≥ 10 years, 2.61 (95% CI 1.89–3.61) for past smoker who stopped smoking for < 10 years, and 4.01 (95% CI 3.17, 5.08) for current smoker. In conclusion, cigarette smoking but not Swedish snus dipping increases the risk of PAD.
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Caligiuri SPB, Pierce GN, Ravandi A, Aukema HM. The Plasma Oxylipidome Links Smoking Status to Peripheral Artery Disease. Metabolites 2022; 12:metabo12070627. [PMID: 35888750 PMCID: PMC9317423 DOI: 10.3390/metabo12070627] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 06/28/2022] [Accepted: 07/04/2022] [Indexed: 12/31/2022] Open
Abstract
Peripheral artery disease (PAD) is prevalent among individuals with a history of tobacco smoking. Although oxidation of lipids may contribute to atherogenesis in vascular disease, enzymatically and nonenzymatically produced oxidized lipids can have varying and contrasting physiological effects. The underlying mechanisms of atherogenic vulnerability can be better elucidated with the recent advances in oxylipidome quantification using HPLC-MS/MS technology. In a randomized, controlled clinical trial, the plasma oxylipidome was analyzed in participants living with PAD by smoking status (n = 98) and in nonsmoking comparators without chronic disease (n = 20). Individuals with PAD had approximately a four-fold higher level of total plasma oxylipins versus the comparator. Cessation of smoking in individuals with PAD was associated with significantly lower levels of linoleic acid-derived TriHOMEs, greater levels of omega-3 fatty acid-derived oxylipins, and greater levels of nonfragmented oxidized phosphatidylcholines (OxPCs). Individuals living with PAD but without a history of smoking, exhibited higher levels of the putative atherogenic fragmented OxPCs versus individuals who currently or previously smoked. These data implicate the plasma oxylipidome in PAD and that smoking cessation is associated with a less inflammatory profile. Furthermore, fragmented OxPCs may play a more significant role in the pathophysiology of PAD in individuals without a history of smoking.
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Affiliation(s)
- Stephanie P. B. Caligiuri
- Nash Family Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Correspondence:
| | - Grant N. Pierce
- Canadian Centre for Agri-Food Research in Health and Medicine, Albrechtsen Research Centre, St. Boniface Hospital, Winnipeg, MB R2H 2A6, Canada; (G.N.P.); (H.M.A.)
- Institute of Cardiovascular Sciences, Albrechtsen Research Centre, St. Boniface Hospital, Winnipeg, MB R2H 2A6, Canada;
- Department of Physiology and Pathophysiology, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
| | - Amir Ravandi
- Institute of Cardiovascular Sciences, Albrechtsen Research Centre, St. Boniface Hospital, Winnipeg, MB R2H 2A6, Canada;
- Department of Physiology and Pathophysiology, University of Manitoba, Winnipeg, MB R3E 0J9, Canada
- Department of Internal Medicine, University of Manitoba, Winnipeg, MB R3E 0Z2, Canada
| | - Harold M. Aukema
- Canadian Centre for Agri-Food Research in Health and Medicine, Albrechtsen Research Centre, St. Boniface Hospital, Winnipeg, MB R2H 2A6, Canada; (G.N.P.); (H.M.A.)
- Department of Food and Human Nutritional Sciences, University of Manitoba, Winnipeg, MB R3T 6C5, Canada
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Oakley B, Brown HL, Johnson N, Bainbridge C. Nonfreezing Cold Injury and Cold Intolerance in Paddlesport. Wilderness Environ Med 2022; 33:187-196. [PMID: 35501230 DOI: 10.1016/j.wem.2022.03.003] [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: 10/27/2021] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Nonfreezing cold injury (NFCI) occurs when tissues are subjected to prolonged cooling that causes tissue damage, but not freezing. Long-term effects include cold intolerance, with allodynia, pain, or numbness of the affected limb. Those who participate in outdoor paddlesports are at particular risk. METHODS This is an epidemiological study that aimed to determine the risk factors for paddlesport athletes developing NFCI and chronic cold intolerance in their hands. Secondary outcomes were to correlate cumulative cold exposure with the development of cold intolerance and to identify risk factors for developing NFCI or cold intolerance. Six hundred nine athletes responded to a survey distributed by their national governing body obtaining demographic and activity details, symptoms of NFCI, and a cold intolerance severity score (CISS). RESULTS Twenty-three percent reported symptoms consistent with acute NFCI. The median CISS was 31 y (interquartile range 25-43), and 15% had a pathological CISS defined as >50. Females and individuals with Raynaud's phenomenon or migraines had a significantly higher CISS (P<0.05). Regression analysis found that females, smokers, and those with Raynaud's phenomenon or a previous nerve injury had a significantly higher risk of developing pathological cold intolerance (CISS >50). There was no correlation between cumulative cold exposure and CISS. CONCLUSIONS A large proportion of paddlesport athletes undertaking activity in cold conditions have a pathological CISS or episodes consistent with NFCI. Cumulative cold exposure was not associated with a pathologically high CISS. The risk factors were female sex, smokers, and those suffering from either Raynaud's phenomenon or nerve injury.
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Affiliation(s)
- Ben Oakley
- Pulvertaft Hand Centre, Royal Derby Hospital.
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Shi Y, Zhou W, Cheng M, Yu C, Wang T, Zhu L, Bao H, Hu L, Li P, Cheng X. Association of Plasma Bilirubin Levels With Peripheral Arterial Disease in Chinese Hypertensive Patients: New Insight on Sex Differences. Front Physiol 2022; 13:867418. [PMID: 35492585 PMCID: PMC9047868 DOI: 10.3389/fphys.2022.867418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 03/29/2022] [Indexed: 12/24/2022] Open
Abstract
Background and aims: Previous studies have indicated that Plasma total bilirubin (TBiL) might play an essential role in peripheral arterial disease (PAD). However, the effects of different levels of TBiL on PAD development remain uncertain. We aimed to examine the TBiL and the prevalence of PAD among Chinese adults with hypertension, with particular attention paid to sex differences. Methods: A total of 10,900 hypertensive subjects were included in the current study. The mean age of our study participants was 63.86 ± 9.25 years, and there were 5,129 males and 5,771 females. The outcome was peripheral arterial disease (PAD), defined as present when the ankle-brachial index (ABI) of either side was ≤0.90. The association between TBiL and PAD was examined using multivariate logistic regression analysis and the restricted cubic spline. Results: Of 10,900 hypertensive participants, 350 (3.21%) had PAD, and the mean plasma total bilirubin was 14.66 (6.86) μmol/L. The mean TBiL was 15.67 μmol/L in men and 13.76 μmol/L in women. The smoothing curve showed that a U-shaped curve association existed between TBiL and the prevalence of PAD in Chinese adults with hypertension. When stratified by sex, TBiL was significantly U-shaped associated with PAD among men but not women. Among males, the inflection point was 11.48 μmol/L; to the left inflection point, the effect size and 95% CI were 0.08, 0.01, 0.66, respectively; to the right inflection point, OR, 5.16; 95% CI,1.64, 16.25. Conclusions: We found an independent U-shaped association between TBiL and the prevalence of PAD among hypertensive subjects and a differential association between men and women. We further revealed a turning point by threshold effect analysis.
