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Burtscher J, Millet GP, Fresa M, Lanzi S, Mazzolai L, Pellegrin M. The link between impaired oxygen supply and cognitive decline in peripheral artery disease. Prog Cardiovasc Dis 2024; 85:63-73. [PMID: 38061613 DOI: 10.1016/j.pcad.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 12/04/2023] [Indexed: 12/26/2023]
Abstract
Although peripheral artery disease (PAD) primarily affects large arteries outside the brain, PAD is also associated with elevated cerebral vulnerabilities, including greater risks for brain injury (such as stroke), cognitive decline and dementia. In the present review, we aim to evaluate recent literature and extract information on potential mechanisms linking PAD and consequences on the brain. Furthermore, we suggest novel therapeutic avenues to mitigate cognitive decline and reduce risk of brain injury in patients with PAD. Various interventions, notably exercise, directly or indirectly improve systemic blood flow and oxygen supply and are effective strategies in patients with PAD or cognitive decline. Moreover, triggering protective cellular and systemic mechanisms by modulating inspired oxygen concentrations are emerging as potential novel treatment strategies. While several genetic and pharmacological approaches to modulate adaptations to hypoxia showed promising results in preclinical models of PAD, no clear benefits have yet been clinically demonstrated. We argue that genetic/pharmacological regulation of the involved adaptive systems remains challenging but that therapeutic variation of inspired oxygen levels (e.g., hypoxia conditioning) are promising future interventions to mitigate associated cognitive decline in patients with PAD.
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Affiliation(s)
- Johannes Burtscher
- Institute of Sport Sciences, University of Lausanne, 1015 Lausanne, Switzerland; Department of Biomedical Sciences, University of Lausanne, 1005 Lausanne, Switzerland.
| | - Grégoire P Millet
- Institute of Sport Sciences, University of Lausanne, 1015 Lausanne, Switzerland; Department of Biomedical Sciences, University of Lausanne, 1005 Lausanne, Switzerland
| | - Marco Fresa
- Angiology Department, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Stefano Lanzi
- Angiology Department, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Lucia Mazzolai
- Angiology Department, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland
| | - Maxime Pellegrin
- Institute of Sport Sciences, University of Lausanne, 1015 Lausanne, Switzerland; Angiology Department, Lausanne University Hospital, University of Lausanne, 1011 Lausanne, Switzerland.
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2
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Vincent F, Redfors B, Kotinkaduwa LN, Kar S, Lim DS, Mishell JM, Whisenant BK, Lindenfeld J, Abraham WT, Mack MJ, Stone GW. Cerebrovascular Events After Transcatheter Edge-to-Edge Repair and Guideline-Directed Medical Therapy in the COAPT Trial. JACC Cardiovasc Interv 2023; 16:1448-1459. [PMID: 37380226 DOI: 10.1016/j.jcin.2023.03.023] [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: 11/21/2022] [Revised: 03/01/2023] [Accepted: 03/14/2023] [Indexed: 06/30/2023]
Abstract
BACKGROUND Little is known regarding the risk of cerebrovascular events (CVE) in patients with heart failure and severe secondary mitral regurgitation treated with transcatheter edge-to-edge repair (TEER). OBJECTIVES The study sought to examine the incidence, predictors, timing, and prognostic impact of CVE (stroke or transient ischemic attack) in the COAPT (Cardiovascular Outcomes Assessment of the Mitraclip Percutaneous Therapy for Heart Failure Patients with Functional Mitral Regurgitation) trial. METHODS A total of 614 patients with heart failure and severe secondary mitral regurgitation were randomized to TEER plus guideline-directed medical therapy (GDMT) vs GDMT alone. RESULTS At 4-year follow-up, 50 CVEs occurred in 48 (7.8%) of the 614 total patients enrolled in the COAPT trial; Kaplan-Meier event rates were 12.3% in the TEER group and 10.2 in the GDMT alone group (P = 0.91). Within 30 days of randomization, CVE occurred in 2 (0.7%) patients randomized to TEER and 0% randomized to GDMT (P = 0.15). Baseline renal dysfunction and diabetes were independently associated with increased risk of CVE, while baseline anticoagulation was associated with a reduction of CVE. A significant interaction was present between treatment group and anticoagulation such that TEER compared with GDMT alone was associated with a reduced risk of CVE among patients with anticoagulation (adjusted HR: 0.24; 95% CI: 0.08-0.73) compared with an increased risk of CVE in patients without anticoagulation (adjusted HR: 2.27; 95% CI: 1.08-4.81; Pinteraction = 0.001). CVE was an independent predictor of death within 30 days after the event (HR: 14.37; 95% CI: 7.61, 27.14; P < 0.0001). CONCLUSIONS In the COAPT trial, the 4-year rate of CVE was similar after TEER or GDMT alone. CVE was strongly associated with mortality. Whether anticoagulation is effective at reducing CVE risk after TEER warrants further study. (Cardiovascular Outcomes Assessment of the MitraClip Percutaneous Therapy for Heart Failure Patients With Functional Mitral Regurgitation [The COAPT Trial] and COAPT CAS [COAPT); NCT01626079).
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Affiliation(s)
- Flavien Vincent
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Department of Cardiology, Regional Hospital ISSSTE Puebla, Puebla, Mexico
| | - Björn Redfors
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA; Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Lak N Kotinkaduwa
- Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA
| | - Saibal Kar
- Los Robles Regional Medical Center, Thousand Oaks, California, USA; Bakersfield Heart Hospital, Bakersfield, California, USA
| | - D Scott Lim
- Division of Cardiology, University of Virginia, Charlottesville, Virginia, USA
| | - Jacob M Mishell
- Kaiser Permanente San Francisco Hospital, San Francisco, California, USA
| | | | - JoAnn Lindenfeld
- Advanced Heart Failure and Cardiac Transplantation Section, Vanderbilt Heart and Vascular Institute, Nashville, Tennessee, USA
| | - William T Abraham
- Department of Medicine, The Ohio State University, Columbus, Ohio, USA; Department of Physiology and Cell Biology, The Ohio State University, Columbus, Ohio, USA; Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA; Davis Heart and Lung Research Institute, The Ohio State University, Columbus, Ohio, USA
| | - Michael J Mack
- Baylor Scott & White Heart Hospital Plano, Plano, Texas, USA
| | - Gregg W Stone
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
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Chang YM, Lee TL, Su HC, Chien CY, Lin TY, Lin SH, Chen CH, Sung PS. The Association between Ankle-Brachial Index/Pulse Wave Velocity and Cerebral Large and Small Vessel Diseases in Stroke Patients. Diagnostics (Basel) 2023; 13:diagnostics13081455. [PMID: 37189557 DOI: 10.3390/diagnostics13081455] [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: 02/18/2023] [Revised: 04/01/2023] [Accepted: 04/08/2023] [Indexed: 05/17/2023] Open
Abstract
(1) Background: The study investigated whether the ankle-brachial index (ABI) and pulse wave velocity (baPWV) could reflect the severity of small vessel disease (SVD) and large artery atherosclerosis (LAA). (2) Methods: A total of 956 consecutive patients diagnosed with ischemic stroke were prospectively enrolled from July 2016 to December 2017. SVD severity and LAA stenosis grades were evaluated via magnetic resonance imaging and carotid duplex ultrasonography. Correlation coefficients were calculated between the ABI/baPWV and measurement values. Multinomial logistic regression analysis was performed to determine predictive potential. (3) Results: Among the 820 patients included in the final analysis, the stenosis grade of extracranial and intracranial vessels was inversely correlated with the ABI (p < 0.001, respectively) and positively correlated with the baPWV (p < 0.001 and p = 0.004, respectively). Abnormal ABI, not baPWV, independently predicted the presence of moderate (adjusted odds ratio, aOR: 2.18, 95% CI: 1.31-3.63) to severe (aOR: 5.59, 95% CI: 2.21-14.13) extracranial vessel stenosis and intracranial vessel stenosis (aOR: 1.89, 95% CI: 1.15-3.11). Neither the ABI nor baPWV was independently associated with SVD severity. (4) Conclusions: ABI is better than baPWV in screening for and identifying the existence of cerebral large vessel disease, but neither test is a good predictor of cerebral SVD severity.
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Affiliation(s)
- Yu-Ming Chang
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Tsung-Lin Lee
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Hui-Chen Su
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Chung-Yao Chien
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Tien-Yu Lin
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Sheng-Hsiang Lin
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
- Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Chih-Hung Chen
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
| | - Pi-Shan Sung
- Department of Neurology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 704, Taiwan
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4
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Gupta S, Dixit R, Prakash A, Daga MK, Mishra A. Can Sublingual Nitrate Improve Visualization of Lower Limb Arteries on Computed Tomography Angiography? J Comput Assist Tomogr 2023:00004728-990000000-00152. [PMID: 36877793 DOI: 10.1097/rct.0000000000001446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
OBJECTIVE The aim of the study is to evaluate the role of sublingual nitrate in improving vessel visualization on peripheral computed tomography angiography (CTA). METHODS Fifty patients clinically diagnosed with peripheral arterial disease of the lower limb were prospectively included in this study: Twenty-five underwent CTA after sublingual nitrate administration (nitrate group) and 25 without (non-nitrate group). Two blinded observers qualitatively and quantitatively assessed the data thus generated. The mean luminal diameter, intraluminal attenuation, site, and percentage of stenosis were evaluated in all segments. Assessment of collateral visualization at sites of significant stenosis was also done. RESULTS Patients in the nitrate and non-nitrate groups were similar in age and sex characteristics (P > 0.05).On subjective evaluation, there was significantly improved visualization of the femoropopliteal and tibioperoneal vasculature of the lower limb in the nitrate group compared with the non-nitrate group (P < 0.05). Quantitative evaluation showed a statistically significant difference in the measured arterial diameters for all evaluated segments in the nitrate group versus the non-nitrate group (P < 0.05). Intra-arterial attenuation was significantly greater for all segments in the nitrate group resulting in better contrast opacification in these studies. Collateral visualization around segments with more than 50% stenosis/occlusion was also better in the nitrate group. CONCLUSIONS Our study suggests that nitrate administration before peripheral vascular CTA can improve visualization, especially in the distal segments by increasing the vessel diameter and intraluminal attenuation along with better delineation of the collateral circulation around stenotic areas. It may also improve the number of evaluable segments of vasculature in these angiographic studies.
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Affiliation(s)
- Sanchita Gupta
- From the Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India
| | - Rashmi Dixit
- From the Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India
| | - Anjali Prakash
- From the Department of Radiodiagnosis, Maulana Azad Medical College, New Delhi, India
| | - Mradul Kumar Daga
- Department of Internal Medicine and Infectious disease, Institute of Liver and Biliary Sciences, New Delhi, India
| | - Anurag Mishra
- Department of Surgery, Maulana Azad Medical College, New Delhi, India
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5
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Han J, Luo L, Marcelina O, Kasim V, Wu S. Therapeutic angiogenesis-based strategy for peripheral artery disease. Theranostics 2022; 12:5015-5033. [PMID: 35836800 PMCID: PMC9274744 DOI: 10.7150/thno.74785] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/14/2022] [Indexed: 01/12/2023] Open
Abstract
Peripheral artery disease (PAD) poses a great challenge to society, with a growing prevalence in the upcoming years. Patients in the severe stages of PAD are prone to amputation and death, leading to poor quality of life and a great socioeconomic burden. Furthermore, PAD is one of the major complications of diabetic patients, who have higher risk to develop critical limb ischemia, the most severe manifestation of PAD, and thus have a poor prognosis. Hence, there is an urgent need to develop an effective therapeutic strategy to treat this disease. Therapeutic angiogenesis has raised concerns for more than two decades as a potential strategy for treating PAD, especially in patients without option for surgery-based therapies. Since the discovery of gene-based therapy for therapeutic angiogenesis, several approaches have been developed, including cell-, protein-, and small molecule drug-based therapeutic strategies, some of which have progressed into the clinical trial phase. Despite its promising potential, efforts are still needed to improve the efficacy of this strategy, reduce its cost, and promote its worldwide application. In this review, we highlight the current progress of therapeutic angiogenesis and the issues that need to be overcome prior to its clinical application.
