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[Evolution of the prevalence of peripheral artery disease in clinical practice: A descriptive population study with real databases (SIDIAP-CMBD)]. Aten Primaria 2022; 54:102437. [PMID: 35964545 PMCID: PMC9399170 DOI: 10.1016/j.aprim.2022.102437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/29/2022] [Accepted: 07/01/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate, with real world data (SIDIAP and CMBD), the evolution of the prevalence of peripheral arterial disease (PAD) in the Catalan population and the cardiovascular risk factors present in people with this pathology. DESIGN Longitudinal descriptive population study. SITE: Primary health care. PARTICIPANTS Patients listed in SIDIAP and CMBD with a diagnosis of peripheral artery disease between 2008 and 2018 ≥ 35 years, as well as those without a diagnosis, but with an ABI < 0.9 in SIDIAP. INTERVENTIONS AND MAIN MEASUREMENTS Main variable AP (ICD-9, ICD-10). Sociodemographic data, risk factors and cardiovascular disease, drug use and prevalent cardiovascular events at the time of diagnosis. RESULTS 141,520 patients were studied. 75% had hypertension, 58% were smokers or former smokers, and 23% had a myocardial infarction. The global prevalence increased from 1.15% in 2008 to 3.10% in 2018. The prevalence of PAD increased with age, with a moderate increase at younger ages, and more pronounced in > 55 years, exceeding 10% in > 85 years. CONCLUSION This is a population study where it is observed that the evolution of the prevalence of peripheral artery disease has presented a constant increase during the years 2008-2018, being higher in men, especially from 55 years of age. Studies with large databases can facilitate the design and implementation of new policies in national health systems.
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López-Novoa J. Importancia del conocimiento de los mecanismos implicados en la revascularización postisquémica en cirugía vascular. ANGIOLOGIA 2015. [DOI: 10.1016/j.angio.2014.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Valdivielso P, Ramírez-Bollero J, Pérez-López C. Peripheral arterial disease, type 2 diabetes and postprandial lipidaemia: Is there a link? World J Diabetes 2014; 5:577-585. [PMID: 25317236 PMCID: PMC4138582 DOI: 10.4239/wjd.v5.i5.577] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 03/19/2014] [Accepted: 07/17/2014] [Indexed: 02/05/2023] Open
Abstract
Peripheral arterial disease, manifested as intermittent claudication or critical ischaemia, or identified by an ankle/brachial index < 0.9, is present in at least one in every four patients with type 2 diabetes mellitus. Several reasons exist for peripheral arterial disease in diabetes. In addition to hyperglycaemia, smoking and hypertension, the dyslipidaemia that accompanies type 2 diabetes and is characterised by increased triglyceride levels and reduced high-density lipoprotein cholesterol concentrations also seems to contribute to this association. Recent years have witnessed an increased interest in postprandial lipidaemia, as a result of various prospective studies showing that non-fasting triglycerides predict the onset of arteriosclerotic cardiovascular disease better than fasting measurements do. Additionally, the use of certain specific postprandial particle markers, such as apolipoprotein B-48, makes it easier and more simple to approach the postprandial phenomenon. Despite this, only a few studies have evaluated the role of postprandial triglycerides in the development of peripheral arterial disease and type 2 diabetes. The purpose of this review is to examine the epidemiology and risk factors of peripheral arterial disease in type 2 diabetes, focusing on the role of postprandial triglycerides and particles.