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Affiliation(s)
- Yumeng Shi
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, China
| | - Wei Zhou
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Mingshu Cheng
- China Jiangxi Wuyuan County Fuchun Hospitals, Shangrao, China
| | - Chao Yu
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Tao Wang
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lingjuan Zhu
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Huihui Bao
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Lihua Hu
- Department of Cardiovascular Medicine, Peking University First Hospital, Beijing, China
| | - Ping Li
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- *Correspondence: Ping Li, ; Xiaoshu Cheng,
| | - Xiaoshu Cheng
- Department of Cardiovascular Medicine, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- Jiangxi Provincial Cardiovascular Disease Clinical Medical Research Center, Nanchang, China
- Center for Prevention and Treatment of Cardiovascular Diseases, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- *Correspondence: Ping Li, ; Xiaoshu Cheng,
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Yuan S, Damrauer SM, Håkansson N, Åkesson A, Larsson SC. A Prospective Evaluation of Modifiable Lifestyle Factors in Relation to Peripheral Artery Disease Risk. Eur J Vasc Endovasc Surg 2022; 64:83-91. [DOI: 10.1016/j.ejvs.2022.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 03/21/2022] [Accepted: 04/02/2022] [Indexed: 11/03/2022]
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Wu CW, Chuang HY, Watanabe K, Wu PS, Pan HC, Wang CL, Yang CC, Hung CH, Dai CY, Ho CK, Kawakami N. Association between secondhand smoke and peripheral arterial disease: a meta-analysis of cross-sectional studies. Int Arch Occup Environ Health 2022; 95:1091-1101. [PMID: 35083550 DOI: 10.1007/s00420-022-01837-9] [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: 08/07/2021] [Accepted: 01/10/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE The association between secondhand smoke (SHS) and peripheral arterial disease (PAD) was inconsistent and the studies were relatively scarce, hence, we conducted a meta-analysis of the association between SHS and PAD. MATERIALS AND METHODS We systematically searched three electronic databases (PubMed, EMBASE, and Web of Science), and calculated the pooled prevalence risk ratio (RR) and estimated standard error by random effect model from the meta-analysis. Furthermore, we performed a subgroup meta-analysis according to the location of SHS exposure. RESULTS We initially identified 502 articles from the electronic database, and 6 articles, cross-sectional data from 4 cross-sectional studies and 2 prospective cohort studies, were included in the meta-analysis. Among these six articles, two studies showed a significant correlation between SHS exposure and PAD, whereas no study showed a negative correlation between SHS exposure and PAD. In the meta-analysis, pooled prevalence showed a significant association between SHS exposure and PAD (RR = 1.23; 95% confidence interval [CI] 1.08-1.41; z = 3.02, p = 0.003). In the subgroup analysis based on location of SHS exposure, the prevalence RR of PAD at home was 1.30 (95% CI 1.14-1.49, Z-3.99, p < 0.0001). The prevalence RR in the subgroup of SHS exposure at work was not significant (RR = 0.89; 95% CI 0.55-1.44; z = 0.48, p = 0.63). CONCLUSION Exposure to SHS was significantly and positively associated with PAD. Moreover, we found a significant association between exposure to SHS and PAD at home, but the association was not significant at work.
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Affiliation(s)
- Chih-Wei Wu
- Department of Occupational and Environmental Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, No. 482, Shanming Rd., Siaogang Dist., Kaohsiung City, 812, Taiwan
- Department of Family Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung City 812, Taiwan
| | - Hung-Yi Chuang
- Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 807, Taiwan
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City 807, Taiwan
| | - Kazuhiro Watanabe
- Department of Public Health, School of Medicine, Kitasato University, Sagamihara, Japan
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Pei-Shan Wu
- Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 807, Taiwan
| | - Hui-Chen Pan
- Department of Family Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung City 812, Taiwan
- Department of Nursing, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung City 812, Taiwan
| | - Chao-Ling Wang
- Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 807, Taiwan
| | - Chen-Cheng Yang
- Department of Occupational and Environmental Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, No. 482, Shanming Rd., Siaogang Dist., Kaohsiung City, 812, Taiwan.
- Department of Family Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung City 812, Taiwan.
- Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 807, Taiwan.
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City 807, Taiwan.
| | - Chih-Hsing Hung
- Environmental and Occupational Medicine Center, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung City 812, Taiwan
| | - Chia-Yen Dai
- Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 807, Taiwan
| | - Chi-Kung Ho
- Department of Occupational and Environmental Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung City 807, Taiwan
| | - Norito Kawakami
- Department of Mental Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Stone K, Fryer S, Faulkner J, Meyer ML, Heffernan K, Kucharska-Newton A, Zieff G, Paterson C, Matsushita K, Hughes TM, Tanaka H, Stoner L. Associations of lower-limb atherosclerosis and arteriosclerosis with cardiovascular risk factors and disease in older adults: The Atherosclerosis Risk in Communities (ARIC) study. Atherosclerosis 2022; 340:53-60. [PMID: 34799100 PMCID: PMC10167791 DOI: 10.1016/j.atherosclerosis.2021.10.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/14/2021] [Accepted: 10/29/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND & AIMS Atherosclerosis and arteriosclerosis contribute to vascular aging and cardiovascular disease (CVD) risk. Both processes can be assessed simply in the lower-limbs and reflect systemic pathology. However, only atherosclerosis is routinely assessed, typically via ankle-brachial index (ABI). Arteriosclerosis can be assessed using femoral-ankle pulse wave velocity (faPWV), but no studies have identified whether ABI and faPWV similarly associate with overt CVD and risk factors, nor whether faPWV confers additional information. The aims of this study were to (i) compare associations of ABI and faPWV with traditional CVD risk factors, including age, sex, systolic blood pressure (SBP), high-density lipoprotein (HDL), total cholesterol (TC), smoking, and diabetes; and (ii) determine the independent and additive associations of ABI and faPWV with a composite measure of prevalent CVD. METHODS We evaluated ABI and faPWV in 4330 older-aged (75.3 ± 5.0 years) adults using an oscillometric screening device. Associations between ABI and faPWV with CVD risk factors and CVD were determined using mixed-model linear- and logistic-regression. RESULTS ABI and faPWV were associated with age, HDL, and smoking. ABI was associated with sex, TC, diabetes. faPWV was associated with SBP. Both ABI and faPWV were inversely associated with CVD. Low ABI (≤0.9 vs. >0.9) and low faPWV (≤9.94 vs. >9.94) increased the odds of CVD by 2.41-fold (95% CI:1.85,3.17) and 1.46-fold (95% CI:1.23,1.74), respectively. The inverse association between faPWV and CVD was independent of ABI and CVD risk factors. CONCLUSIONS ABI and faPWV, measures of lower-limb atherosclerosis and arteriosclerosis, are independently associated with CVD risk factors and prevalent CVD. Assessment of faPWV may confer additional risk information beyond ABI.
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Affiliation(s)
- Keeron Stone
- School of Sport and Exercise, University of Gloucestershire, Gloucester, UK.
| | - Simon Fryer
- School of Sport and Exercise, University of Gloucestershire, Gloucester, UK
| | - James Faulkner
- Department of Sport, Exercise & Health, University of Winchester, Winchester, UK
| | - Michelle L Meyer
- Department of Emergency Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kevin Heffernan
- Department of Exercise Science, Syracuse University, Syracuse, USA
| | - Anna Kucharska-Newton
- Department of Epidemiology, The Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY, USA
| | - Gabriel Zieff
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Craig Paterson
- School of Sport and Exercise, University of Gloucestershire, Gloucester, UK
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Timothy M Hughes
- Section of Gerontology and Geriatric Medicine, Department of Internal Medicine, Wake Forest School of Medicine, Winston Salem, NC, USA
| | - Hirofumi Tanaka
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, TX, USA
| | - Lee Stoner
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Lindsø Andersen P, Jemec GBE, Loft IC, Saunte DML, Pedersen OB. Quality of Life in Danish Blood Donors Treated for Superficial Fungal Infections. Acta Derm Venereol 2021; 101:adv00617. [PMID: 34842934 PMCID: PMC9472089 DOI: 10.2340/actadv.v101.749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Pernille Lindsø Andersen
- Department of Dermatology, Zealand University Hospital Roskilde, Sygehusvej 5, DK-4000 Roskilde, Denmark.
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Marumo M, Ekawa K, Wakabayashi I. Urinary pteridines as a discriminator of atherosclerotic risk in patients with diabetes. ATHEROSCLEROSIS PLUS 2021; 46:27-34. [PMID: 36643725 PMCID: PMC9833246 DOI: 10.1016/j.athplu.2021.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/22/2021] [Accepted: 11/03/2021] [Indexed: 01/18/2023]
Abstract
Background and aims We have recently proposed urinary pteridine level as a useful biomarker of oxidative stress in a general population. However, the significance of urinary pteridines in patients with diabetes is unknown. Methods The relationships of the level of urinary pteridine derivatives with d-dimer, ankle-brachial pressure index (ABI), and known cardiovascular risk factors were investigated in patients with type 2 diabetes. Results Urinary pteridine level showed significant positive correlations with urinary15-isoprostane F2t, female gender, history of smoking and d-dimer and significant inverse correlations with history of alcohol drinking, body mass index (BMI) and ABI. ABI was significantly lower and d-dimer was significantly higher in the highest tertile group of pteridines than in the lowest tertile group. The odds ratios of the highest vs. lowest tertiles for low ABI and high d-dimer were significantly higher than the reference level. The above relationships of urinary pteridines with ABI and d-dimer were not altered when age, gender, BMI, hemoglobin A1c and history of alcohol drinking were used as explanatory variables in multivariable analyses. History of smoking confounded the relation of pteridines with ABI but not that with d-dimer. However, in logistic regression analysis, the association between pteridines and ABI remained significant with adjustment for history of smoking. Conclusion Urinary pteridine level was associated with d-dimer and ABI, which reflect blood coagulability and arterial flow to the lower extremities, respectively, and is thus thought to be a useful discriminator of thromboatherosclerotic risk in patients with diabetes.