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Affiliation(s)
- Jingxuan Han
- The Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing 400044, China.,State and Local Joint Engineering Laboratory for Vascular Implants, Chongqing 400044, China
| | - Lailiu Luo
- The Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing 400044, China.,State and Local Joint Engineering Laboratory for Vascular Implants, Chongqing 400044, China
| | - Olivia Marcelina
- The Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing 400044, China.,State and Local Joint Engineering Laboratory for Vascular Implants, Chongqing 400044, China
| | - Vivi Kasim
- The Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing 400044, China.,State and Local Joint Engineering Laboratory for Vascular Implants, Chongqing 400044, China.,The 111 Project Laboratory of Biomechanics and Tissue Repair, College of Bioengineering, Chongqing University, Chongqing 400044, China.,✉ Corresponding authors: Vivi Kasim, College of Bioengineering, Chongqing University, Chongqing, China; Phone: +86-23-65112672, Fax: +86-23-65111802, ; Shourong Wu, College of Bioengineering, Chongqing University, Chongqing, China; Phone: +86-23-65111632, Fax: +86-23-65111802,
| | - Shourong Wu
- The Key Laboratory of Biorheological Science and Technology, Ministry of Education, College of Bioengineering, Chongqing University, Chongqing 400044, China.,State and Local Joint Engineering Laboratory for Vascular Implants, Chongqing 400044, China.,The 111 Project Laboratory of Biomechanics and Tissue Repair, College of Bioengineering, Chongqing University, Chongqing 400044, China.,✉ Corresponding authors: Vivi Kasim, College of Bioengineering, Chongqing University, Chongqing, China; Phone: +86-23-65112672, Fax: +86-23-65111802, ; Shourong Wu, College of Bioengineering, Chongqing University, Chongqing, China; Phone: +86-23-65111632, Fax: +86-23-65111802,
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6
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Anghel R, Adam CA, Mitu O, Marcu DTM, Onofrei V, Roca M, Costache AD, Miftode RS, Tinica G, Mitu F. Cardiac Rehabilitation and Mortality Risk Reduction in Peripheral Artery Disease at 6-Month Outcome. Diagnostics (Basel) 2022; 12:diagnostics12061500. [PMID: 35741309 PMCID: PMC9222166 DOI: 10.3390/diagnostics12061500] [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: 04/27/2022] [Revised: 06/06/2022] [Accepted: 06/14/2022] [Indexed: 12/29/2022] Open
Abstract
The management of patients with peripheral artery disease (PAD) is integrative and multidisciplinary, in which cardiac rehabilitation (CR) plays a prognostic role in terms of functional status, quality of life, and long-term impact on morbidity and mortality. We conducted a prospective cohort study on 97 patients with PAD admitted to a single tertiary referral center. Based on a prognostic index developed to stratify long-term mortality risk in PAD patients, we divided the cohort into two groups: low and low-intermediate risk group (45 cases) and high-intermediate and high risk group (52 cases). We analyzed demographics, clinical parameters, and paraclinical parameters in the two groups, as well as factors associated with cardiological reassessment prior to the established deadline of 6 months. Obesity (p = 0.048), renal dysfunction (p < 0.001), dyslipidemia (p < 0.001), tobacco use (p = 0.048), and diabetes mellitus (p < 0.001) are comorbidities with long-term prognostic value. Low-density lipoprotein cholesterol (p = 0.002), triglycerides (p = 0.032), fasting glucose (p = 0.011), peak oxygen uptake (p = 0.005), pain-free walking distance (p = 0.011), maximum walking time (p < 0.001), and maximum walking distance (p = 0.002) influence the outcome of PAD patients by being factors associated with clinical improvement at the 6-month follow-up. PAD patients benefit from enrollment in CR programs, improvement of clinical signs, lipid and carbohydrate profile, and weight loss and maintenance of blood pressure profile within normal limits, as well as increased exercise capacity being therapeutic targets.
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Affiliation(s)
- Razvan Anghel
- Clinical Rehabilitation Hospital, Cardiovascular Rehabilitation Clinic, Pantelimon Halipa Street nr 14, 700661 Iaşi, Romania; (R.A.); (C.A.A.); (M.R.); (A.D.C.); (F.M.)
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street nr 16, 700115 Iaşi, Romania; (D.T.M.M.); (V.O.); (R.S.M.)
| | - Cristina Andreea Adam
- Clinical Rehabilitation Hospital, Cardiovascular Rehabilitation Clinic, Pantelimon Halipa Street nr 14, 700661 Iaşi, Romania; (R.A.); (C.A.A.); (M.R.); (A.D.C.); (F.M.)
| | - Ovidiu Mitu
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street nr 16, 700115 Iaşi, Romania; (D.T.M.M.); (V.O.); (R.S.M.)
- Sf. Spiridon” Clinical Emergency Hospital, Independence Boulevard nr 1, 700111 Iaşi, Romania
- Correspondence:
| | - Dragos Traian Marius Marcu
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street nr 16, 700115 Iaşi, Romania; (D.T.M.M.); (V.O.); (R.S.M.)
| | - Viviana Onofrei
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street nr 16, 700115 Iaşi, Romania; (D.T.M.M.); (V.O.); (R.S.M.)
- Sf. Spiridon” Clinical Emergency Hospital, Independence Boulevard nr 1, 700111 Iaşi, Romania
| | - Mihai Roca
- Clinical Rehabilitation Hospital, Cardiovascular Rehabilitation Clinic, Pantelimon Halipa Street nr 14, 700661 Iaşi, Romania; (R.A.); (C.A.A.); (M.R.); (A.D.C.); (F.M.)
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street nr 16, 700115 Iaşi, Romania; (D.T.M.M.); (V.O.); (R.S.M.)
| | - Alexandru Dan Costache
- Clinical Rehabilitation Hospital, Cardiovascular Rehabilitation Clinic, Pantelimon Halipa Street nr 14, 700661 Iaşi, Romania; (R.A.); (C.A.A.); (M.R.); (A.D.C.); (F.M.)
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street nr 16, 700115 Iaşi, Romania; (D.T.M.M.); (V.O.); (R.S.M.)
| | - Radu Stefan Miftode
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street nr 16, 700115 Iaşi, Romania; (D.T.M.M.); (V.O.); (R.S.M.)
- Sf. Spiridon” Clinical Emergency Hospital, Independence Boulevard nr 1, 700111 Iaşi, Romania
| | - Grigore Tinica
- Department of Cardiovascular Surgery, University of Medicine and Pharmacy “Grigore T. Popa”, University Street nr 16, 700115 Iaşi, Romania;
- Institute of Cardiovascular Diseases ”Prof. Dr. George I.M. Georgescu”, 700503 Iași, Romania
| | - Florin Mitu
- Clinical Rehabilitation Hospital, Cardiovascular Rehabilitation Clinic, Pantelimon Halipa Street nr 14, 700661 Iaşi, Romania; (R.A.); (C.A.A.); (M.R.); (A.D.C.); (F.M.)
- Department of Internal Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, University Street nr 16, 700115 Iaşi, Romania; (D.T.M.M.); (V.O.); (R.S.M.)
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Lee H, Lee IH, Heo J, Baik M, Park H, Lee HS, Nam HS, Kim YD. Impact of Sarcopenia on Functional Outcomes Among Patients With Mild Acute Ischemic Stroke and Transient Ischemic Attack: A Retrospective Study. Front Neurol 2022; 13:841945. [PMID: 35370897 PMCID: PMC8964497 DOI: 10.3389/fneur.2022.841945] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/17/2022] [Indexed: 01/08/2023] Open
Abstract
Introduction Sarcopenia, a age-related disease characterized by loss of muscle mass accompanied by loss of function, is associated with nutrition imbalance, physical inactivity, insulin resistance, inflammation, metabolic syndrome, and atherosclerosis which are risk factors for cardiovascular disease. However, its association with outcomes after ischemic stroke has not been well-established. This study investigated whether functional outcomes of patients with acute ischemic stroke is associated with sarcopenia. Methods Data were collected from 568 consecutive patients with acute ischemic stroke with National Institute of Health Stroke Scale 0–5 or transient ischemic attack who underwent bioelectrical impedance analysis between March 2018 and March 2021. Sarcopenia was defined, as low muscle mass, as measured by bioelectrical impedance analysis, and low muscle strength, as indicated by the Medical Research Council score. Unfavorable functional outcome was defined as mRS score of 2–6 at 90 days after discharge. The relationship between functional outcomes and the presence of sarcopenia or its components was determined. Results Of the 568 patients included (mean age 65.5 ± 12.6 years, 64.6% male), sarcopenia was detected in 48 (8.5%). After adjusting for potential confounders, sarcopenia was independently and significantly associated with unfavorable functional outcome (odds ratio 2.37, 95% confidence interval 1.15–4.73 for unfavorable functional outcome, odds ratio 2.10, 95% confidence interval 1.18–3.71 for an increase in the mRS score). Each component of sarcopenia was also independently associated with unfavorable functional outcome (odds ratio 1.76, 95% confidence interval 1.05–2.95 with low muscle mass, odds ratio 2.64, 95% confidence interval 1.64–4.23 with low muscle strength). The impact of low muscle mass was larger in men than in women, and in patients with lower muscle mass of the lower extremities than in those with lower muscle mass of the upper extremities. Conclusions In this study, the prevalence of sarcopenia in patients with stroke was lower than most of previous studies and patients with sarcopenia showed higher likelihood for unfavorable functional outcomes at 90 days after acute ischemic stroke or TIA. Further investigation of the interventions for treating sarcopenia and its impact on the outcome of ischemic stroke patients is needed.
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Affiliation(s)
- Hyungwoo Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Il Hyung Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - JoonNyung Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Minyoul Baik
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyungjong Park
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Department of Neurology, Keimyung University School of Medicine, Daegu, South Korea
| | - Hye Sun Lee
- Biostatistics Collaboration Unit, Department of Research Affairs, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, South Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
- Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, South Korea
- *Correspondence: Young Dae Kim
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8
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Han M, Kim YD, Lee I, Lee H, Heo J, Lee HS, Nam HS. Low Toe-Brachial Index Is Associated With Stroke Outcome Despite Normal Ankle-Brachial Index. Front Neurol 2022; 12:754258. [PMID: 34987463 PMCID: PMC8720783 DOI: 10.3389/fneur.2021.754258] [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: 08/06/2021] [Accepted: 11/05/2021] [Indexed: 01/01/2023] Open
Abstract
Introduction: We investigated whether the toe-brachial index (TBI) is associated with stroke prognosis and evaluated this association in patients with normal ankle-brachial index (ABI). Methods: Acute ischemic stroke patients who underwent TBI measurements were enrolled. Poor functional outcome was defined as modified Rankin Scale score ≥3. Major adverse cardiovascular event (MACE) was defined as stroke recurrence, myocardial infarction, or death. Normal ABI was defined as 0.9 ≤ ABI ≤ 1.4. Results: A total of 1,697 patients were enrolled and followed up for a median 39.7 (interquartile range, 25.7-54.6) months. During the period, 305 patients suffered MACE (18.0%), including 171 (10.1%) stroke recurrences. TBI was associated with hypertension, diabetes, atrial fibrillation, aortic plaque score, ABI, and brachial-ankle pulse wave velocity (all p < 0.05). In multivariable logistic regression, TBI was inversely associated with poor functional outcome in all patients [odds ratio (OR) 0.294, 95% confidence interval (CI) 0.114-0.759], even in patients with normal ABI (OR 0.293, 95% CI 0.095-0.906). In multivariable Cox regression, TBI < 0.6 was associated with stroke recurrence [hazard ratio (HR) 1.651, 95% CI 1.135-2.400], all-cause mortality (HR 2.105, 95% CI 1.343-3.298), and MACE (HR 1.838, 95% CI 1.396-2.419) in all patients. TBI < 0.6 was also associated with stroke recurrence (HR 1.681, 95% CI 1.080-2.618), all-cause mortality (HR 2.075, 95% CI 1.180-3.651), and MACE (HR 1.619, 95% CI 1.149-2.281) in patients with normal ABI. Conclusions: Low TBI is independently associated with poor short- and long-term outcomes in acute ischemic stroke patients despite normal ABI.
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Affiliation(s)
- Minho Han
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, South Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, South Korea
| | - Ilhyung Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyungwoo Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Joonnyung Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea
| | - Hye Sun Lee
- Department of Research Affairs, Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea.,Integrative Research Center for Cerebrovascular and Cardiovascular Diseases, Yonsei University College of Medicine, Seoul, South Korea
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9
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Lin CH, Armstrong DG, Liu PH, Lin CW, Huang CH, Huang YY. Survival of Patients Following First Diagnosis of Diabetic Foot Complications: A Nationwide 15-Year Longitudinal Analysis. Front Endocrinol (Lausanne) 2021; 12:801324. [PMID: 34966361 PMCID: PMC8711267 DOI: 10.3389/fendo.2021.801324] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 11/22/2021] [Indexed: 01/22/2023] Open
Abstract
Background and Aims The long-term survival in people with type 2 diabetes following first diagnosis of diabetic foot complications (FDDFC) is unclear. The object is to evaluate the mortality rate in subjects with type 2 diabetes following FDDFC and the impacts of the major cardiovascular comorbidities. Methods Nationwide data were analyzed for subjects with T2D and DFC between 2003 and 2017 according to ICD-9 coding. DFC was defined with the codes of ulcers, infections, or severe peripheral artery disease that required intervention (PAD) to mimic the real world diagnosis. Criteria of FDDFC were preceded by a period without any DFC for at least 5 years. Major cardiovascular comorbidities: established PAD and cardiovascular diseases (CVD: including coronary heart disease (CHD), stroke, or heart failure) before the index date as well as lower-extremity amputations (LEA) at the index episode were analyzed. Results Among 300,115 subjects with DFC, a total of 103,396 patients had FDDFC. The mean 5-year survival rate of these subjects was 81.05%. Using subjects without associated major cardiovascular comorbidity as baseline, the adjusted hazard ratios (aHR) were1.43 (95% confidence interval 1.38-1.49) in group PAD-/CVD+, followed by 1.70 (1.59-1.80) in PAD+/CVD- and 1.98 (1.89-2.08) in PAD+/CVD+. The aHR was further increased in patients with PAD who additionally had heart failure (3.77, 3.50-4.05), stroke (2.06, 1.95-2.18), or CHD (1.89, 1.79-2.00). Subjects with PAD rather than other CVD were associated with LEA at FDDFC. Patients with major LEA (above the ankle) at FDDFC episode had lower 5-year survival rate (65.01%) followed by those with minor LEA (72.24%) and without LEA (81.61%). Conclusions Cardiovascular comorbidity as well as LEA status at the event of FDDFCs were both associated with patient survival outcomes. Earlier identification of this large population could lead to higher survival rates.