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Diagnóstico precoz de la arteriopatía periférica mediante la determinación automática del índice tobillo-brazo. Med Clin (Barc) 2014; 143:352-3. [DOI: 10.1016/j.medcli.2014.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 01/09/2014] [Indexed: 11/24/2022]
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Banerjee S, Vinas A, Mohammad A, Hadidi O, Thomas R, Sarode K, Banerjee A, Garg P, Weideman RA, Little BB, Brilakis ES. Significance of an abnormal ankle-brachial index in patients with established coronary artery disease with and without associated diabetes mellitus. Am J Cardiol 2014; 113:1280-4. [PMID: 24602299 DOI: 10.1016/j.amjcard.2014.01.403] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 01/03/2014] [Accepted: 01/03/2014] [Indexed: 12/15/2022]
Abstract
An abnormal ankle-brachial index (ABI) is associated with higher risk for future cardiovascular (CV) events; however, it is unknown whether this association is true in patients with established coronary artery disease (CAD) and associated diabetes mellitus (DM). We evaluated 679 patients with stable CAD enrolled in the Excellence in Peripheral Arterial Disease and Veterans Affairs North Texas Healthcare System peripheral arterial disease databases. ABI and 12-month major adverse CV events (MACEs, a composite of all-cause death, nonfatal myocardial infarction, need for repeat coronary revascularization, and ischemic stroke) were assessed. Cox proportional hazard models were used to assess the association of ABI and DM with subsequent CV events. An abnormal ABI (<0.9 or >1.4) was present in 72% of patients with stable CAD and 68% had DM. Using patients without DM and normal ABI as reference, the adjusted hazard ratio for 12-month MACE was 1.7 (95% confidence interval [CI] 0.71 to 4.06) for patients with DM and normal ABI; 2.03 (95% CI 0.83 to 4.9) for patients without DM with abnormal ABI; and 4.85 (95% CI 2.22 to 10.61) for patients with DM and abnormal ABI. In conclusion, in patients with stable CAD, an abnormal ABI confers an incremental risk of MACE in addition to DM and traditional CV risk factors.
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Affiliation(s)
- Subhash Banerjee
- Department of Cardiology, Veterans Affairs North Texas Healthcare System, Dallas, Texas; Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Ariel Vinas
- Department of Cardiology, Veterans Affairs North Texas Healthcare System, Dallas, Texas; Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Atif Mohammad
- Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Omar Hadidi
- Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rahul Thomas
- Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Karan Sarode
- Department of Cardiology, Veterans Affairs North Texas Healthcare System, Dallas, Texas; Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Avantika Banerjee
- Department of Cardiology, Veterans Affairs North Texas Healthcare System, Dallas, Texas
| | - Puja Garg
- Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rick A Weideman
- Department of Cardiology, Veterans Affairs North Texas Healthcare System, Dallas, Texas
| | - Bertis B Little
- Department of Cardiology, Veterans Affairs North Texas Healthcare System, Dallas, Texas
| | - Emmanouil S Brilakis
- Department of Cardiology, Veterans Affairs North Texas Healthcare System, Dallas, Texas; Department of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
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Sözmen K, Ünal B. Prevalence of low ankle brachial index and relationship with cardiovascular risk factors in a Western urban population in Turkey. Angiology 2012; 65:43-50. [PMID: 23221277 DOI: 10.1177/0003319712466581] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
We determined the prevalence of peripheral arterial disease (PAD) and associated risk factors in an urban population age ≥30 years in Turkey and assessed the impact of incorporating ankle brachial index (ABI) measurement with coronary heart disease risk calculations to the risk reclassification of individuals. The sample was drawn from 4600 participants of Balcova Heart Study. The prevalence of low ABI (<0.9) was 6.3%. Current smoking (odds ratio [OR]: 5.07, 95% confidence interval [CI]: 1.85-13.88), cardiovascular disease history (OR: 6.83, 95% CI: 3.00-15.53), hypertension (OR: 2.58, 95% CI: 1.06-6.33), diabetes (OR: 3.25, 95% CI: 1.51-6.98), and high waist circumference (OR: 2.24, 95% CI: 1.02-4.94) were positively associated with prevalent PAD. When ABI measurement was taken into account, 3.5% of low or intermediate risk patients were reclassified as high risk. Screening individuals who have one of these risk factors with ABI can help reclassifying individuals toward the high-risk category.