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Affiliation(s)
- Mikio Marumo
- Department of Environmental and Preventive Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Kazumi Ekawa
- Department of Environmental and Preventive Medicine, Hyogo College of Medicine, Nishinomiya, Japan
| | - Ichiro Wakabayashi
- Department of Environmental and Preventive Medicine, Hyogo College of Medicine, Nishinomiya, Japan
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Biscetti F, Cecchini AL, Rando MM, Nardella E, Gasbarrini A, Massetti M, Flex A. Principal predictors of major adverse limb events in diabetic peripheral artery disease: A narrative review. ATHEROSCLEROSIS PLUS 2021; 46:1-14. [PMID: 36643723 PMCID: PMC9833249 DOI: 10.1016/j.athplu.2021.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 10/10/2021] [Accepted: 10/28/2021] [Indexed: 01/18/2023]
Abstract
Background and aims The increasing prevalence of diabetes mellitus is causing a massive growth of peripheral artery disease incidences, a disabling complication of diabetic atherosclerosis, which leads often to the amputation of the affected limb. Critical limb ischemia is the terminal disease stage, which requires a prompt intervention to relieve pain and save limbs. However, patients undergoing revascularization often suffer from cardiovascular, cerebrovascular and major adverse limb events with poor outcomes. Furthermore, the same procedure performed in apparently similar patients has various outcomes and lack of an outcome predictive support causes a high lower limb arterial revascularization rate with disastrous effects for patients. We collected the main risk factors of major adverse limb events in a more readable and immediate format of the topic, to propose an overview of parameters to manage effectively peripheral artery disease patients and to propose basics of a new predictive tool to prevent from disabling vascular complications of the disease. Methods Most recent and updated literature about the prevalence of major adverse limb events in peripheral artery disease was reviewed to identify possible main predictors. Results In this article, we summarized major risk factors of limb revascularization failure and disabling vascular complications collecting those parameters principally responsible for major adverse limb events, which provides physio-pathological explanation of their role in peripheral artery disease. Conclusion We evaluated and listed a panel of possible predictors of MALE (Major Adverse Limb Event) in order to contribute to the development of a predictive score, based on a summary of the main risk factors reported in scientific articles, which could improve the management of peripheral artery disease by preventing vascular accidents.
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Affiliation(s)
- Federico Biscetti
- Internal and Cardiovascular Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy,Department of Cardiovascular Sciences, Università Cattolica del Sacro Cuore, Roma, Italy,Corresponding author. Internal and Cardiovascular Medicine Unit. Fondazione Policlinico Universitario A. Gemelli IRCCS, Largo Agostino Gemelli, 8, Rome, 00168, Italy.
| | | | - Maria Margherita Rando
- Department of Cardiovascular Sciences, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Elisabetta Nardella
- Department of Cardiovascular Sciences, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Antonio Gasbarrini
- Department of Medical and Surgical Sciences, Universitá Cattolica del Sacro Cuore, Roma, Italy
| | - Massimo Massetti
- Department of Cardiovascular Sciences, Università Cattolica del Sacro Cuore, Roma, Italy
| | - Andrea Flex
- Internal and Cardiovascular Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma, Italy,Department of Medical and Surgical Sciences, Universitá Cattolica del Sacro Cuore, Roma, Italy
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Zhang X, Xu Z, Ran X, Ji L. Development and validation of a risk score model for prediction of lower extremity arterial disease in Chinese with type 2 diabetes aged over 50 years. Endocr Connect 2021; 10:1212-1220. [PMID: 34424851 PMCID: PMC8494415 DOI: 10.1530/ec-21-0152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 08/20/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Lower extremity arterial disease (LEAD) is highly prevalent in people with diabetes in China, but half of cases are underdiagnosed due to diversities of clinical presentations and complexities of diagnosis approaches. The purpose of this study was to develop a risk score model for LEAD to facilitate early screening among type 2 diabetes (T2DM) patients. METHODS A total of 8313 participants with T2DM from the China DIA-LEAD study, a multicenter, cross-sectional epidemiological study, were selected as the training dataset to develop a risk score model for LEAD by logistic regression. The area under receiver operating characteristic curve (AUC) and bootstrapping were utilized for internal validation. A dataset of 287 participants consecutively enrolled from a teaching hospital between July 2017 and November 2017 was used as external validation for the risk score model. RESULTS A total of 931 (11.2%) participants were diagnosed as LEAD in the training dataset. Factors including age, current smoking, duration of diabetes, blood pressure control, low density lipoprotein cholesterol, estimated glomerular filtration rate, and coexistence of cardio and/or cerebrovascular disease correlated with LEAD in logistic regression analysis and resulted in a weighed risk score model of 0-13. A score of ≥5 was found to be the optimal cut-off for discriminating moderate-high risk participants with AUC of 0.786 (95% CI: 0.778-0.795). The bootstrapping validation showed that the AUC was 0.784. Similar performance of the risk score model was observed in the validation dataset with AUC of 0.731 (95% CI: 0.651-0.811). The prevalence of LEAD was 3.4, 12.1, and 27.6% in the low risk (total score 0-4), moderate risk (total score 5-8), and high risk (total score 9-13) groups of LEAD in the training dataset, respectively, which were 4.3, 19.6, and 30.2% in the validation dataset. CONCLUSION The weighed risk score model for LEAD could reliably discriminate the presence of LEAD in Chinese with T2DM aged over 50 years, which may be helpful for a precise risk assessment and early diagnosis of LEAD.
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Affiliation(s)
- Xiaomei Zhang
- Department of Endocrinology, Peking University International Hospital, Beijing, China
| | - Zhangrong Xu
- Diabetes Center, Characteristic Medical Center of Strategic Support Force, Beijing, China
| | - Xingwu Ran
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
- Correspondence should be addressed to X Ran or L Ji: or
| | - Linong Ji
- Department of Endocrinology, Peking University International Hospital, Beijing, China
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China
- Correspondence should be addressed to X Ran or L Ji: or
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Pérez Mejias EL, Faxas SM, Taveras NT, Talpur AS, Kumar J, Khalid M, Aruwani SK, Khalid D, Khalid H, Memon S. Peripheral Artery Disease as a Risk Factor for Myocardial Infarction. Cureus 2021; 13:e15655. [PMID: 34277248 PMCID: PMC8280959 DOI: 10.7759/cureus.15655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction: Atherosclerosis contributes to the underlying pathophysiology for peripheral arterial disease (PAD), coronary artery disease (CAD), and cerebrovascular disease. Several studies have been conducted to demonstrate PAD as a major risk factor for cardiovascular (CV) events, however, the regional data are limited. This study aims to highlight PAD as a major risk factor in CV events in a local setting. Methods: In this longitudinal study, 400 hypertensive patients with a confirmed diagnosis of PAD were enrolled from the outpatient department of the cardiology unit. Diagnosis of PAD was made using the ankle brachial index (ABI). ABI less than 0.9 was labeled as participants with PAD. Another group of 400 without PAD was also enrolled as the control group from the outpatient department of cardiology unit. Patients were followed up for 12 months or for the development of myocardial infarction (MI). Result: Participants with PAD had a significant increased risk of total MI events with a relative risk (RR) of 1.67 (confidence interval, CI 95%: 1.05-2.66; p-value: 0.02). The RR for fatal MI was 2.62 (CI 95%: 0.94-7.29; p-value: 0.06) compared to the participants without PAD, however, it was not significant. Conclusion: This study has focused on the risk factors of PAD and has suggested that the patients who have any of the mentioned risk factors should be treated with caution under strict instructions given by doctors. A variety of treatment options is available, but the initial changes should be made in the lifestyle of these patients, making sure the risk factors are being treated.