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Affiliation(s)
- Chia-Hung Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - David G. Armstrong
- Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California (USC), Los Angeles, United States
| | - Pi-Hua Liu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Wei Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chung-Huei Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yu-Yao Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Medical Nutrition Therapy, Chang Gung Memorial Hospital, Linkou, Taiwan
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10
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Gong J, Harris K, Tzourio C, Harrap S, Naismith S, Anderson CS, Chalmers J, Woodward M. Sex differences in predictors for cognitive decline and dementia in people with stroke or transient ischemic attack in the PROGRESS trial. Int J Stroke 2021; 17:17474930211059298. [PMID: 34791978 DOI: 10.1177/17474930211059298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Stroke and transient ischemic attack confer greater risk of cognitive decline and dementia. AIMS We used data from the Perindopril Protection Against Recurrent Stroke Study (PROGRESS), a blood pressure-lowering randomized controlled trial in stroke/transient ischemic attack. We evaluated overall and sex-specific differences in treatment effects for cognitive decline/dementia, as well as associations with vascular and stroke-specific predictors,considering death as a competing risk. METHODS Multinomial logistic regression was used to estimate overall and sex-specific odds ratios (OR) (95% confidence intervals (CI)) for treatment effects and predictors associated with the risk of cognitive decline/dementia, and the women-to-men ratio of odds ratio (RORs). RESULTS Over a median four years, 763 cognitive decline/dementia (30.9% women) were recorded in 5888 participants. Women had lower odds of cognitive decline/dementia than men (OR 0.78, 95%CI 0.63-0.95). Active treatment was associated with lower odds of cognitive decline/dementia (0.84, 0.72-0.98), with no evidence of sex difference. Higher education (0.96,0.94-0.98 (per year)) and baseline Mini-Mental State Examination (MMSE)) were associated with lower odds of cognitive decline/dementia (0.84,0.82-0.86 (per point higher)). Higher diastolic blood pressure (1.11,1.02-1.20 (per 10 mmHg)), low estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m2 (1.27,1.03-1.58), and peripheral arterial disease (1.78,1.26-2.52) were associated with higher odds of cognitive decline/dementia. APOE ɛ4 was not associated with cognitive decline/dementia (1.05 (0.85-1.30)). Low eGFR was more strongly associated with cognitive decline/dementia in women than men (RORs, 1.60 (1.03-2.48)). Diabetes was more strongly associated with men than women. CONCLUSIONS Several risk factors were associated with cognitive decline/dementia in people with prior stroke/transient ischemic attack, with notable sex differences. Long-term cognitive sequelae of stroke should be considered to strengthen joint prevention strategies for stroke, cognitive decline, and dementia.Trial Registration: This trial was not registered because enrolment began before 1 July 2005.
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Affiliation(s)
- Jessica Gong
- George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Katie Harris
- George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Christophe Tzourio
- Bordeaux Population Health Research Center, Bordeaux University, INSERM, Bordeaux, France
- Hospital Center Bordeaux University, Bordeaux, France
| | - Stephen Harrap
- Department of Physiology, University of Melbourne, Melbourne, Australia
| | - Sharon Naismith
- School of Psychology, University of Sydney, Sydney, Australia
- Brain and Mind Centre, University of Sydney, Sydney, Australia
| | - Craig S Anderson
- George Institute China, Peking University Health Science Center, Beijing, China
- Neurology Department, Royal Prince Alfred Hospital, Sydney Health Partners, Sydney, Australia
- Heart Health Research Center, Beijing, China
| | - John Chalmers
- George Institute for Global Health, University of New South Wales, Sydney, Australia
| | - Mark Woodward
- George Institute for Global Health, University of New South Wales, Sydney, Australia
- George Institute for Global Health, Imperial College London, London, UK
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11
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Nakashima K, Kumakura H, Funada R, Matsuo Y, Sakata K, Ichikawa A, Iwasaki T, Ichikawa S. Influence of Microalbuminuria on Long-Term Survival and Cardiovascular or Limb Events in Peripheral Arterial Disease. Ann Vasc Dis 2021; 14:236-243. [PMID: 34707745 PMCID: PMC8474086 DOI: 10.3400/avd.oa.21-00045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Accepted: 06/01/2021] [Indexed: 11/24/2022] Open
Abstract
Objective: This study aimed to examine the relationship between microalbuminuria and long-term life expectancy or limb events in patients with peripheral arterial disease (PAD). Materials and Methods: A prospective cohort study was performed in 714 patients with PAD. The primary outcomes were cardiovascular or cerebrovascular death (CCVD) and all-cause death (AD), and secondary outcomes were major adverse cardiovascular events (MACE) and cardiovascular and/or limb events (CVLE). Results: The 5, 10, and 15 year survival rates were 82.4%, 53.1%, and 33.0%, respectively. The prevalence of patients with increased microalbuminuria was 39.2%. Higher microalbuminuria, age, C-reactive protein (CRP), lower serum albumin, estimated glomerular filtration rate (eGFR), ankle–brachial pressure index (ABI), diabetes, cerebral infarction, and coronary heart disease (CHD) were associated with CCVD; higher microalbuminuria, age, CRP, D-dimer, lower serum albumin, eGFR, and critical limb ischemia were related to AD; higher microalbuminuria, age, CRP, lower serum albumin, ABI, diabetes, and CHD were related to MACE; higher microalbuminuria, age, lower ABI, cerebral infarction, and CHD were related to CVLE in Cox multivariate analyses (p<0.05). Statins reduced CCVD, AD, MACE, and CVLE (p<0.001). Conclusion: Higher microalbuminuria was a significant predictor for CCVD, AD, MACE, and CVLE in PAD patients.
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Affiliation(s)
- Kuniki Nakashima
- Department of Cardiovascular Surgery, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Shibukawa, Gunma, Japan
| | - Hisao Kumakura
- Department of Cardiovascular Medicine, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Shibukawa, Gunma, Japan
| | - Ryuichi Funada
- Department of Cardiovascular Medicine, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Shibukawa, Gunma, Japan
| | - Yae Matsuo
- Department of Cardiovascular Medicine, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Shibukawa, Gunma, Japan
| | - Kimimasa Sakata
- Department of Cardiovascular Surgery, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Shibukawa, Gunma, Japan
| | - Akiko Ichikawa
- Department of Nephrology, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Shibukawa, Gunma, Japan
| | - Toshiya Iwasaki
- Department of Cardiovascular Medicine, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Shibukawa, Gunma, Japan
| | - Shuichi Ichikawa
- Department of Cardiovascular Medicine, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Shibukawa, Gunma, Japan
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12
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Nakashima K, Kumakura H, Funada R, Matsuo Y, Sakata K, Ichikawa A, Iwasaki T, Ichikawa S. Impact of brain natriuretic peptide for predicting long-term life expectancy and cardiovascular or limb events in peripheral arterial disease. INT ANGIOL 2021; 40:520-527. [PMID: 34313412 DOI: 10.23736/s0392-9590.21.04720-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Brain natriuretic peptide (BNP) is introduced as a predictor of the degree of ventricular dysfunction and is associated with mortality. There are limited reports on the relationship of BNP with long-term all-cause death (AD) and cardiovascular or limb events in peripheral artery disease (PAD). We examined the relationship between BNP level and these events in PAD patients. METHODS We performed a prospective cohort study in 938 PAD patients. The patients were divided into four groups based on BNP levels with median (interquartile range): Q1: ≤20.4; Q2: 20.5-42.8; Q3: 42.9-103.4; and Q4: ≥103.5 pg/mL. The endpoints were AD, freedom from major adverse cardiovascular events (MACE), and MACE plus limb events (MALE). RESULTS The median follow-up time was 65 months. There were 383 deaths (40.8%) during follow-up period. AD depended on BNP levels (p<0.01), with 5-year freedom from AD rates of Q1: 94%, Q2: 84%, Q3: 69%, and Q4: 55%. The Kaplan-Meier estimates of freedom from AD, MACE, and MALE had significant differences among Q1- Q4 groups (p< 0.001). In multiple regression analysis, BNP had significant negative correlations with eGFR, serum albumin, and BMI and positive correlations with diabetes (p<0.05). In Cox multivariate analysis, higher BNP, age, CRP, D-dimer, lower BMI, ABI, serum albumin, and eGFR were related to AD; and higher BNP, age, lower ABI, serum albumin, CAD, and DM were related to MACE and MALE (p<0.05). Statins improved AD, MACE, and MALE (p<0.01). CONCLUSIONS BNP was a promising biomarker for AD, MACE, and MALE in patients with PAD.
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Affiliation(s)
- Kuniki Nakashima
- Department of Cardiovascular Surgery, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Shibukawa, Gunma, Japan
| | - Hisao Kumakura
- Department of Cardiovascular Medicine, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Shibukawa, Gunma, Japan -
| | - Ryuichi Funada
- Department of Cardiovascular Medicine, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Shibukawa, Gunma, Japan
| | - Yae Matsuo
- Department of Cardiovascular Medicine, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Shibukawa, Gunma, Japan
| | - Kimimasa Sakata
- Department of Cardiovascular Surgery, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Shibukawa, Gunma, Japan
| | - Akiko Ichikawa
- Department of Nephrology, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Shibukawa, Gunma, Japan
| | - Toshiya Iwasaki
- Department of Cardiovascular Medicine, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Shibukawa, Gunma, Japan
| | - Shuichi Ichikawa
- Department of Cardiovascular Medicine, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Shibukawa, Gunma, Japan
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13
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Poon CL, Chen CY. Exploring the Impact of Cerebrovascular Disease and Major Depression on Non-diseased Human Tissue Transcriptomes. Front Genet 2021; 12:696836. [PMID: 34349785 PMCID: PMC8327210 DOI: 10.3389/fgene.2021.696836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 06/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background The development of complex diseases is contributed by the combination of multiple factors and complicated interactions between them. Inflammation has recently been associated with many complex diseases and may cause long-term damage to the human body. In this study, we examined whether two types of complex disease, cerebrovascular disease (CVD) or major depression (MD), systematically altered the transcriptomes of non-diseased human tissues and whether inflammation is linked to identifiable molecular signatures, using post-mortem samples from the Genotype-Tissue Expression (GTEx) project. Results Following a series of differential expression analyses, dozens to hundreds of differentially expressed genes (DEGs) were identified in multiple tissues between subjects with and without a history of CVD or MD. DEGs from these disease-associated tissues-the visceral adipose, tibial artery, caudate, and spinal cord for CVD; and the hypothalamus, putamen, and spinal cord for MD-were further analyzed for functional enrichment. Many pathways associated with immunological events were enriched in the upregulated DEGs of the CVD-associated tissues, as were the neurological and metabolic pathways in DEGs of the MD-associated tissues. Eight gene-tissue pairs were found to overlap with those prioritized by our transcriptome-wide association studies, indicating a potential genetic effect on gene expression for circulating cytokine phenotypes. Conclusion Cerebrovascular disease and major depression cause detectable changes in the gene expression of non-diseased tissues, suggesting that a possible long-term impact of diseases, lifestyles and environmental factors may together contribute to the appearance of "transcriptomic scars" on the human body. Furthermore, inflammation is probably one of the systemic and long-lasting effects of cerebrovascular events.
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Affiliation(s)
- Chi-Lam Poon
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Weill Cornell Graduate School of Medical Sciences, Cornell University, New York, NY, United States
| | - Cho-Yi Chen
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
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14
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Kyle D, Boylan L, Wilson L, Haining S, Oates C, Sims A, Guri I, Allen J, Wilkes S, Stansby G. Accuracy of Peripheral Arterial Disease Registers in UK General Practice: Case-Control Study. J Prim Care Community Health 2021; 11:2150132720946148. [PMID: 32959726 PMCID: PMC7513392 DOI: 10.1177/2150132720946148] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background: Approximately 20% of the UK population aged 55 to 75 years have evidence of
peripheral arterial disease (PAD). PAD affects quality of life and life
expectancy if not appropriately diagnosed and managed. At risk patients
require accurate diagnosis to ensure optimal treatment to slow disease
progression and minimize adverse outcomes. Aim: To assess the accuracy of general practice (GP) registration of the diagnosis
of peripheral arterial disease (PAD). Design and Setting: An observational analytic case-control study. As part of a National Institute
for Health Research–funded (ISRCTN13301188) project assessing novel
diagnostic methods set in GP practice. Methods: A total of 125 patients registered as having PAD and 125 age- and sex-matched
controls were recruited from 15 general practices across North East England.