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Affiliation(s)
- Kaan Sözmen
- 1Narlidere Community Health Center, Ministry of Health of Turkey, Izmir, Turkey
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Novo-García C, Ciria-Uriel J, Novo-García E, Niño-de Mateo M. Determinación del índice tobillo-brazo mediante doppler portátil y tensiómetro automático en pacientes diabéticos. ENFERMERIA CLINICA 2012; 22:198-204. [DOI: 10.1016/j.enfcli.2012.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 04/20/2012] [Accepted: 06/03/2012] [Indexed: 11/28/2022]
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Relevancia de la enfermedad arterial periférica en sujetos de edad avanzada. HIPERTENSION Y RIESGO VASCULAR 2012. [DOI: 10.1016/j.hipert.2011.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Escobar C, Blanes I, Ruiz A, Vinuesa D, Montero M, Rodríguez M, Barbera G, Manzano L. Prevalence and clinical profile and management of peripheral arterial disease in elderly patients with diabetes. Eur J Intern Med 2011; 22:275-81. [PMID: 21570647 DOI: 10.1016/j.ejim.2011.02.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2010] [Revised: 01/27/2011] [Accepted: 02/03/2011] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Peripheral arterial disease (PAD) increases with age and diabetes. The aim of this study was to assess the prevalence of PAD in an elderly population with diabetes. METHODS This multicenter and cross-sectional study included patients >70 years, with an established diagnosis of diabetes. PAD was defined as those patients with a history of revascularization or amputation due to ischemia, or a pathological ankle-brachial index (ABI). Adequate blood pressure (BP), LDL cholesterol and HbA1c control were considered as <130/80 mm Hg, <100 mg⁄dL and <7.0%, respectively. RESULTS A total of 1462 patients were included. The most frequent cardiovascular risk factor and cardiovascular disease were hypertension (80.37%) and PAD (60.60% overall; 83.2% of those assisted by vascular surgeons vs 31.9% of those attended by other medical specialists; p<0.001), respectively. However, when ABI was measured, 70.99% of the study population had PAD (80.2% of those assisted by vascular surgeons vs 59.6% of those attended by other medical specialists; p<0.001). The predictors for a pathological ABI included male gender, smoking, dyslipidemia, family history of premature cardiovascular disease, sedentary lifestyle, diabetic-related complications, heart and cerebrovascular diseases. Although risk factors control was very poor, it was even lower in patients with PAD. CONCLUSIONS The prevalence of PAD is high in diabetic elderly patients. The concomitance with other risk factors and cardiovascular diseases was very high. The ABI allowed increasing the diagnosis of PAD.
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Affiliation(s)
- Carlos Escobar
- Cardiology Department, Hospital Infanta Sofía, Madrid, Spain
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Baena-Díez JM, Alzamora MT, Forés R, Pera G, Torán P, Sorribes M. Ankle-brachial index improves the classification of cardiovascular risk: PERART/ARTPER Study. Rev Esp Cardiol 2011; 64:186-92. [PMID: 21330032 DOI: 10.1016/j.recesp.2010.10.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Accepted: 10/18/2010] [Indexed: 12/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES The sensitivity of cardiovascular risk functions is low because many cardiovascular events occur in low- or intermediate-risk patients. The aim of the present study was to evaluate how the ankle-brachial index (ABI) reclassifies these patients. METHODS We conducted a descriptive, transversal, multicenter study (28 centers) of 3171 randomly selected patients aged >49 years. We studied demographic variables, clinical history and cardiovascular risk factors, ABI (defined as pathologic if <0.9) and 10-year cardiovascular risk with the Framingham-Wilson, REGICOR and SCORE equations, dividing risk into three categories: low (Framingham<10%, REGICOR<5% and SCORE<2.5%, intermediate (10-19.9%, 5-9.9% and 2.5-4.9%, respectively) and high (≥20%, ≥10% and ≥5%, respectively). Low- or intermediate-risk patients were reclassified as high-risk if they presented ABI <0.9. RESULTS We compared patients with ABI <0.9 and patients with ABI ≥0.9 and found the former were significantly older, more frequently men, had a worse history and more cardiovascular risk factors, and included more high-risk patients than when the classification used Framingham-Wilson (42.7% vs. 18.5%), REGICOR (25.8% vs. 9.3%) and SCORE (42.2% vs. 15.9%) equations. In men, using ABI led to a 5.8% increase in the high-risk category versus Framingham-Wilson, a 19.1% increase versus REGICOR and a 4.4% increase versus SCORE. In women, the increases were 78.6% versus Framingham-Wilson, 151.6% versus REGICOR and 50.0% versus SCORE. CONCLUSIONS The ABI reclassifies a substantial proportion of patients towards the high-risk category. This is particularly marked in women and by comparison with REGICOR scores.