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Affiliation(s)
| | | | | | | | - Jitesh Kumar
- Internal Medicine, Ghulam Muhammad Mahar Medical College, Sukkur, PAK
| | - Maria Khalid
- Internal Medicine, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, PAK
| | - Suraj K Aruwani
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Dua Khalid
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Haya Khalid
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Sidra Memon
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
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Gao X, Tong Z, Wu Y, Guo L, Gu Y, Dardik A. Similarities and differences in peripheral artery disease between China and Western countries. J Vasc Surg 2021; 74:1417-1424.e1. [PMID: 33864826 DOI: 10.1016/j.jvs.2021.03.030] [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: 07/14/2020] [Accepted: 03/26/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Peripheral artery disease (PAD) affects more than 200 million people worldwide, among whom more than two-thirds reside in low- and middle-income countries. China, as the largest low- and middle-income country, faces a challenge from the burden of PAD as the country undergoes economic expansion. We compared the patterns of PAD between China and Western countries to determine if there are differences in risk factors, awareness, or treatment of PAD. METHODS Literature searches were performed both in English databases and Chinese databases covering January 1, 1995, to March 1, 2020. Both landmark and high-quality articles were evaluated. RESULTS The prevalence of PAD in high-income countries increases linearly with age, whereas PAD increases slowly until the middle 60s and exponentially thereafter in China. In contrast with Western countries, the prevalence of PAD in China is reported to be higher in women than in men. There is a higher prevalence of risk factors in China, but the rates of awareness and treatment of these risk factors are low. CONCLUSIONS The lack of awareness and lower rates of treatment and control of PAD and its risk factors in China may be underlying the higher prevalence of PAD in women than in men as well as the steep increase in PAD after the middle 60s. In all countries, more attention should be paid to the planning and implementation of preventative strategies and clinical services. The societal and economic effects of PAD are considerable and ongoing studies are needed to help curtail the burden of this disease.
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Affiliation(s)
- Xixiang Gao
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University and Institute of Vascular Surgery, Capital Medical University, Beijing, China; Vascular Biology and Therapeutics Program, Department of Surgery, Yale School of Medicine, New Haven, Conn
| | - Zhu Tong
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Yingfeng Wu
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Lianrui Guo
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Yongquan Gu
- Department of Vascular Surgery, Xuanwu Hospital, Capital Medical University and Institute of Vascular Surgery, Capital Medical University, Beijing, China
| | - Alan Dardik
- Vascular Biology and Therapeutics Program, Department of Surgery, Yale School of Medicine, New Haven, Conn.
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Golledge J, Drovandi A. Evidence-Based Recommendations for Medical Management of Peripheral Artery Disease. J Atheroscler Thromb 2021; 28:573-583. [PMID: 33746159 PMCID: PMC8219542 DOI: 10.5551/jat.62778] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Patients with lower limb artery stenosis or occlusion (peripheral artery disease; PAD) have been determined to be at very high risk of both major adverse cardiovascular events, such as myocardial infarction and stroke, and major adverse limb events, such as amputation and requirement for artery surgery. Effective medical management has been identified as key in reducing this risk; however, this is often poorly implemented in clinical practice. Thus, the aim of this narrative review was to summarize the current evidence on the medical management of PAD in order to inform clinicians and highlight recommendations for clinical practice. International guidelines, randomized controlled trials, and relevant systematic reviews and meta-analyses have been included in this study. The focus was the management of the key modifiable risk factors to mitigate possible adverse events through prescription of anti-platelet and anticoagulation drugs and medications to control low-density lipoprotein cholesterol, blood pressure, and diabetes and aid smoking cessation. The available evidence from randomized clinical trials provide a strong rationale for the need for holistic medical management programs that are effective in achieving uptake of these medical therapies in patients with PAD. In conclusion, people with PAD have some of the highest adverse event rates among those with cardiovascular diseases. Secondary preventive measures have been proven effective in reducing these adverse events; however, they remain to be adequately implemented. Thus, the need for an effective implementation program has emerged to reduce adverse events in this patient group.
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Affiliation(s)
- Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University.,The Australian Institute of Tropical Health and Medicine, James Cook University.,The Department of Vascular and Endovascular Surgery, The Townsville University Hospital
| | - Aaron Drovandi
- Queensland Research Centre for Peripheral Vascular Disease, College of Medicine and Dentistry, James Cook University.,The Australian Institute of Tropical Health and Medicine, James Cook University
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34
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Kou M, Ding N, Ballew SH, Salameh MJ, Martin SS, Selvin E, Heiss G, Ballantyne CM, Matsushita K, Hoogeveen RC. Conventional and Novel Lipid Measures and Risk of Peripheral Artery Disease. Arterioscler Thromb Vasc Biol 2021; 41:1229-1238. [PMID: 33504178 PMCID: PMC8188625 DOI: 10.1161/atvbaha.120.315828] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/13/2021] [Indexed: 01/28/2023]
Abstract
OBJECTIVE The aim of this study was to comprehensively assess the association of multiple lipid measures with incident peripheral artery disease (PAD). Approach and Results: We used Cox proportional hazards models to characterize the associations of each of the fasting lipid measures (total cholesterol, LDL-C [low-density lipoprotein cholesterol], HDL-C [high-density lipoprotein cholesterol], triglycerides, RLP-C [remnant lipoprotein cholesterol], LDL-TG [LDL-triglycerides], sdLDL-C [small dense LDL-C], and Apo-E-HDL [Apo-E-containing HDL-C]) with incident PAD identified by pertinent International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) hospital discharge codes (eg, 440.2) among 8330 Black and White ARIC (Atherosclerosis Risk in Communities) participants (mean age 62.8 [SD 5.6] years) free of PAD at baseline (1996-1998) through 2015. Since lipid traits are biologically correlated to each other, we also conducted principal component analysis to identify underlying components for PAD risk. There were 246 incident PAD cases with a median follow-up of 17 years. After accounting for potential confounders, the following lipid measures were significantly associated with PAD (hazard ratio per 1-SD increment [decrement for HDL-C and Apo-E-HDL]): triglycerides, 1.21 (95% CI, 1.08-1.36); RLP-C, 1.18 (1.08-1.29); LDL-TG, 1.18 (1.05-1.33); HDL-C, 1.39 (1.16-1.67); and Apo-E-HDL, 1.27 (1.07-1.51). The principal component analysis identified 3 components (1: mainly loaded by triglycerides, RLP-C, LDL-TG, and sdLDL-C; 2: by HDL-C and Apo-E-HDL; and 3: by LDL-C and RLP-C). Components 1 and 2 showed independent associations with incident PAD. CONCLUSIONS Triglyceride-related and HDL-related lipids were independently associated with incident PAD, which has implications on preventive strategies for PAD. However, none of the novel lipid measures outperformed conventional ones. Graphic Abstract: A graphic abstract is available for this article.
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Affiliation(s)
- Minghao Kou
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ning Ding
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Maya J. Salameh
- Johns Hopkins Bloomberg School of Medicine, Baltimore, Maryland
| | - Seth S. Martin
- Johns Hopkins Bloomberg School of Medicine, Baltimore, Maryland
| | - Elizabeth Selvin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Johns Hopkins Bloomberg School of Medicine, Baltimore, Maryland
| | - Gerardo Heiss
- University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, North Carolina
| | | | - Kunihiro Matsushita
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Johns Hopkins Bloomberg School of Medicine, Baltimore, Maryland
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Martinez-Morata I, Sanchez TR, Shimbo D, Navas-Acien A. Electronic Cigarette Use and Blood Pressure Endpoints: a Systematic Review. Curr Hypertens Rep 2020; 23:2. [PMID: 33230755 PMCID: PMC10867863 DOI: 10.1007/s11906-020-01119-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE OF REVIEW E-cigarettes (e-cigs) release toxic chemicals known to increase blood pressure (BP) levels. The effects of e-cigs on BP, however, remain unknown. Studying BP may help characterize potential cardiovascular risks of short- and long-term e-cig use. We summarized published studies on the association of e-cig use with BP endpoints. RECENT FINDINGS Thirteen e-cig trials (12 cross-over designs) and 1 observational study evaluated systolic and diastolic blood pressure (SBP and DBP). All trials included at least one e-cig arm with nicotine, 6 a no-nicotine e-cig arm, and 3 a placebo arm. SBP/DBP increased in most nicotine e-cig arms, in some non-nicotine e-cig arms, and in none of the placebo arms. The observational study followed e-cig users and nonsmokers for 3.5 years with inconsistent findings. The use of e-cigs with and without nicotine may result in short-term elevations of both SBP and DBP. Prospective studies that investigate the long-term cardiovascular impact of e-cig use are needed.
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Affiliation(s)
- Irene Martinez-Morata
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University Irving Medical Center, 722 West 168th Street, New York, NY, 10032, USA.
| | - Tiffany R Sanchez
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University Irving Medical Center, 722 West 168th Street, New York, NY, 10032, USA
| | - Daichi Shimbo
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Ana Navas-Acien
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University Irving Medical Center, 722 West 168th Street, New York, NY, 10032, USA.