The register was then assessed for accuracy of diagnosis. Duplex vascular
ultrasound scanning (DUS) undertaken by vascular scientists was used as the
gold standard reference for PAD. Results: The PAD register had a sensitivity of 86% (95% CI 77%-92%) and specificity of
74% (95% CI 67%-81%) when compared with DUS. The positive predictive value,
however, was 69.6% (95% CI 63%-75%) and negative predictive value 88.8% (95%
CI 82%-92%). The overall diagnostic effectiveness of the PAD register was
79.2% (95% CI 73%-84%). Conclusion: This analysis indicates that while PAD is detected with reasonable
sensitivity in primary care, many patients registered with a diagnosis of
PAD lacked DUS-proven disease. Improved approaches to the objective
diagnosis of PAD may improve diagnosis and management of PAD in primary
care.
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Affiliation(s)
- Daniel Kyle
- Freeman Hospital, The Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK.,University of Newcastle, Newcastle upon Tyne, UK
| | - Luke Boylan
- Freeman Hospital, The Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK.,University of Newcastle, Newcastle upon Tyne, UK
| | - Lesley Wilson
- Freeman Hospital, The Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK
| | - Shona Haining
- North of England Commissioning Support (NECS), Durham, UK
| | - Crispian Oates
- Freeman Hospital, The Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK
| | - Andrew Sims
- Freeman Hospital, The Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK.,University of Newcastle, Newcastle upon Tyne, UK
| | - Ina Guri
- Freeman Hospital, The Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK.,University of Newcastle, Newcastle upon Tyne, UK
| | - John Allen
- Freeman Hospital, The Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK.,University of Newcastle, Newcastle upon Tyne, UK
| | - Scott Wilkes
- University of Sunderland, Sunderland, Tyne and Wear, UK
| | - Gerry Stansby
- Freeman Hospital, The Newcastle upon Tyne NHS Hospitals Foundation Trust, Newcastle upon Tyne, UK
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15
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Liberman AL, Wang C, Friedman BW, Prabhakaran S, Esenwa CC, Rostanski SK, Cheng NT, Erdfarb A, Labovitz DL, Lipton RB. Head Computed tomography during emergency department treat-and-release visit for headache is associated with increased risk of subsequent cerebrovascular disease hospitalization. Diagnosis (Berl) 2021; 8:199-208. [PMID: 33006951 DOI: 10.1515/dx-2020-0082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/14/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The occurrence of head computed tomography (HCT) at emergency department (ED) visit for non-specific neurological symptoms has been associated with increased subsequent stroke risk and may be a marker of diagnostic error. We evaluate whether HCT occurrence among ED headache patients is associated with increased subsequent cerebrovascular disease risk. METHODS We conducted a retrospective cohort study of consecutive adult patients with headache who were discharged home from the ED (ED treat-and-release visit) at one multicenter institution. Patients with headache were defined as those with primary ICD-9/10-CM discharge diagnoses codes for benign headache from 9/1/2013-9/1/2018. The primary outcome of cerebrovascular disease hospitalization was identified using ICD-9/10-CM codes and confirmed via chart review. We matched headache patients who had a HCT (exposed) to those who did not have a HCT (unexposed) in the ED in a one-to-one fashion using propensity score methods. RESULTS Among the 28,121 adult patients with ED treat-and-release headache visit, 45.6% (n=12,811) underwent HCT. A total of 0.4% (n=111) had a cerebrovascular hospitalization within 365 days of index visit. Using propensity score matching, 80.4% (n=10,296) of exposed patients were matched to unexposed. Exposed patients had increased risk of cerebrovascular hospitalization at 365 days (RR: 1.65: 95% CI: 1.18-2.31) and 180 days (RR: 1.62; 95% CI: 1.06-2.49); risk of cerebrovascular hospitalization was not increased at 90 or 30 days. CONCLUSIONS Having a HCT performed at ED treat-and-release headache visit is associated with increased risk of subsequent cerebrovascular disease. Future work to improve cerebrovascular disease prevention strategies in this subset of headache patients is warranted.
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Affiliation(s)
- Ava L Liberman
- Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Cuiling Wang
- Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Benjamin W Friedman
- Department of Emergency Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Charles C Esenwa
- Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sara K Rostanski
- Department of Neurology, New York University School of Medicine, New York, NY, USA
| | - Natalie T Cheng
- Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Amichai Erdfarb
- Department of Radiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Daniel L Labovitz
- Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Richard B Lipton
- Department of Neurology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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16
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Lee JK, Hung CS, Huang CC, Chen YH, Wu HW, Chuang PY, Yu JY, Ho YL. The Costs and Cardiovascular Benefits in Patients With Peripheral Artery Disease From a Fourth-Generation Synchronous Telehealth Program: Retrospective Cohort Study. J Med Internet Res 2021; 23:e24346. [PMID: 34003132 PMCID: PMC8170551 DOI: 10.2196/24346] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 10/22/2020] [Accepted: 04/14/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patients with peripheral artery disease (PAD) are at high risk for major cardiovascular events, including myocardial infarction, stroke, and hospitalization for heart failure. We have previously shown the clinical efficacy of a fourth-generation synchronous telehealth program for some patients, but the costs and cardiovascular benefits of the program for PAD patients remain unknown. OBJECTIVE The telehealth program is now widely used by higher-risk cardiovascular patients to prevent further cardiovascular events. This study investigated whether patients with PAD would also have better cardiovascular outcomes after participating in the fourth-generation synchronous telehealth program. METHODS This was a retrospective cohort study. We screened 5062 patients with cardiovascular diseases who were treated at National Taiwan University Hospital and then enrolled 391 patients with a diagnosis of PAD. Of these patients, 162 took part in the telehealth program, while 229 did not and thus served as control patients. Inverse probability of treatment weighting (IPTW) based on the propensity score was used to mitigate possible selection bias. Follow-up outcomes included heart failure hospitalization, acute coronary syndrome, stroke, and all-cause readmission during the 1-year follow-up period and through the last follow-up. RESULTS The mean follow-up duration was 3.1 (SD 1.8) years for the patients who participated in the telehealth program and 3.2 (SD 1.8) for the control group. The telehealth program patients exhibited lower risk of ischemic stroke than did the control group in the first year after IPTW (0.9% vs 3.5%; hazard ratio [HR] 0.24; 95% CI 0.07-0.80). The 1-year composite endpoint of vascular accident, including acute coronary syndrome and stroke, was also significantly lower in the telehealth program group after IPTW (2.4% vs 5.2%; HR 0.46; 95% CI 0.21-0.997). At the end of the follow-up, the telehealth program group continued to exhibit a significantly lower rate of ischemic stroke than did the control group after IPTW (0.9% vs 3.5%; HR 0.52, 95% CI 0.28-0.93). Furthermore, the medical costs of the telehealth program patients were not higher than those of the control group, whether in terms of outpatient, emergency department, hospitalization, or total costs. CONCLUSIONS The PAD patients who participated in the fourth-generation synchronous telehealth program exhibited lower risk of ischemic stroke events over both mid- and long-term follow-up periods. However, larger-scale and prospective randomized clinical trials are needed to confirm our findings.
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Affiliation(s)
- Jen-Kuang Lee
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Laboratory Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.,Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan.,Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chi-Sheng Hung
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan.,Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ching-Chang Huang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan.,Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ying-Hsien Chen
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan.,Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hui-Wen Wu
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Pao-Yu Chuang
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Jiun-Yu Yu
- Department of Business Administration, College of Management, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Lwun Ho
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan.,Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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17
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Grachev VG, Vedenskaya SS, Smolenskaya OG. Features of Antithrombotic Therapy in Patients with Multifocal Arterial Disease. ACTA ACUST UNITED AC 2021; 61:87-95. [PMID: 33849424 DOI: 10.18087/cardio.2021.3.n1498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/26/2021] [Accepted: 02/25/2021] [Indexed: 12/24/2022]
Abstract
Multifocal arterial injury is common in patients with atherosclerotic cardiovascular diseases and is associated with increased risk of cardiovascular complications and death. Administration of more intensive antithrombotic therapy, particularly combinations of acetylsalicylic acid and a "vascular" dose of rivaroxaban, in patients with multifocal arterial injury is characterized by a beneficial ratio of efficiency and safety due to a pronounced decrease in the risk of cardiovascular complications. Detection of peripheral artery diseases in patients with ischemic heart disease and atherosclerotic cerebrovascular pathology makes it possible to improve the risk stratification, optimize the diagnostic tactics and clarify indications for more intensive antithrombotic therapy.
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Affiliation(s)
- V G Grachev
- Urals State Medical University of Ministry Healthcare of Russian Federation, Yekaterinburg
| | - S S Vedenskaya
- Urals State Medical University of Ministry Healthcare of Russian Federation, Yekaterinburg
| | - O G Smolenskaya
- Urals State Medical University of Ministry Healthcare of Russian Federation, Yekaterinburg
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18
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Bhatt SK, Tseng AS, Firth C, Girardo M, Sykora D, Abdelmalek M, Fortuin FD, Wennberg P, Liedl D, Shamoun FE. Abnormal vascular physiology in the lower extremities as a risk factor for ischemic stroke and mortality. J Osteopath Med 2021; 121:463-470. [PMID: 33691353 DOI: 10.1515/jom-2020-0290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 12/22/2020] [Indexed: 11/15/2022]
Abstract
CONTEXT Peripheral artery disease (PAD) is highly prevalent in the general population, affecting up to 25% of patients 55 years of age or older. There is a known association with acute ischemic stroke, but limited large cohort studies exist pertaining to the relationship between PAD severity and incident ischemic stroke. OBJECTIVES To evaluate the risk of incident ischemic stroke and mortality along the spectrum of low and elevated ankle brachial index (ABI) measurement. METHODS We performed a retrospective extraction of ABI data of all adult patients who underwent lower extremity physiology study for any indication from January 1, 1996 to June 30, 2018 in the Mayo Clinic health system. PAD was categorized into severe, moderate, mild, and borderline based on ABI measurements and poorly compressible arteries (PCA). These were compared with normal ABI measurements. Associations of PAD/PCA with new ischemic stroke events and all cause mortality were analyzed. Hazard ratios (HR) were calculated using multivariable Cox proportional regression with 95% confidence intervals. RESULTS A total of 39,834 unique patients were included with a median follow up duration of 4.59 years. All abnormal ABI groups, except borderline PAD, were associated with increased risk of incident ischemic stroke after multivariate regression compared to normal ABI. A severity-dependent association was observed between PAD and ischemic stroke with moderate (HR, 1.22 [95% CI, 1.10-1.35]) and severe (HR, 1.19 [95% CI, 1.02-1.40]) categories conferring similar risk in comparison to normal ABI. Patients with PCA carried the greatest ischemic stroke risk (HR, 1.30 [95% CI, 1.15-1.46]). Similarly, abnormal ABI groups were associated with a significant risk for all cause mortality in a severity-dependent manner, with severe PAD conferring the greatest risk (HR, 3.07 [95% CI, 2.88-3.27]). CONCLUSIONS This study adds to the growing body of evidence that both PAD and PCA are independent risk factors for incident ischemic stroke and all cause mortality. The association of PAD severity and PCA with risk of ischemic stroke may help clinicians with risk stratification and determining treatment intensity.
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Affiliation(s)
| | - Andrew S Tseng
- Department of Cardiovascular Diseases at the Mayo Clinic, Rochester, MN, USA
| | - Christine Firth
- Department of Cardiovascular Diseases at the Mayo Clinic, Phoenix, AZ, USA
| | - Marlene Girardo
- Department of Biomedical Statistics and Informatics, Division of Health Sciences Research at the Mayo Clinic, Scottsdale, AZ, USA
| | - Daniel Sykora
- Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA
| | - Mina Abdelmalek
- Department of Cardiovascular Diseases at the Mayo Clinic, Phoenix, AZ, USA
| | - F David Fortuin
- Department of Cardiovascular Diseases at the Mayo Clinic, Phoenix, AZ, USA
| | - Paul Wennberg
- Department of Cardiovascular Diseases at the Mayo Clinic, Rochester, MN, USA
| | - David Liedl
- Department of Cardiovascular Diseases at the Mayo Clinic, Rochester, MN, USA
| | - Fadi E Shamoun
- Department of Cardiovascular Diseases at the Mayo Clinic, Phoenix, AZ, USA
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Grachev VG, Vedenskaya SS, Smolenskaya OG. Features of Risk Stratification, Diagnosis and Secondary Prevention in Patients with Multifocal Arterial Disease. Part 1: Risk Stratification and Diagnosis. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2021. [DOI: 10.20996/1819-6446-2021-02-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Multifocal arterial disease is common in patients with atherosclerotic cardiovascular disease and is associated with an increased risk of cardiovascular complications and death. The possibility of improving the prognosis of patients with multifocal arterial disease is associated with a more efficient diagnosis of both the underlying disease and obstructive atherosclerotic lesions of other localizations and with a more intensive secondary prevention. According to observational studies, the presence of significant stenoses of the carotid arteries and, especially, lower extremities arterial disease can be predictorы of similar lesions in other vascular beds and their detection with screening methods available in clinical practice allows improvement of the diagnosis in patients with suspected coronary artery disease. On the other hand, screening of lower extremities artery diseases in patients with acute coronary syndrome can clarify indications for the use of invasive diagnostic and treatment strategy, in patients with chronic coronary artery disease it can justify more aggressive approaches to secondary prevention.