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Affiliation(s)
- José M Baena-Díez
- Centro de Salud La Marina, Institut Català de la Salut, Barcelona, España.
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Lara-Hernández R, Lozano-Vilardell P. Isquemia crítica de miembros inferiores: una enfermedad cada vez más prevalente. Med Clin (Barc) 2011; 136:106-8. [DOI: 10.1016/j.medcli.2010.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2010] [Accepted: 09/07/2010] [Indexed: 10/18/2022]
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Páez E. AN, Oróstegui A. M, Hernández G. HJ, Valencia A. LI, Reyes S. CI, Tapias V. LF, Orozco V. LC. Validación del índice tobillo brazo oscilométrico comparado con eco-Doppler arterial de miembros inferiores para enfermedad arterial. REVISTA COLOMBIANA DE CARDIOLOGÍA 2010. [DOI: 10.1016/s0120-5633(10)70235-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Manzano L, Mostaza JM, Suarez C, Del Valle FJ, Ortiz JA, Sampedro JL, Pose A, Roman P, Vieitez P, Sánchez-Zamorano MA. Prognostic value of the ankle-brachial index in elderly patients with a stable chronic cardiovascular event. J Thromb Haemost 2010; 8:1176-84. [PMID: 20230414 DOI: 10.1111/j.1538-7836.2010.03841.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Patients with polyvascular arterial disease have a greater risk of suffering a new atherothrombotic episode than those with involvement of only one vascular territory. We have studied the predictive prognostic value of the detection of non-diagnosed peripheral arterial disease, determined by measuring the ankle-brachial index in a population of elderly patients with stable chronic cardiac or cerebrovascular disease. METHODS This was a multicenter, prospective cohort study with consecutive inclusion of patients between 65 and 85 years of age with a previous atherothrombotic event, but without previously established peripheral arterial disease. RESULTS A total of 1096 patients were evaluated during 11.7 (+ or - 2.2) months of follow-up. An ankle-brachial index of < 0.9 was observed in 29.9% and > 1.4 in 6.9%. The detection of an ankle-brachial index < 0.9 was clearly associated with the presence of a combined primary event of cardiovascular death and non-fatal cardiovascular event [HR 1.99 (95% CI, 1.49-2.66; P < 0.001)]. There was also a significant relationship between ankle-brachial index > 1.4 and total (P = 0.001) or cardiovascular (P = 0.020) deaths. The predictive value of both ranges of the ankle-brachial index was maintained after adjusting for age, sex, diabetes mellitus, vascular territory, macroalbuminuria or glomerular filtration rate. CONCLUSIONS The detection of non-diagnosed peripheral arterial disease in patients with stable coronary or cerebrovascular events identifies a very high risk population that might benefit from more intensive treatment.
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Affiliation(s)
- L Manzano
- Heart Failure and Vascular Risk Unit, Internal Medicine Department, Hospital Ramón y Cajal, Universidad de Alcalá, Madrid, Spain.