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Larsson SC, Mason AM, Bäck M, Klarin D, Damrauer SM, Michaëlsson K, Burgess S. Genetic predisposition to smoking in relation to 14 cardiovascular diseases. Eur Heart J 2020; 41:3304-3310. [PMID: 32300774 PMCID: PMC7544540 DOI: 10.1093/eurheartj/ehaa193] [Citation(s) in RCA: 71] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 08/29/2019] [Accepted: 03/05/2020] [Indexed: 12/31/2022] Open
Abstract
AIMS The aim of this study was to use Mendelian randomization (MR) to determine the causality of the association between smoking and 14 different cardiovascular diseases (CVDs). METHODS AND RESULTS Our primary genetic instrument comprised 361 single-nucleotide polymorphisms (SNPs) associated with smoking initiation (ever smoked regularly) at genome-wide significance. Data on the associations between the SNPs and 14 CVDs were obtained from the UK Biobank study (N = 367 643 individuals), CARDIoGRAMplusC4D consortium (N = 184 305 individuals), Atrial Fibrillation Consortium (2017 dataset; N = 154 432 individuals), and Million Veteran Program (MVP; N = 190 266 individuals). The main analyses were conducted using the random-effects inverse-variance weighted method and complemented with multivariable MR analyses and the weighted median and MR-Egger approaches. Genetic predisposition to smoking initiation was most strongly and consistently associated with higher odds of coronary artery disease, heart failure, abdominal aortic aneurysm, ischaemic stroke, transient ischaemic attack, peripheral arterial disease, and arterial hypertension. Genetic predisposition to smoking initiation was additionally associated with higher odds of deep vein thrombosis and pulmonary embolism in the UK Biobank but not with venous thromboembolism in the MVP. There was limited evidence of causal associations of smoking initiation with atrial fibrillation, aortic valve stenosis, thoracic aortic aneurysm, and intracerebral and subarachnoid haemorrhage. CONCLUSION This MR study supports a causal association between smoking and a broad range of CVDs, in particular, coronary artery disease, heart failure, abdominal aortic aneurysm, ischaemic stroke, transient ischaemic attack, peripheral arterial disease, and arterial hypertension.
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Affiliation(s)
- Susanna C Larsson
- Department of Surgical Sciences, Uppsala University, Uppsala 75185, Sweden
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm 17177, Sweden
| | - Amy M Mason
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
| | - Magnus Bäck
- Department of Medicine, Center for Molecular Medicine, Karolinska Institutet, Stockholm 17177, Sweden
- Division of Valvular and Coronary Disease, Heart and Vascular Theme, Karolinska University Hospital, Stockholm 14186, Sweden
| | - Derek Klarin
- Boston VA Healthcare System, Boston, MA 02132-4927, USA
- Center for Genomic Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA
- Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, MA 02142, USA
- Division of Vascular Surgery and Endovascular Therapy, University of Florida College of Medicine, Gainesville, FL 32610, USA
| | - Scott M Damrauer
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA 19104, USA
- Department of Surgery, Perlman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | | | - Karl Michaëlsson
- Department of Surgical Sciences, Uppsala University, Uppsala 75185, Sweden
| | - Stephen Burgess
- Department of Public Health and Primary Care, University of Cambridge, Cambridge CB1 8RN, UK
- MRC Biostatistics Unit, University of Cambridge, Cambridge CB20SR, UK
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Association of Carboxyhemoglobin Levels with Peripheral Arterial Disease in Chronic Smokers Managed at Dr George Mukhari Academic Hospital. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17155581. [PMID: 32748882 PMCID: PMC7432926 DOI: 10.3390/ijerph17155581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/11/2020] [Accepted: 06/16/2020] [Indexed: 12/20/2022]
Abstract
Chronic cigarette smokers (CCS) are known to have elevated levels of carboxyhemoglobin (COHb). However, it is not known whether increased levels of COHb are associated with endothelial dysfunction (ED), and therefore the development of peripheral arterial disease (PAD). The aim of the study was to investigate the association of blood COHb and plasma nitric oxide (NO) levels, and whether it is an independent risk factor in the development of PAD among CCS at Dr George Mukhari Academic Hospital (DGMAH). A sample of 120 CCS with PAD and a convenience sample of 100 CCS without PAD were recruited into the study. Blood COHb levels were measured using the ABL 90 FLEX CO-oximeter automated spectroscopy. Plasma nitric oxide (NO) levels were measure using ELISA. Logistic regression analysis was used to investigate the association of blood COHb and plasma NO with PAD. Blood COHb levels of CCS with PAD were significantly higher than those of CCS without PAD, and the NO levels of CCS with PAD were significantly lower than those of CCS without PAD. Although both the blood COHb and plasma NO in CCS were significantly associated with PAD in bivariate logistic analysis, only plasma NO was independently associated with PAD in multivariate logistic analysis. This finding is consistent with the hypothesis that COHb is a cause of arterial damage in PAD, leading to reduced NO, and therefore reduced arterial dilation.
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Lei X, Goel R, Sun D, Bhangu G, Bitzer ZT, Trushin N, Ma L, Richie JP, Xiu G, Muscat J. Free Radical and Nicotine Yields in Mainstream Smoke of Chinese Marketed Cigarettes: Variation with Smoking Regimens and Cigarette Brands. Chem Res Toxicol 2020; 33:1791-1797. [PMID: 32363856 PMCID: PMC10037311 DOI: 10.1021/acs.chemrestox.0c00041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Free radicals and nicotine are components of cigarette smoke that are thought to contribute to the development of smoking-induced diseases. China has the largest number of smokers in the world, yet little is known about the yields of tobacco smoke constituents in different Chinese brands of cigarettes. In this study, gas-phase and particulate-phase free radicals as well as nicotine yields were quantified in mainstream cigarette smoke from five popular Chinese brands and two research cigarettes (3R4F and 1R6F). Mainstream smoke was generated under International Organization of Standardization (ISO) and Canadian Intense (CI) smoking regimens using a linear smoking machine. Levels of free radicals and nicotine were measured by electron paramagnetic resonance spectroscopy (EPR) and gas chromatography with flame-ionization detection, respectively. Under the ISO puffing regimen, Chinese brand cigarettes produced an average of 3.0 ± 1.2 nmol/cig gas-phase radicals, 118 ± 44.7 pmol/cig particulate-phase radicals, and 0.6 ± 0.2 mg/cig nicotine. Under the CI puffing regimen, Chinese brand cigarettes produced an average of 5.6 ± 1.2 nmol/cig gas-phase radicals, 282 ± 92.1 pmol/cig particulate-phase radicals, and 2.1 ± 0.4 mg/cig nicotine. Overall, both gas- and particulate-phase free radicals were substantially lower compared to the research cigarettes under both regimens, whereas no significant differences were observed for nicotine levels. When Chinese brands were compared, the highest free radical and nicotine yields were found in "LL" and "BS" brands, while lowest levels were found in "YY". These results suggested that the lower radical delivery by Chinese cigarettes compared to United States reference cigarettes may be associated with reductions in oxidant-related harm.
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Affiliation(s)
- Xiaoning Lei
- State Environmental Protection Key Laboratory of Risk Assessment and Control on Chemical processes, East China University of Science and Technology (ECUST), Shanghai 200237, China
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033, United States
- Dr. Lei is currently with School of Public Health, Key Lab of Public Health Safety of the Ministry of Education and NHC Key Laboratory of Health Technology Assessment, Fudan University, Shanghai, 200433, China
| | - Reema Goel
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033, United States
| | - Dongxiao Sun
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033, United States
| | - Gurkirat Bhangu
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033, United States
| | - Zachary T Bitzer
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033, United States
| | - Neil Trushin
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033, United States
| | - Lin Ma
- State Environmental Protection Key Laboratory of Risk Assessment and Control on Chemical processes, East China University of Science and Technology (ECUST), Shanghai 200237, China
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033, United States
| | - John P. Richie
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033, United States
| | - Guangli Xiu
- State Environmental Protection Key Laboratory of Risk Assessment and Control on Chemical processes, East China University of Science and Technology (ECUST), Shanghai 200237, China
| | - Joshua Muscat
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, Pennsylvania 17033, United States
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Zhao X, Zhang X, Ran X, Xu Z, Ji L. Simple-to-use nomogram for evaluating the incident risk of moderate-to-severe LEAD in adults with type 2 diabetes: A cross-sectional study in a Chinese population. Sci Rep 2020; 10:3182. [PMID: 32081869 PMCID: PMC7035353 DOI: 10.1038/s41598-019-55101-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/17/2019] [Indexed: 02/05/2023] Open
Abstract
This study aimed to analyze the clinical characteristics of lower extremity atherosclerotic disease (LEAD) in Chinese adult type 2 diabetes (T2D) patients, and also explored the risk factors for LEAD and developed simple-to-use nomograms for LEAD and lesion degree in these patients. We retrospectively studied 4422 patients (male = 2084; female = 2338) with T2D who were ≥50. Based on lower extremity arterial ultrasound findings, we divided the patients into three groups: normal, mild, and moderate-to-severe group. The factors related to LEAD in patients with T2D were analyzed by logistic regression analysis. The risk factors for moderate-to-severe LEAD included: high HbA1c (OR = 1.07 95% CI 1.02–1.13), diabetic peripheral neuropathy (OR = 1.93 95% CI 1.57–2.37), and diabetic retinopathy (OR = 1.26 95%CI 1.01–1.57). The overall areas under the receiver operating characteristic curves for the nomograms for predicting the risks of LEAD and moderate-to-severe LEAD in adult T2D patients were 0.793 (95%CI 0.720, 0.824) and 0.736 (95%CI 0.678, 0.795), respectively. The developed nomograms are simple to use and enable preliminary visual prediction of the risk and degree of LEAD in Chinese T2D patients over 50 years. The nomograms are accurate to a certain degree and provide a clinical basis for predicting the occurrence and progression of LEAD.