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20
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Huang YC, Chang CC, Yeh CC, Lin CS, Hu CJ, Chen TL, Liao CC. The protective effect of statins against pressure ulcers in stroke patients: A propensity-score matched study based on a real-world database. Atherosclerosis 2020; 317:22-28. [PMID: 33333345 DOI: 10.1016/j.atherosclerosis.2020.11.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 10/18/2020] [Accepted: 11/20/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND AIMS Limited information is available regarding the association between statins and pressure ulcers. The purpose of this study is to evaluate the beneficial effects of statins on pressure ulcers in stroke patients. METHODS Using the claims data of Taiwan's National Health Insurance, we conducted a retrospective cohort study and identified new-onset stroke patients in 2000-2004. The propensity-score matching procedure was used to select eligible stroke patients with (n = 49,919) and without (n = 49,919) the use of statins. These two groups were followed until the end of 2009 to track the occurrence of pressure ulcers. Multivariate Cox proportional hazard models were conducted to calculate adjusted hazard rations (HRs) and 95% confidence intervals (CIs) of pressure ulcer associated with the use of statins. RESULTS Stroke patients who used statins had a reduced risk of pressure ulcers during the follow-up period (HR 0.74, 95% CI 0.71-0.78). The association between statin use and a reduced risk of poststroke pressure ulcers was significant in men (HR 0.73, 95% CI 0.68-0.78), women (HR 0.75, 95% CI 0.71-0.80), and people aged more than 50 years. Use of lovastatin, pravastatin, rosuvastatin, atrovastatin, fluvastatin, and simvastatin was associated with reduced poststroke pressure ulcers. There was a dose-dependent decrease in the frequency of pressure ulcers with increasing quantities of statins used, from 1 prescription to ≥3 prescriptions. CONCLUSION We raised the possibility that use of statins was associated with reduced risk of pressure ulcers in stroke patients. However, the potential beneficial effect associated with statins requires further validation using randomized clinical trials.
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Affiliation(s)
- Yu-Chen Huang
- Department of Dermatology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chuen-Chau Chang
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan; Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chun-Chieh Yeh
- Department of Surgery, China Medical University Hospital, Taichung, Taiwan; Department of Surgery, University of Illinois, Chicago, IL, USA
| | - Chao-Shun Lin
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan; Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chaur-Jong Hu
- Division of Neurology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - Ta-Liang Chen
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Chien-Chang Liao
- Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan; Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan; Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan.
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21
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Lee JK, Hwang JJ, Chiang FT, Wu CK. The impact of left ventricular diastolic dysfunction for the prognosis in patients with lower extremity arterial disease. ESC Heart Fail 2020; 7:2611-2620. [PMID: 32578966 PMCID: PMC7524108 DOI: 10.1002/ehf2.12839] [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] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 04/28/2020] [Accepted: 05/29/2020] [Indexed: 11/17/2022] Open
Abstract
Aims Lower extremity arterial disease (LEAD) and left ventricular diastolic dysfunction (LVDD) share many risk factors, but the characteristics of LVDD and its association with prognosis in patients with LEAD have not been fully examined. Methods and results We investigated the impact of LVDD on the clinical outcomes in LEAD patients. LVDD was classified according to the newest suggested classification by the American Society of Echocardiography. Survival analysis for mortality (primary endpoint) and major adverse cardiac events (MACE; secondary endpoint) was calculated with all clinical variables and adjusted by multivariate Cox regression. We consecutively enrolled 221 controls and 464 LEAD patients from outpatient clinics and hospitals. The prevalence of LVDD was proportional to the severity of LEAD defined by the Rutherford class. The difference of LVDD severity is significant when compared with the control and LEAD patients or LEAD patients who underwent endovascular therapy (EVT), and it is also proportional to the LEAD severity. The grade of LVDD was a significant factor in predicting MACE and mortality in LEAD patients after multivariate Cox regression analysis [hazard ratio (HR) = 2.11, 95% CI = 1.47–2.83, P = 0.026; HR = 1.47, 95% CI = 1.02–2.02, P = 0.041]. This impact remained significant in LEAD patients who underwent EVT. Conclusions The degree of LVDD may predict MACE and mortality in LEAD patients. Whether early identification of LVDD in LEAD patients is helpful warrants further large‐scale prospective randomized studies.
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Affiliation(s)
- Jen-Kuang Lee
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.,Department of Laboratory Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.,Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan
| | - Juey-Jen Hwang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Fu-Tien Chiang
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Cho-Kai Wu
- Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
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22
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Elbadawi A, Naqvi SY, Saad M, Elgendy IY, Mahmoud AA, Zainal A, Megaly M, Almahmoud MF, Altaweel A, Kleiman N, Abbott JD. In-Hospital Outcomes with Transfemoral Versus Transapical Access for Transcatheter Aortic Valve Replacement in Patients with Peripheral Arterial Disease. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2020; 21:604-609. [DOI: 10.1016/j.carrev.2019.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/01/2019] [Accepted: 09/06/2019] [Indexed: 01/19/2023]
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23
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Zilberszac R, Chandiramani R, Hengstenberg C, Sartori S, Cao D, Chandrasekhar J, Schafer U, Tchetche D, Violini R, Jeger R, Van Belle E, Boekstegers P, Hambrecht R, Tron C, Dumenteil N, Linke A, Ten Berg JM, Deliargyris EN, Anthopoulos P, Mehran R, Dangas G. Clinical outcomes after TAVR with heparin or bivalirudin as periprocedural anticoagulation in patients with and without peripheral arterial disease: Results from the BRAVO-3 randomized trial. Catheter Cardiovasc Interv 2019; 96:E377-E386. [PMID: 31808295 PMCID: PMC7540270 DOI: 10.1002/ccd.28642] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 09/18/2019] [Accepted: 11/21/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVES This study sought to investigate the clinical outcomes of patients with and without peripheral artery disease (PAD) in the BRAVO-3 trial with respect to the effect of bivalirudin versus unfractionated heparin (UFH). BACKGROUND PAD is found frequently in patients undergoing transcatheter aortic valve replacement (TAVR) and is reported to confer an increased risk of adverse events. It is unknown whether patients with and without PAD may demonstrate a differential response to bivalirudin versus UFH. METHODS BRAVO-3 was a randomized multicenter trial comparing transfemoral TAVR with bivalirudin versus UFH (31 centers, n = 802). Major adverse cardiovascular events (MACE) were a composite of 30-day death, myocardial infarction, or cerebrovascular accidents (CVA). Net adverse cardiovascular events (NACE) were a composite of major bleeding or MACE. RESULTS The total cohort included 119 patients with PAD. Vascular complications occurred significantly more frequently in patients with PAD both in-hospital (25.2 vs. 16.7%; OR 1.68) and at 30 days (29.4 vs. 17.3%; OR 1.99). No significant differences were observed regarding mortality, NACE, MACE, major bleeding or CVA with bivalirudin versus UFH among patients with or without PAD. In patients with PAD, bivalirudin was associated with an increased risk of minor vascular complications at 30 days. CONCLUSIONS Patients with PAD undergoing transfemoral TAVR did not exhibit an increased risk of any major adverse events, according to the procedural anticoagulant randomization. However, patients treated with Bivalirudin had significantly higher rates of minor vascular complications.
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Affiliation(s)
- Robert Zilberszac
- Department of Cardiology, Medical University of Vienna, Vienna, Austria
| | - Rishi Chandiramani
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Samantha Sartori
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Jaya Chandrasekhar
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Ulrich Schafer
- Department of Cardiology, University Heart Center, Hamburg, Germany.,Department of Cardiology, Asklepios Clinics St. Georg, Hamburg, Germany
| | - Didier Tchetche
- Department of General and Interventional Cardiology, Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Roberto Violini
- Interventional Cardiology Unit, San Camillo Hospital, Rome, Italy
| | - Raban Jeger
- Department of Cardiology, University Hospital Basel, University of Basel, Switzerland
| | - Eric Van Belle
- Department of Cardiology and INSERM UMR 1011, University Hospital and CHRU Lille, Lille, France
| | - Peter Boekstegers
- Department of Cardiology, Helios Heart Center Siegburg, Siegburg, Germany
| | - Rainer Hambrecht
- Department of Cardiology, Klinikum Links der Weser, Bremen, Germany
| | - Christophe Tron
- Department of Cardiology, Rouen University Hospital, Rouen, France
| | - Nicolas Dumenteil
- Department of General and Interventional Cardiology, Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Axel Linke
- Department of Cardiology, Universität Leipzig, Herzzentrum, Leipzig, Germany
| | - Jurriën M Ten Berg
- Department of Cardiology, St Antonius Hospital, Nieuwegein, the Netherlands
| | | | | | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - George Dangas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York
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24
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Matsuo Y, Kumakura H, Kanai H, Iwasaki T, Ichikawa S. The Geriatric Nutritional Risk Index Predicts Long-Term Survival and Cardiovascular or Limb Events in Peripheral Arterial Disease. J Atheroscler Thromb 2019; 27:134-143. [PMID: 31217396 PMCID: PMC7049470 DOI: 10.5551/jat.49767] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Aim: The Geriatric Nutritional Risk Index (GNRI) was developed to assess the nutritional risk and is associated with mortality. However, there are limited reports on the relationship between the GNRI and overall survival (OS) in peripheral artery disease (PAD). Therefore, the purpose of this study was to examine the relationship between GNRI and OS and cardiovascular or limb events in patients with PAD. Methods: A prospective cohort study was performed on 1,219 patients with PAD. The baseline GNRI was calculated from the serum albumin level and body mass index obtained at the first visit. The patients were divided into four groups according to the GNRI: G0 (> 98), G1 (92–98), G2 (82–91), and G3 (< 82). The endpoints were OS and freedom from major adverse cardiovascular events (MACE) and MACE plus limb events (MACLE). Results: The median follow-up period was 73 months. There were 626 deaths (51.4%) during the follow-up. The rate of cardiovascular death was 51.3%. OS clearly depended on the GNRI (p < 0.01), with five-year OS rates of 80.8% for G0, 62.0% for G1, 40.0% for G2, and 23.3% for G3. In multivariate analyses, the GNRI, age, ankle–brachial pressure index (ABPI), critical limb ischemia, estimated glomerular filtration rate (eGFR), and C-reactive protein (CRP) were independent factors associated with OS, and GNRI, age, ABPI, coronary artery disease, diabetes mellitus, eGFR, and CRP were associated with MACE and MACLE (all p < 0.05). Statins were found to improve OS, MACE, and MACLE (p < 0.01). Conclusions: GNRI is an independent predictor for OS, MACE, and MACLE in patients with PAD.
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Affiliation(s)
- Yae Matsuo
- Department of Vascular Medicine, Vascular Center, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital)
| | - Hisao Kumakura
- Department of Vascular Medicine, Vascular Center, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital)
| | - Hiroyoshi Kanai
- Department of Vascular Medicine, Vascular Center, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital)
| | - Toshiya Iwasaki
- Department of Vascular Medicine, Vascular Center, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital)
| | - Shuichi Ichikawa
- Department of Vascular Medicine, Vascular Center, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital)
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25
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Nozoe M, Kanai M, Kubo H, Yamamoto M, Shimada S, Mase K. Prestroke Sarcopenia and Stroke Severity in Elderly Patients with Acute Stroke. J Stroke Cerebrovasc Dis 2019; 28:2228-2231. [PMID: 31129104 DOI: 10.1016/j.jstrokecerebrovasdis.2019.05.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 04/20/2019] [Accepted: 05/02/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The association between prestroke sarcopenia and stroke severity has not been evaluated previously. The purpose of this study was to determine whether prestroke sarcopenia is associated with stroke severity in elderly patients with acute stroke. METHODS We assessed prestroke sarcopenia of elderly patients with acute stroke by using a questionnaire for sarcopenia (SARC-F). Patients were divided into groups according to their SARC-F score: SARC-F score less than 4 (nonsarcopenia) and SARC-F score ≥4 (prestroke sarcopenia). Stroke severity was assessed according to the National Institute of Health Stroke Scale. Logistic regression was used to derive crude and adjusted odds ratio for the presence of prestroke sarcopenia and stroke severity. RESULTS Among the 183 patients enrolled (age, median [interquartile range]: 75 [11] years; 103 men), the prevalence of prestroke sarcopenia was 15% (n = 27). Crude odds ratio for the presence of prestroke sarcopenia and moderate-to-severe stroke (National Institute of Health Stroke Scale score > 5) was 4.00 (95% confidence interval, 1.68-9.53; P = .002). After adjusting for confounding variables (age, sex, and stroke risk factors), the presence of prestroke sarcopenia remained an independent predictor of severe stroke, with an odds ratio of 3.54 (95% confidence interval, 1.32-9.49; P= .01). CONCLUSIONS Prestroke sarcopenia can predict moderate to severe stroke in elderly patients with acute stroke.