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[Ankle-brachial index in patients with chest pain and suspected acute coronary syndrome]. Med Clin (Barc) 2010; 134:202-5. [PMID: 19879603 DOI: 10.1016/j.medcli.2009.07.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Accepted: 07/08/2009] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Acute chest pain (ACP) is a non-specific symptom that may be the expression of coronary artery disease (CAD). Atherosclerosis is usually present in more than one vascular territory. Ankle-brachial index (ABI) is a useful tool for the diagnosis of peripheral arterial disease (PAD). Our aim was to evaluate the value of ABI in patients with ACP when CAD is suspected. PATIENTS AND METHODS We performed a cross-sectional study of 94 patients, mean age: 57.4 (12.2), admitted consecutively due to ACP with suspicion of CAD. ABI and presence of CAD were determined. RESULTS CAD was present in 22 patients (23.4%) and absent in 72 (76.6%). Asymptomatic PAD (ABI < or = 0.9) was present in 6 patients (27.2%) of CAD group and in 7 patients (9.7%) of the non-CAD group. Significant difference was found in ABI based on the presence or not of CAD [0.95 (0.23) vs 1.17 (0.15), p<0.001]. The diagnostic value of ABI for CAD detection was evaluated: area under the ROC curve was 0.8 (IC 95%: 0.70-0.87) and optimal cut-off point was 0.8 (sensitivity=22.7% and specificity=98.6%). In the multivariate analysis, ABI was the best independent predictor of CAD (p<0.001). CONCLUSION ABI is a simple, cheap and efficient method, which complements other conventional diagnostic methods in the recognition of patients with ACP due to CAD.
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Índice tobillo-brazo como método de cribado de arteriopatía periférica asintomática en atención primaria. Aten Primaria 2010; 42:61-2. [DOI: 10.1016/j.aprim.2009.02.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Accepted: 02/23/2009] [Indexed: 11/18/2022] Open
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Manzano L, García-Díaz JDD, Suárez C, Mostaza JM, Cairols M, González-Sarmiento E, Rojas AM, Vieitez P, Sánchez-Zamorano MA, Zamora J. Thigh and buttock exertional pain for the diagnosis of peripheral arterial disease. Eur J Intern Med 2009; 20:429-34. [PMID: 19524189 DOI: 10.1016/j.ejim.2008.12.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Revised: 11/02/2008] [Accepted: 12/18/2008] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To evaluate the prevalence of both non-calf intermittent claudication (IC) and classic IC in patients with no known atherosclerotic disease, and their accuracy to detect peripheral arterial disease (PAD). DESIGN Cross sectional, observational study conducted at 96 internal medicine services. MATERIALS AND METHODS 1487 outpatients with no known atherosclerotic disease, and either diabetes or a SCORE risk estimation of at least 3% were enrolled. IC was assessed using the Edinburgh Claudication Questionnaire and PAD was confirmed by an ankle-brachial index (ABI) <0.9. RESULTS Overall, 7.2% met criteria of classic and 5.8% of non-calf IC. PAD was diagnosed in 393 cases (26.4%). In these PAD patients, 17.8% exhibited classic and 13.2% non-calf IC. Both calf and non-calf IC had similar overall accuracy for detecting PAD. Considering both categories as a whole, the sensitivity of IC to predict a low ABI was 31% and the specificity 93%. CONCLUSIONS Non-calf IC is comparable to classic IC for the diagnosis of PAD in patients with no known arterial disease. The systematic implementation of Edinburgh Claudication Questionnaire could be a valuable call-to-action to improve clinical evaluation of PAD, bearing in mind that PAD detected by either non-calf or classic IC must be confirmed by ABI testing.
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Affiliation(s)
- Luis Manzano
- Heart Failure and Vascular Risk Unit, Hospital Ramón y Cajal, Universidad de Alcalá, Madrid, Spain.