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Affiliation(s)
- Xin Zhao
- Department of Endocrinology, Peking University International Hospital, Beijing, 100001, China
| | - Xiaomei Zhang
- Department of Endocrinology, Peking University International Hospital, Beijing, 100001, China
| | - Xingwu Ran
- Department of Endocrinology, West China Hospital, Sichuan University, Sichuan, 610041, China
| | - Zhangrong Xu
- Diabetes Center, Department of Endocrinology, The 306th Hospital of PLA, Beijing, 100001, China
| | - Linong Ji
- Department of Endocrinology, Peking University People's Hospital, Beijing, 100001, China.
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Patel KK, Jones PG, Ellerbeck EF, Buchanan DM, Chan PS, Pacheco CM, Moneta G, Spertus JA, Smolderen KG. Underutilization of Evidence-Based Smoking Cessation Support Strategies Despite High Smoking Addiction Burden in Peripheral Artery Disease Specialty Care: Insights from the International PORTRAIT Registry. J Am Heart Assoc 2019; 7:e010076. [PMID: 30371269 PMCID: PMC6474973 DOI: 10.1161/jaha.118.010076] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Background Smoking is the most important risk factor for peripheral artery disease (PAD). Smoking cessation is key in PAD management. We aimed to examine smoking rates and smoking cessation interventions offered to patients with PAD consulting a vascular specialty clinic; and assess changes in smoking behavior over the year following initial visit. Methods and Results A total of 1272 patients with PAD and new or worsening claudication were enrolled at 16 vascular specialty clinics (2011–2015, PORTRAIT (Patient‐Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories) registry). Interviews collected smoking status and cessation interventions at baseline, 3, 6, and 12 months. Among smokers, transition state models analyzed smoking transitions at each time point and identified factors associated with quitting and relapse. On presentation, 474 (37.3%) patients were active, 660 (51.9%) former, and 138 (10.8%) never smokers. Among active smokers, only 16% were referred to cessation counseling and 11% were prescribed pharmacologic treatment. At 3 months, the probability of quitting smoking was 21%; among those continuing to smoke at 3 months, the probability of quitting during the next 9 months varied between 11% and 12% (P<0.001). The probability of relapse among initial quitters was 36%. At 12 months, 72% of all smokers continued to smoke. Conclusions More than one third of patients with claudication consulting a PAD provider are active smokers and few received evidence‐based cessation interventions. Patients appear to be most likely to quit early in their treatment course, but many quickly relapse and 72% of all patients smoking at baseline are still smoking at 12 months. Better strategies are needed to provide continuous cessation support. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT01419080.
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Affiliation(s)
- Krishna K. Patel
- Saint Luke's Mid America Heart InstituteUniversity of Missouri‐Kansas CityMO
| | - Philip G. Jones
- Saint Luke's Mid America Heart InstituteUniversity of Missouri‐Kansas CityMO
| | | | - Donna M. Buchanan
- Saint Luke's Mid America Heart InstituteUniversity of Missouri‐Kansas CityMO
| | - Paul S. Chan
- Saint Luke's Mid America Heart InstituteUniversity of Missouri‐Kansas CityMO
| | | | | | - John A. Spertus
- Saint Luke's Mid America Heart InstituteUniversity of Missouri‐Kansas CityMO
| | - Kim G. Smolderen
- Saint Luke's Mid America Heart InstituteUniversity of Missouri‐Kansas CityMO
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Dalgaard F, Bondonno NP, Murray K, Bondonno CP, Lewis JR, Croft KD, Kyrø C, Gislason G, Scalbert A, Cassidy A, Tjønneland A, Overvad K, Hodgson JM. Associations between habitual flavonoid intake and hospital admissions for atherosclerotic cardiovascular disease: a prospective cohort study. Lancet Planet Health 2019; 3:e450-e459. [PMID: 31777336 DOI: 10.1016/s2542-5196(19)30212-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/03/2019] [Accepted: 10/09/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Flavonoids, compounds found in plant-based foods and beverages, might ameliorate vascular damage and atherosclerosis. Therefore, our aim was to assess the association between flavonoid intake and hospital admissions due to atherosclerotic cardiovascular disease. METHODS In this prospective cohort study, participants from the Danish Diet, Cancer, and Health Study were cross-linked with Danish nationwide registries. Eligible participants were aged 50-65 years, had no previous history of atherosclerotic cardiovascular disease, and had completed a food-frequency questionnaire at baseline. We examined associations between flavonoid intake (calculated from food-frequency questionnaires with use of the Phenol-Explorer database) and hospital admissions for atherosclerotic cardiovascular disease, ischaemic heart disease, ischaemic stroke, or peripheral arterial disease. We obtained hazard ratios (HRs) using restricted cubic splines based on Cox proportional hazards models. FINDINGS Of the participants recruited to the Danish Diet, Cancer, and Health study between 1993 and 1997, our study population was comprised of 53 552 participants, with a median follow-up of 21 years (IQR 15-22). During follow-up, 8773 participants were admitted to hospital for atherosclerotic cardiovascular disease. We observed non-linear associations between flavonoid intake and hospital admissions, plateauing at total flavonoid intakes of approximately 1000 mg per day. Compared with an intake of 175 mg per day, an intake of 1000 mg per day was associated with a 14% lower risk of atherosclerotic cardiovascular disease (HR 0·86, 95% CI 0·81-0·91). For disease subtypes, we observed a 9% lower risk of ischaemic heart disease (0·91, 0·85-0·98), a non-significant 9% lower risk of ischaemic stroke (0·91, 0·82-1·01), and a 32% lower risk of peripheral artery disease (0·68, 0·60-0·78). The overall associations were stronger in smokers than in non-smokers, as well as stronger in consumers of high (>20 g per day) quantities of alcohol than in those consuming low-to-moderate (≤20 g per day) quantities. INTERPRETATION Our results suggest that ensuring an adequate consumption of flavonoid-rich foods, particularly in subpopulations at risk of atherosclerosis such as smokers and consumers of high quantities of alcohol might mitigate some of the risk of atherosclerotic cardiovascular disease. More studies are needed to support and validate these data. FUNDING Danish Cancer Society.
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Affiliation(s)
- Frederik Dalgaard
- Department of Cardiology, Herlev & Gentofte University Hospital, Copenhagen, Denmark
| | - Nicola P Bondonno
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia; School of Biomedical Sciences, University of Western Australia, Royal Perth Hospital, Perth, WA, Australia.