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Affiliation(s)
- Masafumi Nozoe
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Kobe, Japan.
| | - Masashi Kanai
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Hiroki Kubo
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Miho Yamamoto
- Department of Rehabilitation, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Shinichi Shimada
- Department of Neurosurgery, Itami Kousei Neurosurgical Hospital, Itami, Japan
| | - Kyoshi Mase
- Department of Physical Therapy, Faculty of Nursing and Rehabilitation, Konan Women's University, Kobe, Japan
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26
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Attar R, Wester A, Koul S, Eggert S, Andell P. Peripheral artery disease and outcomes in patients with acute myocardial infarction. Open Heart 2019; 6:e001004. [PMID: 31245013 PMCID: PMC6560667 DOI: 10.1136/openhrt-2018-001004] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 03/21/2019] [Accepted: 04/14/2019] [Indexed: 12/13/2022] Open
Abstract
Aim To describe the population of patients with previously diagnosed peripheral artery disease (PAD) experiencing a myocardial infarction (MI) and to investigate 1-year major adverse cardiac events (MACE: all-cause mortality, reinfarction, stroke and heart failure hospitalisation) following MI. Background MI patients with PAD constitute a high-risk population with adverse cardiac outcomes. Contemporary real-life data regarding the clinical characteristics of this patient population and clinical event rates following MI remain scarce. Methods This observational study included all MI patients presenting with ST-elevation MI or non-ST-elevation MI between 01 January 2005 and 31 December 2014 with (n=4213) and without (n=106 763) a concurrent PAD diagnosis, identified in the nationwide Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapies registry and the National Patient Registry (PAD prevalence: 3.8%). Cox proportional hazard models were applied to compare the outcome between the two populations. Results MI patients with PAD were older and more often burdened with comorbidities, such as diabetes, hypertension and previous MI. After adjustments, PAD was significantly associated with higher rates of MACE (HR 1.35, 95% CI 1.27 to 1.44), mortality (HR 1.59, 95% CI 1.43 to 1.76), reinfarction (HR 1.48, 95% CI 1.32 to 1.66), stroke (HR 1.27, 95% CI 1.05 to 1.53), heart failure (HR 1.29, 95% CI 1.20 to 1.40) and bleeding (HR 1.26, 95% CI 1.09 to 1.47) at 1 year. Conclusion A concurrent PAD diagnosis was independently significantly associated with higher rates of adverse outcomes following MI in a nationwide real-life MI population. The low prevalence of PAD compared with previous studies suggests significant underdiagnosing. Future studies should investigate if PAD screening with ankle–brachial index may increase diagnosing and subsequently lead to improved treatment of polyvascular disease
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Affiliation(s)
- Rubina Attar
- Cardiology and Clinical Sciences, Lunds Universitet, Lund, Sweden.,Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Axel Wester
- Cardiology and Clinical Sciences, Lunds Universitet, Lund, Sweden
| | - Sasha Koul
- Cardiology and Clinical Sciences, Lunds Universitet, Lund, Sweden
| | - Svend Eggert
- Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Pontus Andell
- Cardiology, Karolinska Institutet, Stockholm, Sweden
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27
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Kumakura H, Kanai H, Matsuo Y, Iwasaki T, Ichikawa S. Asymptomatic cerebral infarction is a predictor of long-term survival and vascular or limb events in peripheral arterial disease. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2019; 5:43-50. [PMID: 29931172 DOI: 10.1093/ehjqcco/qcy024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 06/20/2018] [Indexed: 11/13/2022]
Abstract
Aims The purpose of this study was to examine long-term life expectancy including cerebrovascular events (CVE) and fate of the leg in patients with peripheral arterial disease (PAD) with or without cerebral infarction (CI) detected by computed tomography (CT). Methods and results A prospective cohort study was performed in 932 patients with PAD. The endpoints were overall survival (OS), CVE, stroke-free survival (SFS), freedom from major adverse cardiovascular events (MACE), and freedom from major adverse cardiovascular and limb events (MACLE). The prevalence of CI on CT was 56.8%. There were 413 deaths (44.3%) during follow-up. The rate of cardiovascular deaths among those who died was 53.5%. The 3-, 5-, and 10-year OS rates were 82.0%, 76.9%, and 46.2%, respectively. In Cox multivariate analyses, age, ankle brachial pressure index (ABI), critical limb ischaemia (CLI), estimated glomerular filtration rate (eGFR), albumin level, and CI were independent factors associated with OS (P < 0.05); age, ABI, CLI, atrial fibrillation (AF), and CI were related to CVE (P < 0.05); age, ABI, CLI, diabetes, coronary heart disease (CHD), AF, eGFR, lower albumin, and CI were related to SFS (P < 0.05); age, ABI, CLI, diabetes, CHD, eGFR, lower albumin, and CI were associated with MACE (P < 0.05); and age, ABI, diabetes, CHD, eGFR, lower albumin and CI were related to MACLE (P < 0.05). Statins improved MACE and MACLE (P < 0.05), and AF increased MACLE (P < 0.05). Conclusions CI on CT was an independent predictor for mortality, CVE, SFS, MACE, and MACLE. Statins improved MACE and MACLE, but AF increased CVE and MACLE in patients with PAD.
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Affiliation(s)
- Hisao Kumakura
- Department of Vascular Medicine, Vascular Center, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Shibukawa, Gunma, Japan
| | - Hiroyoshi Kanai
- Department of Vascular Medicine, Vascular Center, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Shibukawa, Gunma, Japan
| | - Yae Matsuo
- Department of Vascular Medicine, Vascular Center, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Shibukawa, Gunma, Japan
| | - Toshiya Iwasaki
- Department of Vascular Medicine, Vascular Center, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Shibukawa, Gunma, Japan
| | - Shuichi Ichikawa
- Department of Vascular Medicine, Vascular Center, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital), Shibukawa, Gunma, Japan
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Jung HJ, Lee SS, Kim HY, Park BS, Kim DI, Nam KJ, Roh JE, Choo KS. Association between carotid artery stenosis and peripheral artery disease: Evaluation by screening carotid ultrasonography (cross-sectional study). Medicine (Baltimore) 2019; 98:e14163. [PMID: 30732131 PMCID: PMC6380666 DOI: 10.1097/md.0000000000014163] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
We aimed to investigate the association between carotid artery stenosis and peripheral artery disease (PAD) by screening carotid ultrasonography (CUS).From January 2012 to December 2015, 231 consecutive patients who had undergone preoperative CUS for PAD were included in this study. A radiologist assessed the degree of internal carotid artery (ICA) stenosis by using the North American Symptomatic Carotid Endarterectomy Trial (NASCET). Severe (>70%) ICA stenosis was evaluated based on the type of vascular surgery, PAD lesion, and ankle-brachial index (ABI). Data were analyzed using multiple logistic regression analysis and the χ test.Among 231 PAD patients, multilevel lesions revealed significantly higher incidence of severe ICA stenosis than iliac and infrainguinal lesion (22.5% vs 9.4% vs 8%: P = .016). Age (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.00-1.12: P = .035), chronic kidney disease (CKD, OR: 6.19, 95% CI: 2.04-45.04: P = .013), and cerebral vascular disease (CVD, OR: 4.08, 95% CI: 1.13-16.46: P = .037) were significant risk factors of severe ICA stenosis in multivariate analysis. Prevalence of severe ICA stenosis according to ABI in PAD was not significant.Preoperative screening by CUS provides valuable information onasymptomatic carotid artery stenosis (ACAS) that can identify severe ACAS patients who are at high risk of stroke and to consider more intensive management of carotid disease in PAD patients. CUS can be a useful noninvasive preoperative screening imaging tool for PAD patients with multilevel lesions, aged > 65 years old, with CKD and CVD.
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Affiliation(s)
| | | | | | | | | | - Kyoung Jin Nam
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan-si, Gyeongsangnam-do, South Korea
| | - Ji Eun Roh
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan-si, Gyeongsangnam-do, South Korea
| | - Ki Seok Choo
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan-si, Gyeongsangnam-do, South Korea
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Kähm K, Laxy M, Schneider U, Holle R. Exploring Different Strategies of Assessing the Economic Impact of Multiple Diabetes-Associated Complications and Their Interactions: A Large Claims-Based Study in Germany. PHARMACOECONOMICS 2019; 37:63-74. [PMID: 30167918 DOI: 10.1007/s40273-018-0699-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND In the context of an aging population with increasing diabetes prevalence, people are living longer with diabetes, which leads to increased multimorbidity and economic burden. OBJECTIVE The primary aim was to explore different strategies that address the economic impact of multiple type 2 diabetes-related complications and their interactions. METHODS We used a generalized estimating equations approach based on nationwide statutory health insurance data from 316,220 patients with type 2 diabetes (baseline year 2012, 3 years of follow-up). We estimated annual total costs (in 2015 euros) for type 2 diabetes-related complications and, in addition, explored different strategies to assess diabetes-related multimorbidity: number of prevalent complications, co-occurrence of micro- and macrovascular complications, disease-disease interactions of prevalent complications, and interactions between prevalent/incident complications. RESULTS The increased number of complications was significantly associated with higher total costs. Further assessment of interactions showed that macrovascular complications (e.g., chronic heart failure) and high-cost complications (e.g., end-stage renal disease, amputation) led to significant positive effects of interactions on costs, whereas early microvascular complications (e.g., retinopathy) caused negative interactions. The chronology of the onset of these complications turned out to have an additional impact on the interactions and their effect on total costs. CONCLUSIONS Health economic diabetes models and evaluations of interventions in patients with diabetes-related complications should pay more attention to the economic effect of specific disease interactions. Politically, our findings support the development of more integrated diabetes care programs that take better account of multimorbidity. Further observational studies are needed to elucidate the shared pathogenic mechanisms of diabetes complications.
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Affiliation(s)
- Katharina Kähm
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH)-German Research Center for Environmental Health (GmbH), Ingolstädter Landstraße 1, 85758, Neuherberg, Germany.
- German Center for Diabetes Research (DZD), Munich, Neuherberg, Germany.
| | - Michael Laxy
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH)-German Research Center for Environmental Health (GmbH), Ingolstädter Landstraße 1, 85758, Neuherberg, Germany
- German Center for Diabetes Research (DZD), Munich, Neuherberg, Germany
| | - Udo Schneider
- Scientific Institute of TK for Benefit and Efficiency in Health Care, Techniker Krankenkasse (TK), Hamburg, Germany
| | - Rolf Holle
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München (GmbH)-German Research Center for Environmental Health (GmbH), Ingolstädter Landstraße 1, 85758, Neuherberg, Germany
- German Center for Diabetes Research (DZD), Munich, Neuherberg, Germany
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Fanaroff AC, Manandhar P, Holmes DR, Cohen DJ, Harrison JK, Hughes GC, Thourani VH, Mack MJ, Sherwood MW, Jones WS, Vemulapalli S. Peripheral Artery Disease and Transcatheter Aortic Valve Replacement Outcomes: A Report From the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Therapy Registry. Circ Cardiovasc Interv 2018; 10:CIRCINTERVENTIONS.117.005456. [PMID: 29042398 DOI: 10.1161/circinterventions.117.005456] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 09/14/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Peripheral artery disease (PAD) is associated with increased cardiovascular mortality, and PAD risk factors overlap with those for aortic stenosis. The prevalence and outcomes associated with PAD in a population undergoing transcatheter aortic valve replacement (TAVR) are unknown. METHODS AND RESULTS Using the Society of Thoracic Surgeons/Transcatheter Valve Therapy Registry linked to Medicare claims data, we identified patients ≥65 years old undergoing TAVR from 2011 to 2015. We calculated hazard ratios for 1-year adverse outcomes, including mortality, readmission, and bleeding, for patients with PAD compared with those without, adjusting for baseline characteristics and postprocedure medications. Analyses were performed separately by access site (transfemoral and nontransfemoral). Of 19 660 patients undergoing transfemoral TAVR, 4810 (24.5%) had PAD; 3730 (47.9%) of 7780 patients undergoing nontransfemoral TAVR had PAD. In both groups, patients with PAD were significantly more likely to have coronary and carotid artery diseases. At 1-year follow-up, patients with PAD undergoing TAVR via transfemoral access had a higher incidence of death (16.8% versus 14.4%; adjusted hazard ratio, 1.14; P=0.01), readmission (45.5% versus 42.1%; hazard ratio, 1.11; P<0.001), and bleeding (23.1% versus 19.7%; hazard ratio, 1.18; P<0.001) compared with patients without PAD. Patients with PAD undergoing TAVR via nontransfemoral access did not have significantly higher rates of 1-year mortality or readmission compared with patients without PAD. CONCLUSIONS PAD is common among patients undergoing commercial TAVR via transfemoral and nontransfemoral access. Among patients undergoing transfemoral TAVR, PAD is associated with a higher incidence of 1-year adverse outcomes compared with absence of PAD. CLINICAL TRIAL REGISTRATION URL: http://www.clinicaltrials.gov. Unique identifier: NCT01737528.