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González-Juanatey JR, Grigorian-Shamagian L, Juiz-Crespo MA, Sánchez-Loureiro M, Rodríguez-Moldes E, Dopico-Pita J, Gutiérrez-Fernández G, Torres-Colomer J, Blanco-Rodríguez R, Otero-Raviña F. Impacto pronóstico de la localización de la enfermedad aterosclerosa previa en pacientes diabéticos. Estudio Barbanza-diabetes. Rev Esp Cardiol 2008. [DOI: 10.1157/13127848] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Mostaza JM, Manzano L, Suárez C, Cairols M, María Ferreira E, Rovira E, Sánchez A, Suárez-Tembra MA, Estirado E, de Dios Estrella J, Vega F, Ángel Sánchez-Zamorano M. Prevalencia de enfermedad arterial periférica asintomática, estimada mediante el índice tobillo-brazo, en pacientes con enfermedad vascular. Estudio MERITO II. Med Clin (Barc) 2008; 131:561-5. [DOI: 10.1157/13128016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Schmolling Y, Del Valle FJ, Pérez de Oteyza C, de Lucas A, Brasero F, Fajardo F. La medida del índice tobillo-brazo: particularmente indicada en pacientes con síndrome metabólico sin enfermedad arterial conocida. Rev Clin Esp 2008; 208:175-81. [PMID: 18381001 DOI: 10.1157/13117038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Y Schmolling
- Centro de Salud La Solana, Talavera de la Reina, Toledo, España.
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Alfonso F, Segovia J, Heras M, Bermejo J. Prevención cardiovascular: ¿siempre demasiado tarde? Rev Esp Cardiol 2008. [DOI: 10.1157/13116657] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Alzamora MT, Baena-Díez JM, Sorribes M, Forés R, Toran P, Vicheto M, Pera G, Reina MD, Albaladejo C, Llussà J, Bundó M, Sancho A, Heras A, Rubiés J, Arenillas JF. Peripheral Arterial Disease study (PERART): prevalence and predictive values of asymptomatic peripheral arterial occlusive disease related to cardiovascular morbidity and mortality. BMC Public Health 2007; 7:348. [PMID: 18070367 PMCID: PMC2241612 DOI: 10.1186/1471-2458-7-348] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2007] [Accepted: 12/11/2007] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND The early diagnosis of atherosclerotic disease is essential for developing preventive strategies in populations at high risk and acting when the disease is still asymptomatic. A low ankle-arm index (AAI) is a good marker of vascular events and may be diminished without presenting symptomatology (silent peripheral arterial disease). The aim of the PERART study (PERipheral ARTerial disease) is to determine the prevalence of peripheral arterial disease (both silent and symptomatic) in a general population of both sexes and determine its predictive value related to morbimortality (cohort study). METHODS/DESIGN This cross-over, cohort study consists of 2 phases: firstly a descriptive, transversal cross-over study to determine the prevalence of peripheral arterial disease, and secondly, a cohort study to evaluate the predictive value of AAI in relation to cardiovascular morbimortality. From September 2006 to June 2007, a total of 3,010 patients over the age of 50 years will be randomly selected from a population adscribed to 24 healthcare centres in the province of Barcelona (Spain). The diagnostic criteria of peripheral arterial disease will be considered as an AAI < 0.90, determined by portable Doppler (8 Mhz probe) measured twice by trained personnel. Cardiovascular risk will be calculated with the Framingham-Wilson tables, with Framingham calibrated by the REGICOR and SCORE groups. The subjects included will be evaluted every 6 months by telephone interview and the clnical history and death registries will be reviewed. The appearance of the following cardiovascular events will be considered as variables of response: transitory ischaemic accident, ictus, angina, myocardial infartction, symptomatic abdominal aneurysm and vascular mortality. DISCUSSION In this study we hope to determine the prevalence of peripheral arterial disease, especially the silent forms, in the general population and establish its relationship with cardiovascular morbimortality. A low AAI may be a better marker of arterial disease than the classical cardiovascular risk factors and may, therefore, contribute to improving the predictive value of the equations of cardiovascular risk and thereby allowing optimisation of multifactorial treatment of atherosclerotic disease.