| | - Kevin Murray
- School of Population and Global Health, University of Western Australia, Perth, WA, Australia
| | - Catherine P Bondonno
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia; School of Biomedical Sciences, University of Western Australia, Royal Perth Hospital, Perth, WA, Australia
| | - Joshua R Lewis
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia; School of Biomedical Sciences, University of Western Australia, Royal Perth Hospital, Perth, WA, Australia
| | - Kevin D Croft
- School of Biomedical Sciences, University of Western Australia, Royal Perth Hospital, Perth, WA, Australia
| | - Cecilie Kyrø
- Danish Cancer Society Research Centre, Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Herlev & Gentofte University Hospital, Copenhagen, Denmark; National Institute of Public Health, University of Southern Denmark, Odense, Denmark; Danish Heart Foundation, Copenhagen, Denmark
| | | | - Aedin Cassidy
- Institute for Global Food Security, Queen's University Belfast, Belfast, UK
| | | | - Kim Overvad
- Department of Public Health, Aarhus University, Aarhus, Denmark; Faculty of Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Jonathan M Hodgson
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA, Australia; School of Biomedical Sciences, University of Western Australia, Royal Perth Hospital, Perth, WA, Australia
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Niederstrasser NG, Rogers NT, Bandelow S. Determinants of frailty development and progression using a multidimensional frailty index: Evidence from the English Longitudinal Study of Ageing. PLoS One 2019; 14:e0223799. [PMID: 31665163 PMCID: PMC6821067 DOI: 10.1371/journal.pone.0223799] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Accepted: 09/28/2019] [Indexed: 01/10/2023] Open
Abstract
Objective To identify modifiable risk factors for development and progression of frailty in older adults living in England, as conceptualised by a multidimensional frailty index (FI). Methods Data from participants aged 50 and over from the English Longitudinal Study of Ageing (ELSA) was used to examine potential determinants of frailty, using a 56-item FI comprised of self-reported health conditions, disabilities, cognitive function, hearing, eyesight, depressive symptoms and ability to carry out activities of daily living. Cox proportional hazards regression models were used to measure frailty development (n = 7420) and linear regression models to measure frailty progression over 12 years follow-up (n = 8780). Results Increasing age (HR: 1.08 (CI: 1.08–1.09)), being in the lowest wealth quintile (HR: 1.79 (CI: 1.54–2.08)), lack of educational qualifications (HR: 1.19 (CI: 1.09–1.30)), obesity (HR: 1.33 (CI: 1.18–1.50) and a high waist-hip ratio (HR: 1.25 (CI: 1.13–1.38)), being a current or previous smoker (HR: 1.29 (CI: 1.18–1.41)), pain (HR: 1.39 (CI: 1.34–1.45)), sedentary behaviour (HR: 2.17 (CI: 1.76–2.78) and lower body strength (HR: 1.07 (CI: 1.06–1.08)), were all significant risk factors for frailty progression and incidence after simultaneous adjustment for all examined factors. Conclusion The findings of this study suggest that there may be scope to reduce both frailty incidence and progression by trialling interventions aimed at reducing obesity and sedentary behaviour, increasing intensity of physical activity, and improving success of smoking cessation tools. Furthermore, improving educational outcomes and reducing poverty may also reduce inequalities in frailty.
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Affiliation(s)
- Nils Georg Niederstrasser
- School of Applied Social Sciences, De Montfort University, Leicester, England, United Kingdom
- * E-mail:
| | - Nina Trivedy Rogers
- Department of Epidemiology and Public Health, University College London, London, England, United Kingdom
| | - Stephan Bandelow
- Department of Physiology, Neuroscience and Behavioural Sciences, St. George’s University, St. George’s, Grenada
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Peters R, Ee N, Peters J, Beckett N, Booth A, Rockwood K, Anstey KJ. Common risk factors for major noncommunicable disease, a systematic overview of reviews and commentary: the implied potential for targeted risk reduction. Ther Adv Chronic Dis 2019; 10:2040622319880392. [PMID: 31662837 PMCID: PMC6794648 DOI: 10.1177/2040622319880392] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 09/13/2019] [Indexed: 12/31/2022] Open
Abstract
Noncommunicable disease now contributes to the World Health Organization top 10
causes of death in low-, middle- and high-income countries. Particular examples
include stroke, coronary heart disease, dementia and certain cancers. Research
linking clinical and lifestyle risk factors to increased risk of noncommunicable
disease is now well established with examples of confirmed risk factors,
including smoking, physical inactivity, obesity and hypertension. However,
despite a need to target our resources to achieve risk reduction, relatively
little work has examined the overlap between the risk factors for these main
noncommunicable diseases. Our high-level review draws together the evidence in
this area. Using a systematic overview of reviews, we demonstrate the likely
commonality of established risk factors having an impact on multiple
noncommunicable disease outcomes. For example, systematic reviews of the
evidence on physical inactivity and poor diet found each to be associated with
increased risk of cancers, coronary heart disease, stroke, diabetes mellitus and
dementia. We highlight the potential for targeted risk reduction to
simultaneously impact multiple noncommunicable disease areas. These
relationships now need to be further quantified to allow the most effective
development of public health interventions in this area.
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Affiliation(s)
- Ruth Peters
- Neuroscience Research Australia, Barker Street, Randwick, Sydney, New South Wales, 2031, Australia
| | - Nicole Ee
- University of New South Wales, Sydney, NSW, Australia
| | | | - Nigel Beckett
- Guys and St Thomas's NHS Foundation Trust, London, UK
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Oxidative Stress in Peripheral Arterial Disease (PAD) Mechanism and Biomarkers. Antioxidants (Basel) 2019; 8:antiox8090367. [PMID: 31480714 PMCID: PMC6770183 DOI: 10.3390/antiox8090367] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 08/29/2019] [Accepted: 08/30/2019] [Indexed: 12/13/2022] Open
Abstract
Hemodynamic dysfunction mainly characterizes pathophysiology of peripheral arterial disease (PAD) leading to chronic ischemia. Hemodynamic dysfunction is the origin of intermittent claudication (chronic PAD) or of critical limb ischemia (very severe PAD). Notably, it is well known that oxidative stress (OxS) plays a pathophysiological role in PAD. The higher production of reactive oxygen species (ROS) from OxS and reduced redox capability are two crucial players in initiating and progressing PAD. A number of biomarkers highlight OxS and monitor it in PAD. The present review summarizes data on OxS, on biomarkers available to mark OxS occurrence and to monitor on PAD progression, as well as to evaluate the effects treatments in PAD patients. In conclusion, by detailing OxS and its biomarkers, we hope to encourage more studies to focus on drugs which combat OxS and inflammation.
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Saratzis A, Jaspers NEM, Gwilym B, Thomas O, Tsui A, Lefroy R, Parks M, Htun V, Mera Z, Thatcher A, Bosanquet D, Forsythe R, Benson R, Dattani N, Dovell G, Lane T, Shalhoub J, Sidloff D, Visseren FLJ, Dorresteijn JAN, Richards T. Observational study of the medical management of patients with peripheral artery disease. Br J Surg 2019; 106:1168-1177. [PMID: 31259387 DOI: 10.1002/bjs.11214] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 02/21/2019] [Accepted: 03/23/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Previous research has suggested that patients with peripheral artery disease (PAD) are not offered adequate risk factor modification, despite their high cardiovascular risk. The aim of this study was to assess the cardiovascular profiles of patients with PAD and quantify the survival benefits of target-based risk factor modification. METHODS The Vascular and Endovascular Research Network (VERN) prospectively collected cardiovascular profiles of patients with PAD from ten UK vascular centres (April to June 2018) to assess practice against UK and European goal-directed best medical therapy guidelines. Risk and benefits of risk factor control were estimated using the SMART-REACH model, a validated cardiovascular prediction tool for patients with PAD. RESULTS Some 440 patients (mean(s.d.) age 70(11) years, 24·8 per cent women) were included in the study. Mean(s.d.) cholesterol (4·3(1·2) mmol/l) and LDL-cholesterol (2·7(1·1) mmol/l) levels were above recommended targets; 319 patients (72·5 per cent) were hypertensive and 343 (78·0 per cent) were active smokers. Only 11·1 per cent of patients were prescribed high-dose statin therapy and 39·1 per cent an antithrombotic agent. The median calculated risk of a major cardiovascular event over 10 years was 53 (i.q.r. 44-62) per cent. Controlling all modifiable cardiovascular risk factors based on UK and European guidance targets (LDL-cholesterol less than 2 mmol/l, systolic BP under 140 mmHg, smoking cessation, antiplatelet therapy) would lead to an absolute risk reduction of the median 10-year cardiovascular risk by 29 (20-38) per cent with 6·3 (4·0-9·3) cardiovascular disease-free years gained. CONCLUSION The medical management of patients with PAD in this secondary care cohort was suboptimal. Controlling modifiable risk factors to guideline-based targets would confer significant patient benefit.