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Affiliation(s)
- Alexander C Fanaroff
- From the Duke Clinical Research Institute, Durham, NC (A.C.F., P.M., M.W.S., W.S.J., S.V.); Division of Cardiology (A.C.F., J.K.H., W.S.J., S.V.) and Division of Cardiovascular and Thoracic Surgery (G.C.H.), Duke University, Durham, NC; Division of Cardiology, Mayo Clinic, Rochester, MN (D.R.H.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (D.J.C.); Division of Cardiothoracic Surgery, Emory University, Atlanta, GA (V.H.T.); The Heart Hospital Baylor Plano, TX (M.J.M.); and Inova Heart and Vascular Institute, Falls Church, VA (M.W.S.).
| | - Pratik Manandhar
- From the Duke Clinical Research Institute, Durham, NC (A.C.F., P.M., M.W.S., W.S.J., S.V.); Division of Cardiology (A.C.F., J.K.H., W.S.J., S.V.) and Division of Cardiovascular and Thoracic Surgery (G.C.H.), Duke University, Durham, NC; Division of Cardiology, Mayo Clinic, Rochester, MN (D.R.H.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (D.J.C.); Division of Cardiothoracic Surgery, Emory University, Atlanta, GA (V.H.T.); The Heart Hospital Baylor Plano, TX (M.J.M.); and Inova Heart and Vascular Institute, Falls Church, VA (M.W.S.)
| | - David R Holmes
- From the Duke Clinical Research Institute, Durham, NC (A.C.F., P.M., M.W.S., W.S.J., S.V.); Division of Cardiology (A.C.F., J.K.H., W.S.J., S.V.) and Division of Cardiovascular and Thoracic Surgery (G.C.H.), Duke University, Durham, NC; Division of Cardiology, Mayo Clinic, Rochester, MN (D.R.H.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (D.J.C.); Division of Cardiothoracic Surgery, Emory University, Atlanta, GA (V.H.T.); The Heart Hospital Baylor Plano, TX (M.J.M.); and Inova Heart and Vascular Institute, Falls Church, VA (M.W.S.)
| | - David J Cohen
- From the Duke Clinical Research Institute, Durham, NC (A.C.F., P.M., M.W.S., W.S.J., S.V.); Division of Cardiology (A.C.F., J.K.H., W.S.J., S.V.) and Division of Cardiovascular and Thoracic Surgery (G.C.H.), Duke University, Durham, NC; Division of Cardiology, Mayo Clinic, Rochester, MN (D.R.H.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (D.J.C.); Division of Cardiothoracic Surgery, Emory University, Atlanta, GA (V.H.T.); The Heart Hospital Baylor Plano, TX (M.J.M.); and Inova Heart and Vascular Institute, Falls Church, VA (M.W.S.)
| | - J Kevin Harrison
- From the Duke Clinical Research Institute, Durham, NC (A.C.F., P.M., M.W.S., W.S.J., S.V.); Division of Cardiology (A.C.F., J.K.H., W.S.J., S.V.) and Division of Cardiovascular and Thoracic Surgery (G.C.H.), Duke University, Durham, NC; Division of Cardiology, Mayo Clinic, Rochester, MN (D.R.H.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (D.J.C.); Division of Cardiothoracic Surgery, Emory University, Atlanta, GA (V.H.T.); The Heart Hospital Baylor Plano, TX (M.J.M.); and Inova Heart and Vascular Institute, Falls Church, VA (M.W.S.)
| | - G Chad Hughes
- From the Duke Clinical Research Institute, Durham, NC (A.C.F., P.M., M.W.S., W.S.J., S.V.); Division of Cardiology (A.C.F., J.K.H., W.S.J., S.V.) and Division of Cardiovascular and Thoracic Surgery (G.C.H.), Duke University, Durham, NC; Division of Cardiology, Mayo Clinic, Rochester, MN (D.R.H.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (D.J.C.); Division of Cardiothoracic Surgery, Emory University, Atlanta, GA (V.H.T.); The Heart Hospital Baylor Plano, TX (M.J.M.); and Inova Heart and Vascular Institute, Falls Church, VA (M.W.S.)
| | - Vinod H Thourani
- From the Duke Clinical Research Institute, Durham, NC (A.C.F., P.M., M.W.S., W.S.J., S.V.); Division of Cardiology (A.C.F., J.K.H., W.S.J., S.V.) and Division of Cardiovascular and Thoracic Surgery (G.C.H.), Duke University, Durham, NC; Division of Cardiology, Mayo Clinic, Rochester, MN (D.R.H.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (D.J.C.); Division of Cardiothoracic Surgery, Emory University, Atlanta, GA (V.H.T.); The Heart Hospital Baylor Plano, TX (M.J.M.); and Inova Heart and Vascular Institute, Falls Church, VA (M.W.S.)
| | - Michael J Mack
- From the Duke Clinical Research Institute, Durham, NC (A.C.F., P.M., M.W.S., W.S.J., S.V.); Division of Cardiology (A.C.F., J.K.H., W.S.J., S.V.) and Division of Cardiovascular and Thoracic Surgery (G.C.H.), Duke University, Durham, NC; Division of Cardiology, Mayo Clinic, Rochester, MN (D.R.H.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (D.J.C.); Division of Cardiothoracic Surgery, Emory University, Atlanta, GA (V.H.T.); The Heart Hospital Baylor Plano, TX (M.J.M.); and Inova Heart and Vascular Institute, Falls Church, VA (M.W.S.)
| | - Matthew W Sherwood
- From the Duke Clinical Research Institute, Durham, NC (A.C.F., P.M., M.W.S., W.S.J., S.V.); Division of Cardiology (A.C.F., J.K.H., W.S.J., S.V.) and Division of Cardiovascular and Thoracic Surgery (G.C.H.), Duke University, Durham, NC; Division of Cardiology, Mayo Clinic, Rochester, MN (D.R.H.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (D.J.C.); Division of Cardiothoracic Surgery, Emory University, Atlanta, GA (V.H.T.); The Heart Hospital Baylor Plano, TX (M.J.M.); and Inova Heart and Vascular Institute, Falls Church, VA (M.W.S.)
| | - W Schuyler Jones
- From the Duke Clinical Research Institute, Durham, NC (A.C.F., P.M., M.W.S., W.S.J., S.V.); Division of Cardiology (A.C.F., J.K.H., W.S.J., S.V.) and Division of Cardiovascular and Thoracic Surgery (G.C.H.), Duke University, Durham, NC; Division of Cardiology, Mayo Clinic, Rochester, MN (D.R.H.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (D.J.C.); Division of Cardiothoracic Surgery, Emory University, Atlanta, GA (V.H.T.); The Heart Hospital Baylor Plano, TX (M.J.M.); and Inova Heart and Vascular Institute, Falls Church, VA (M.W.S.)
| | - Sreekanth Vemulapalli
- From the Duke Clinical Research Institute, Durham, NC (A.C.F., P.M., M.W.S., W.S.J., S.V.); Division of Cardiology (A.C.F., J.K.H., W.S.J., S.V.) and Division of Cardiovascular and Thoracic Surgery (G.C.H.), Duke University, Durham, NC; Division of Cardiology, Mayo Clinic, Rochester, MN (D.R.H.); Saint Luke's Mid America Heart Institute, University of Missouri-Kansas City (D.J.C.); Division of Cardiothoracic Surgery, Emory University, Atlanta, GA (V.H.T.); The Heart Hospital Baylor Plano, TX (M.J.M.); and Inova Heart and Vascular Institute, Falls Church, VA (M.W.S.)
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Sidyakin AA, Kaysheva AL, Kopylov AT, Lobanov AV, Morozov SG. Proteomic Analysis of Cerebral Cortex Extracts from Sus scrofa with Induced Hemorrhagic Stroke. J Mol Neurosci 2018; 65:28-34. [PMID: 29700768 DOI: 10.1007/s12031-018-1064-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 04/11/2018] [Indexed: 11/25/2022]
Abstract
Cerebrovascular diseases, including stroke and micro stroke, are the main causes of death in contemporary society. Hemorrhagic stroke is the fast emerging defficiency in the brain function resulting from disturbance of blood supply to the brain caused by the rapture of blood vessels (Lopez et al. in Proteomics Clin Appl 6:190-200, 2012). The influence of a model hemorrhagic stroke on white pigs with the change in the protein profile of their cortical samples 24 h and 2 months after the stroke was examined using mass-spectrometric analysis. Different proteins (n = 30) were identified, and their content was elevated. These proteins are involved in the mechanisms of neuroprotection, including compensation of oxidative stress (TXN, SNCA, PRDX6, ENO1), prevention of unwanted protein aggregation and apoptosis (PTMA, SNCA, SNCB), release of neurotransmitters (GAPDH, PEBP1) and assembly of the cytoskeleton (ACTA2, PTMA, TUBA4A, TUBA1D), etc. Also, a group of seven Ras family proteins involved in the regulation of cell proliferation and differentiation was found in the samples taken 24 h following the stroke. The relative concentrations of most of the proteins in the samples taken 2 months after the stroke demonstrate intermediate values between the control sample and the sample taken in 24 h, indicating the extinction of change in the protein profile with time. During the first 24 h after the stroke, there is an increase in protein fractions participating in exocytosis, synaptic plasticity/signaling, and support of neurotransmitter transport. Such shift in the weight of protein functional clusters can be attributed to activation of compensatory mechanisms in the body focused on neuroprotection.
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Affiliation(s)
| | - Anna L Kaysheva
- V.N. Orehovich Institute of Biomedical Chemistry, 10, Pogodinskaya st, Moscow, Russian Federation, 119121.
| | - Artur T Kopylov
- V.N. Orehovich Institute of Biomedical Chemistry, 10, Pogodinskaya st, Moscow, Russian Federation, 119121
| | | | - Sergei G Morozov
- Research Institute of General Pathology and Pathophysiology, Moscow, Russia
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Jia X, Levine GN, Birnbaum Y. The CHA 2DS 2-VASc score: Not as simple as it seems. Int J Cardiol 2018; 257:92-96. [PMID: 29506745 DOI: 10.1016/j.ijcard.2017.12.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 11/29/2017] [Accepted: 12/11/2017] [Indexed: 01/31/2023]
Abstract
The CHA2DS2-VASc score has been widely adopted as a risk stratification tool for strokes in patients with atrial fibrillation and to help in deciding when anticoagulation therapy for stroke prophylaxis may be beneficial. The score as a whole has been well validated and has been included in the current major practice guidelines. An advantage of the CHA2DS2-VASc score is its ease of use, allowing clinicians to quickly estimate risk based on a short set of criteria. However, the benefit of simplicity may also be a weakness. Studies on individual components of the score suggest that only a subset of patients deemed to be at risk based on the current definition are actually at risk for stroke. Thus, users of the score should be aware of the nuances based on available evidence and avoid over-generalization. Accurate assessment of stroke risk has important clinical implications as it influences decision-making on initiation of anticoagulation.
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Affiliation(s)
- Xiaoming Jia
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States.
| | - Glenn N Levine
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States; Michael E. DeBakey VA Medical Center, Houston, TX, United States
| | - Yochai Birnbaum
- Department of Medicine, Baylor College of Medicine, Houston, TX, United States
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Katsiki N, Giannoukas AD, Athyros VG, Mikhailidis DP. Lipid-lowering treatment in peripheral artery disease. Curr Opin Pharmacol 2018; 39:19-26. [DOI: 10.1016/j.coph.2018.01.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 01/14/2018] [Accepted: 01/19/2018] [Indexed: 12/19/2022]
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Association between modified CHA 2DS 2-VASc Score with Ankle-Brachial index < 0.9. Sci Rep 2018; 8:1175. [PMID: 29352195 PMCID: PMC5775199 DOI: 10.1038/s41598-018-19243-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 12/19/2017] [Indexed: 11/09/2022] Open
Abstract
The ankle-brachial index (ABI) is a reliable diagnostic examination for peripheral arterial occlusive disease (PAOD). We previously reported CHADS2 score was significantly correlated with PAOD. However, the association between CHA2DS2-VASc score and ABI < 0.9 is not evaluated in the literature. The aim of the present study was to investigate whether CHA2DS2-VASc score has a strong association with PAOD. We enrolled 1482 patients in this study. PAOD was defined as ABI < 0.9 in either leg. Vascular disease in CHA2DS2-VASc score was modified as vascular disease except PAOD. Of the 1482 subjects, the prevalence of ABI < 0.9 was 5.6%. Multivariate analysis showed that the increased age, decreased estimated glomerular filtration rate and increased modified CHA2DS2-VASc score (OR, 1.764; p < 0.001) were independent associated with ABI < 0.9. In addition, the percentage of ABI < 0.9 in patients with modified CHA2DS2-VASc score of 0, 1, and <2 were 0%, 0.9%, and 0.7%, respectively (All < 1%). Our study demonstrated modified CHA2DS2-VASc score was significantly associated with ABI < 0.9. Calculation of modified CHA2DS2-VASc score might be useful in identifying patients with PAOD and in stratifying the risk of PAOD in non-AF patients.
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Circulating Angiogenic Growth Factors in Diabetes Patients with Peripheral Arterial Disease and Exertional Leg Pain in Ghana. Int J Vasc Med 2017; 2017:2390174. [PMID: 29445546 PMCID: PMC5763056 DOI: 10.1155/2017/2390174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 11/27/2017] [Accepted: 11/29/2017] [Indexed: 11/29/2022] Open
Abstract
Objective Peripheral arterial disease (PAD) is a common complication of diabetes, associated with impairment in angiogenesis. Angiogenesis is regulated by angiogenic growth factors such as angiopoietin 1 (Ang-1), Ang-2, and vascular endothelial growth factor (VEGF). We studied the association between angiogenic growth factors versus PAD and exertional leg symptoms in diabetes patients in Ghana. Method In this cross-sectional study, ankle-brachial index was measured with oscillometrically and exertional leg symptoms were screened with Edinburgh claudication questionnaire in 140 diabetes patients and 110 nondiabetes individuals. Circulating levels of Ang-1, Ang-2, and VEGF were measured with immunosorbent assay. Results The prevalence of PAD and exertional leg pain was 16.8% and 24.8%, respectively. Compared to non-PAD participants, PAD patients had higher VEGF levels [85.8 (37.5–154.5) versus 57.7 (16.6–161.1) p = 0.032] and lower Ang-1 levels [31.3 (24.8–42.6) versus 40.9 (28.2–62.1), p = 0.017]. In multivariable logistic regression, patients with exertional leg pain had increased the odds of plasma Ang-2 levels [OR (95% CI): 2.08 (1.08–6.41), p = 0.036]. Conclusion Diabetes patients with PAD and exertional leg pain have imbalance in angiogenic growth factors, indicating impaired angiogenesis. In patients with exertional leg pains, Ang-2 may be an important biomarker.