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Affiliation(s)
- María Teresa Alzamora
- Primary Healthcare Centre Riu Nord-Riu Sud, Institut Català de la Salut, Santa Coloma de Gramenet, Spain.
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Gállego J, Martínez Vila E, Muñoz R. Patients at high risk for ischemic stroke: identification and actions. Cerebrovasc Dis 2007; 24 Suppl 1:49-63. [PMID: 17971639 DOI: 10.1159/000107379] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Atherosclerosis is a disease of chronic inflammation. It is diffuse, multisystemic and affects the vascular, metabolic and immune systems. The traditional evaluation of risk is based on methods of clinical and biological assessments, and conventional imaging. The existence of symptomatic disease and the number of symptomatic sites of atherothrombosis are critical factors in predicting the recurrence of major vascular events. However, these methods are insufficient to predict near-future episodes, above all in the individual standard clinical practice. Active treatment of modifiable risk factors such as hypertension, dyslipidemia and atrial fibrillation can reduce the number of patients who develop a stroke. There is considerable evidence suggesting that a substantial proportion of the population with high blood pressure receives insufficient treatment. More active treatment of this condition is probably the most efficient single measure. Lifestyle factors such as smoking, diet, physical inactivity and obesity contribute to the relatively high incidence of stroke. There is a need to incorporate new systemic markers and new investigation techniques in the future so as to identify the individuals at risk in the population and to administer more individualized intervention therapies.
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Affiliation(s)
- Jaime Gállego
- Stroke Unit, Department of Neurology, Hospital de Navarra, Pamplona, Spain.
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Manzano L, Mostaza JM, Suárez C, Cairols M, Redondo R, Valdivielso P, Monte R, Blázquez JC, Ferreira EM, Trouillhet I, González-Igual JJ, Sánchez-Zamorano MA. [Value of the ankle-brachial index in cardiovascular risk stratification of patients without known atherotrombotic disease. MERITO study]. Med Clin (Barc) 2007; 128:241-6. [PMID: 17335735 DOI: 10.1157/13099239] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Peripheral arterial disease detected by measurement of ankle-brachial index enables the identification of asymptomatic patients with target organ damage. We have investigated the prevalence of peripheral arterial disease (ankle-brachial index < 0.9), and its potential clinical-therapeutic impact, in patients without known atherotrombotic disease from internal medicine practices. PATIENTS AND METHOD It was a multicenter, cross-sectional, observational study. Outpatients aged 50 through 80 years, with either diabetes or a SCORE risk estimation of at least 3%, were enrolled. RESULTS A total of 1,519 subjects (58% men) were evaluated, 917 with diabetes (61%). The mean age (standard deviation) was 66.2 (8.3) years. The prevalence of an ankle-brachial index < 0.9 was 26.19%. In multiple logistic regressions the risk factors associated to an ankle-brachial index < 0.9 were age, sedentary lifestyle, smoking, macroalbuminuria, and heart rate. There was a significant relationship between the ankle-brachial index and the SCORE risk estimation. With respect to the therapeutic aims of the patients with an ankle-brachial index < 0.9, only 21% were taking antiplatelet drugs, 26% showed low density lipoproteins-cholesterol values < 100 mg/dl (53% < 130 mg/dl), and 16% displayed recommended blood pressure levels. CONCLUSIONS Measurement of ankle-brachial is useful to reclassify as high risk a significant proportion of patients without known previous atherotrombotic disease. The ankle-brachial index should be incorporated into routine cardiovascular evaluation, particularly in subjects with diabetes or a score risk assessment > or = 3%.
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Affiliation(s)
- Luis Manzano
- Unidad de Insuficiencia Cardíaca y Riesgo Vascular del Anciano, Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, España.
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Lahoz C, Mostaza JM. Índice tobillo-brazo: una herramienta útil en la estratificación del riesgo cardiovascular. Rev Esp Cardiol 2006; 59:647-9. [PMID: 16938205 DOI: 10.1157/13091364] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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