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Affiliation(s)
- A Saratzis
- National Institute for Health Research Leicester Biomedical Research Centre, Leicester, UK
| | - N E M Jaspers
- Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - B Gwilym
- Vascular and Endovascular Research Network, Birmingham, UK
| | - O Thomas
- Vascular and Endovascular Research Network, Birmingham, UK
| | - A Tsui
- Vascular and Endovascular Research Network, Birmingham, UK
| | - R Lefroy
- Vascular and Endovascular Research Network, Birmingham, UK
| | - M Parks
- Vascular and Endovascular Research Network, Birmingham, UK
| | - V Htun
- Vascular and Endovascular Research Network, Birmingham, UK
| | - Z Mera
- Vascular and Endovascular Research Network, Birmingham, UK
| | - A Thatcher
- Vascular and Endovascular Research Network, Birmingham, UK
| | - D Bosanquet
- Vascular and Endovascular Research Network, Birmingham, UK
| | - R Forsythe
- Vascular and Endovascular Research Network, Birmingham, UK
| | - R Benson
- Vascular and Endovascular Research Network, Birmingham, UK
| | - N Dattani
- Vascular and Endovascular Research Network, Birmingham, UK
| | - G Dovell
- Vascular and Endovascular Research Network, Birmingham, UK
| | - T Lane
- Vascular and Endovascular Research Network, Birmingham, UK
| | - J Shalhoub
- Vascular and Endovascular Research Network, Birmingham, UK
| | - D Sidloff
- Vascular and Endovascular Research Network, Birmingham, UK
| | - F L J Visseren
- Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - J A N Dorresteijn
- Department of Vascular Medicine, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - T Richards
- Department of Vascular Surgery, University of Western Australia, Perth, Western Australia, Australia
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Abstract
Peripheral arterial disease (PAD) is an atherosclerotic disease closely associated with high morbidity and mortality in cardiac events. Inflammation is crucial in atherosclerosis both at triggering and in progression. Numerous inflammatory biomarkers (cytokines, matrix metalloproteinases (MMPs), selectin, intracellular adhesion molecule (ICAM), vascular cell adhesion molecule (VCAM) C-reactive protein (CRP), fibrinogen) have been measured in atherosclerotic diseases including PAD. This paper summarizes the data on the inflammatory biomarkers for PAD pathophysiology and highlights the most useful markers in monitoring PAD outcomes.
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Clark D, Cain LR, Blaha MJ, DeFilippis AP, Mentz RJ, Kamimura D, White WB, Butler KR, Robertson RM, Bhatnagar A, Butler J, Correa A, Benjamin EJ, Hall ME. Cigarette Smoking and Subclinical Peripheral Arterial Disease in Blacks of the Jackson Heart Study. J Am Heart Assoc 2019; 8:e010674. [PMID: 30672360 PMCID: PMC6405586 DOI: 10.1161/jaha.118.010674] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 11/27/2018] [Indexed: 12/04/2022]
Abstract
Background Prevalence of peripheral artery disease ( PAD ) is significantly higher among blacks as compared with non-Hispanic whites, but the role of cigarette smoking in PAD is understudied in blacks. We aimed to evaluate the relationship between cigarette smoking and PAD in blacks in the (JHS) Jackson Heart Study. Methods and Results JHS participants (n=5306) were classified by self-reported baseline smoking status into current, past (smoked at least 400 cigarettes/life), or never smokers. We examined multivariable logistic and robust linear regression models to estimate the associations between baseline smoking status, smoking intensity, and measures of subclinical PAD (ankle-brachial index [visit 1] and aortic calcium by computed tomography [visit 2]) to yield odds ratios and β-coefficients (estimated adjusted difference) to compare each smoking status with never smokers (reference group). There were 3579 (68%) never smokers, 986 (19%) past smokers, and 693 (13%) current smokers self-identified at baseline. After adjustment for covariates, current smokers had increased risk of ankle-brachial index <1 (odds ratio, 2.2, 95% CI, 1.5-3.3) and increased risk of abdominal aortic (odds ratio, 8.4, 95% CI, 5.8-12.0) and aortoiliac calcium (odds ratio, 9.6, 95% CI, 6.7-13.7). When stratifying by smoking intensity, those smoking more than 20 cigarettes daily (1 pack) had higher likelihood of subclinical PAD by all of these measures compared with lower-intensity use, suggesting a dose-dependent relationship. Conclusions In a large black cohort, cigarette smoking was associated with measures of subclinical PAD in a dose-dependent manner. These findings highlight the association between smoking and PAD in blacks and support further research exploring the impact of interventions on smoking cessation to reduce PAD in this population.
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Affiliation(s)
- Donald Clark
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMS
| | - Loretta R. Cain
- Department of Data SciencesUniversity of Mississippi Medical CenterJacksonMS
| | - Michael J. Blaha
- Johns Hopkins Bloomberg School of Public HealthJohns Hopkins Ciccarone Center for Prevention of Heart DiseaseBaltimoreMD
| | | | - Robert J. Mentz
- Duke University Medical CenterDuke Clinical Research InstituteDurhamNC
| | - Daisuke Kamimura
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMS
| | | | - Kenneth R. Butler
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMS
| | - Rose M. Robertson
- Department of MedicineVanderbilt University Medical CenterNashvilleTN
| | - Aruni Bhatnagar
- Division of Cardiovascular MedicineUniversity of LouisvilleKY
| | - Javed Butler
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMS
| | - Adolfo Correa
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMS
| | - Emelia J. Benjamin
- Department of MedicineBoston University School of MedicineBostonMA
- Department of EpidemiologyBoston University School of Public Health
| | - Michael E. Hall
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMS
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Zhu J, Nelson K, Toth J, Muscat JE. Nicotine dependence as an independent risk factor for atherosclerosis in the National Lung Screening Trial. BMC Public Health 2019; 19:103. [PMID: 30669994 PMCID: PMC6343324 DOI: 10.1186/s12889-019-6419-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 01/09/2019] [Indexed: 12/21/2022] Open
Abstract
Background Atherosclerosis and COPD are systemic inflammatory diseases that share common risk factors including cigarette smoking. A high level of nicotine dependence is emerging as a recently identified risk factor for pulmonary impairment, chronic obstructive pulmonary disease and tobacco-related cancers. We hypothesized that nicotine dependence is associated with the risk of atherosclerosis in long-term cigarette smokers. Methods A nested case-control study was conducted within the National Lung Cancer Screening Trial- American College of Radiology Imaging Network. Cases were defined as having a new diagnosis of any type of atherosclerosis. Controls were matched on a 2:1 basis by age, sex, race, study center, smoking status, years of smoking, and frequency of smoking. Dependence was measured by the time to first cigarette after awakening (TTFC). Results The study included 166 cases and 286 controls. Compared to participants who smoked within 5 min after waking, the risk of atherosclerosis for participants who smoked an hour or more after waking was borderline non-significant (odds ratio = 0.49, 95% confidence intervals [CI] 0.23, 1.00). Findings were similar for men and women. For aortic atherosclerosis, the corresponding odds ratio was 0.24 (95% CI 0.08, 0.69). Hypertension was associated with an increased risk and body mass index was associated with a decreased risk of aortic atherosclerosis. The TTFC was unrelated to coronary atherosclerosis. Conclusions Compared to smoking immediately after waking, delaying an hour or more reduces the risk of aortic atherosclerosis even among long-term heavy smokers. Possible mechanisms that explain this association are intensity of smoking, inflammation and oxidative stress, and elevated lipid levels.
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Affiliation(s)
- Junjia Zhu
- Penn State College of Medicine, Department of Public Health Sciences, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA, 17033, USA
| | - Kevin Nelson
- Penn State College of Medicine, Department of Public Health Sciences, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA, 17033, USA
| | - Jennifer Toth
- Penn State Milton S. Hershey Medical Center, Department of Pulmonary Medicine, 500 University Drive, PO Box 850, Hershey, PA, 17033, USA
| | - Joshua E Muscat
- Penn State College of Medicine, Department of Public Health Sciences, Pennsylvania State University, MC CH69, 500 University Drive, P.O. Box 850, Hershey, PA, 17033, USA.
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Kalkhoran S, Benowitz NL, Rigotti NA. Reprint of: Prevention and Treatment of Tobacco Use. J Am Coll Cardiol 2018; 72:2964-2979. [DOI: 10.1016/j.jacc.2018.10.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Revised: 06/22/2018] [Accepted: 06/24/2018] [Indexed: 02/06/2023]
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Hong X, Lin J, Gu W. Risk factors and therapies in vascular diseases: An umbrella review of updated systematic reviews and meta‐analyses. J Cell Physiol 2018; 234:8221-8232. [PMID: 30317627 DOI: 10.1002/jcp.27633] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 09/27/2018] [Indexed: 12/22/2022]
Affiliation(s)
- Xing‐yu Hong
- Department of Vascular Surgery China‐Japan Union Hospital of JiLin University ChangChun China
| | - Jie Lin
- Department of Vascular Surgery China‐Japan Union Hospital of JiLin University ChangChun China
| | - Wei‐wei Gu
- Department of Hepatopancreatobility Surgery China‐Japan Union Hospital of JiLin University ChangChun China
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