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Yoon HJ, Kim KH, Park H, Cho JY, Hong YJ, Park HW, Kim JH, Ahn Y, Jeong MH, Cho JG, Park JC. Carotid plaque rather than intima-media thickness as a predictor of recurrent vascular events in patients with acute ischemic stroke. Cardiovasc Ultrasound 2017; 15:19. [PMID: 28738808 PMCID: PMC5525267 DOI: 10.1186/s12947-017-0110-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 07/13/2017] [Indexed: 11/13/2022] Open
Abstract
Background To investigate the impacts of carotid plaque and intima-media thickness (IMT) on future vascular events (VEs) in the patients with acute ischemic stroke. Methods A total of 479 consecutive Korean patients with acute ischemic stroke were divided into 2 groups according to development of VEs; VE group (65.4 ± 10.9 years) vs no VE group (62.8 ± 13.2 years). VEs were defined as the development of recurrent stroke, coronary events, peripheral arterial disease, and death. Clinical, laboratory, and imaging findings were compared between the groups. Results During 105.5 ± 29.0 months of follow up, VEs were developed in 142 patients (29.6%). In univariate analysis, VEs were significantly associated with age, gender, diabetes, renal function, lipid levels, left ventricular function, carotid plaque or IMT. In multivariate analysis, the presence of carotid plaque, diabetes, renal function and male gender were independent predictors of future VEs in the patients with ischemic stroke, but carotid IMT was not a predictor of future VEs. Event free survival was significantly lower in patients with carotid plaque than without carotid plaque on Kaplan-Meier analysis (log rank p < 0.001). Conclusion The present study demonstrated that diabetes, impaired renal function, male gender, and the presence of carotid plaque rather than IMT were independent predictors of future VEs in Korean patients with acute ischemic stroke. Active medical management and careful monitoring for the development of recurrent VEs are strongly recommended in patients with acute ischemic stroke and carotid plaque.
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Affiliation(s)
- Hyun Ju Yoon
- Department of Cardiovascular Medicine, Chonnam National University Hospital, 42 Jaebong-ro, Donggu, Gwangju, 501-757, South Korea.,Translational Research Center on Aging, Chonnam National University Hospital, 42 Jaebong-ro, Donggu, Gwangju, 501-757, South Korea
| | - Kye Hun Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, 42 Jaebong-ro, Donggu, Gwangju, 501-757, South Korea. .,Translational Research Center on Aging, Chonnam National University Hospital, 42 Jaebong-ro, Donggu, Gwangju, 501-757, South Korea.
| | - Hyukjin Park
- Department of Cardiovascular Medicine, Chonnam National University Hospital, 42 Jaebong-ro, Donggu, Gwangju, 501-757, South Korea
| | - Jae Yeong Cho
- Department of Cardiovascular Medicine, Chonnam National University Hospital, 42 Jaebong-ro, Donggu, Gwangju, 501-757, South Korea.,Translational Research Center on Aging, Chonnam National University Hospital, 42 Jaebong-ro, Donggu, Gwangju, 501-757, South Korea
| | - Young Joon Hong
- Department of Cardiovascular Medicine, Chonnam National University Hospital, 42 Jaebong-ro, Donggu, Gwangju, 501-757, South Korea
| | - Hyung Wook Park
- Department of Cardiovascular Medicine, Chonnam National University Hospital, 42 Jaebong-ro, Donggu, Gwangju, 501-757, South Korea
| | - Ju Han Kim
- Department of Cardiovascular Medicine, Chonnam National University Hospital, 42 Jaebong-ro, Donggu, Gwangju, 501-757, South Korea
| | - Youngkeun Ahn
- Department of Cardiovascular Medicine, Chonnam National University Hospital, 42 Jaebong-ro, Donggu, Gwangju, 501-757, South Korea
| | - Myung Ho Jeong
- Department of Cardiovascular Medicine, Chonnam National University Hospital, 42 Jaebong-ro, Donggu, Gwangju, 501-757, South Korea
| | - Jeong Gwan Cho
- Department of Cardiovascular Medicine, Chonnam National University Hospital, 42 Jaebong-ro, Donggu, Gwangju, 501-757, South Korea.,Translational Research Center on Aging, Chonnam National University Hospital, 42 Jaebong-ro, Donggu, Gwangju, 501-757, South Korea
| | - Jong Chun Park
- Department of Cardiovascular Medicine, Chonnam National University Hospital, 42 Jaebong-ro, Donggu, Gwangju, 501-757, South Korea.,Translational Research Center on Aging, Chonnam National University Hospital, 42 Jaebong-ro, Donggu, Gwangju, 501-757, South Korea
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Battipaglia I, O’Neill J, Hogarth AJ, Tayebjee MH. Empirical anticoagulation for patients in sinus rhythm at high risk of ischaemic stroke: A review of current literature. World J Cardiol 2017; 9:422-428. [PMID: 28603589 PMCID: PMC5442410 DOI: 10.4330/wjc.v9.i5.422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 11/25/2016] [Accepted: 03/22/2017] [Indexed: 02/06/2023] Open
Abstract
Ischaemic stroke is one of the commonest causes of morbidity and mortality worldwide and around a fifth of events can be attributed to a cardioembolic source. This is typically due to atrial fibrillation (AF), the most common sustained cardiac arrhythmia. However, AF can, at times, be difficult to detect due to a relative lack of symptoms and the fact that it can be paroxysmal in nature. Studies have shown that diagnosis of AF improves as the length of cardiac monitoring increases. However, prolonged cardiac monitoring is not a cost-effective way of diagnosing AF. Therefore, an alternative approach may be to empirically anticoagulate individuals who are at high risk of stroke. This article summarises current evidence surrounding stroke risk prediction, the use of anticoagulation in the secondary prevention of stroke and its use in the primary prevention of stroke in high risk groups with the aim of determining whether empirical anticoagulation is a safe and effective strategy.
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The Association between Residence Floor Level and Cardiovascular Disease: The Health and Environment in Oslo Study. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2016; 2016:2951658. [PMID: 28053608 PMCID: PMC5174177 DOI: 10.1155/2016/2951658] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 10/26/2016] [Indexed: 11/30/2022]
Abstract
Background. Increasingly more people live in tall buildings and on higher floor levels. Factors relating to floor level may protect against or cause cardiovascular disease (CVD). Only one previous study has investigated the association between floor level and CVD. Methods. We studied associations between floor of bedroom and self-reported history of stroke, venous thromboembolism (VTE), and intermittent claudication (IC) among 12.525 inhabitants in Oslo, Norway. We fitted multivariate logistic regression models and adjusted for sociodemographic variables, socioeconomic status (SES), and health behaviors. Additionally, we investigated block apartment residents (N = 5.374) separately. Results. Trend analyses showed that disease prevalence increased by floor level, for all three outcomes. When we investigated block apartment residents alone, the trends disappeared, but one association remained: higher odds of VTE history on 6th floor or higher, compared to basement and 1st floor (OR: 1.504; 95% CI: 1.007–2.247). Conclusion. Floor level is positively associated with CVD, in Oslo. The best-supported explanation may be residual confounding by building height and SES. Another explanation, about the impact of atmospheric electricity, is also presented. The results underline a need to better understand the associations between residence floor level and CVD and multistory housing and CVD.
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Yeboah K, Puplampu P, Ainuson J, Akpalu J, Gyan B, Amoah AGB. Peripheral artery disease and exertional leg symptoms in diabetes patients in Ghana. BMC Cardiovasc Disord 2016; 16:68. [PMID: 27093857 PMCID: PMC4837554 DOI: 10.1186/s12872-016-0247-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 04/14/2016] [Indexed: 11/16/2022] Open
Abstract
Background Peripheral arterial disease (PAD) is a major health problem in diabetes patients in high-income countries, but the PAD burden in sub-Saharan Africa is largely undetermined. We studied the prevalence of PAD and exertional leg symptoms in diabetes (DM) patients in a tertiary hospital in Ghana. Methods In a case control study design, 485 DM and 330 non-diabetes participants were recruited. PAD was diagnosed as Ankle Brachial Index (ABI) < 0.9. Edinburgh Claudication Questionnaire (ECQ) was used to assess exertional leg symptoms. Results The overall prevalence of classical intermittent claudication was 10.3 % and ABI-diagnosed PAD was 26.7 %, with 3.5 % of the participants having both classic intermittent claudication and ABI-diagnosed PAD. The prevalence of exertional leg symptoms were similar in diabetes patients with and without PAD. In non-diabetes participants, intermittent claudication and rest pain were higher in PAD patients than in non-PAD participants. In multivariable logistic regression, intermittent claudication [OR (95 % CI), 3.39 (1.14 – 8.1), p < 0.05] and rest pain [4.3 (1.58 – 9.67), p < 0.001] were independently associated with PAD in non-diabetes group, and rest pain [1.71 (1.13 – 2.17), p < 0.05] was associated with PAD in all participants. Conclusions There is high burden of PAD and exertional leg pains in DM patients in Ghana. PAD is expressed as intermittent claudication and rest pain in non-diabetes individuals. Electronic supplementary material The online version of this article (doi:10.1186/s12872-016-0247-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kwame Yeboah
- Department of Physiology, School of Biomedical and Allied Health Sciences, University of Ghana, P. O. Box KB 143, Accra, Ghana.
| | - Peter Puplampu
- Department of Medicine & Therapeutics, School of Medicine & Dentistry, University of Ghana, Accra, Ghana
| | - Joana Ainuson
- Department of Dietetics, School of Biomedical and Allied Health Sciences, University of Ghana, Accra, Ghana
| | - Josephine Akpalu
- Department of Medicine & Therapeutics, School of Medicine & Dentistry, University of Ghana, Accra, Ghana
| | - Ben Gyan
- Noguchi Memorial Institute of Medical Research, University of Ghana, Accra, Ghana
| | - Albert G B Amoah
- Department of Medicine & Therapeutics, School of Medicine & Dentistry, University of Ghana, Accra, Ghana.,National Diabetes Management & Research Centre, Korle-Bu Teaching Hospital, Accra, Ghana
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Brahmbhatt R, Brewster LP, Shafii S, Rajani RR, Veeraswamy R, Salam A, Dodson TF, Arya S. Gender and frailty predict poor outcomes in infrainguinal vascular surgery. J Surg Res 2016; 201:156-65. [DOI: 10.1016/j.jss.2015.10.026] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 10/09/2015] [Accepted: 10/14/2015] [Indexed: 02/07/2023]
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Hsu PC, Chiu CA, Chu CY, Lee WH, Su HM, Lin TH, Voon WC, Lai WT, Sheu SH. CHADS2 Score and Risk of New-onset Peripheral Arterial Occlusive Disease in Patients without Atrial Fibrillation: A Nationwide Cohort Study in Taiwan. J Atheroscler Thromb 2016; 22:490-8. [PMID: 25342568 DOI: 10.5551/jat.27284] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM Although our recent cross-sectional study demonstrated that the CHADS2 score is associated with an ankle-brachial index of < 0.9 in patients without atrial fibrillation (AF), the true cause-effect relationship between these parameters remains to be evaluated. Hence, the aim of this study was to investigate whether the CHADS2 score is a useful predictor of new-onset PAOD in non-AF patients. METHODS From January 1, 2000 to December 31, 2001, a total of 723,750 patients older than 18 years of age with no past history of PAOD, rheumatic heart disease or AF were surveyed from the "National Health Insurance Research Database." The CHADS2 score was calculated for each patient. Finally, 581,997 (score 0), 84,971 (score 1), 31,473 (score 2), 14,432 (score 3), 8,156 (score 4), 2,430 (score 5) and 291 (score 6) patients were studied and followed for the onset of PAOD. We further divided the study patients into four groups: group 1 (score 0), group 2 (score 1-2), group 3 (score 3-4) and group 4 (score 5-6). RESULTS During the follow-up period of 9.83 ± 0.01 years, 24,775 (3.4%) patients experienced new-onset PAOD. The overall incidence of PAOD was 0.6 per 1,000 patient-years. The rate of PAOD increased from 1.8% (group 1) to 18.7% (group 4) (p < 0.001). According to a multivariate analysis, groups 2-4 were significantly associated with new-onset PAOD (all p < 0.001). In addition, the hazard ratio of each two-point increment in the CHADS2 score for predicting PAOD was 2.51 (p < 0.001). CONCLUSIONS The CHADS2 score is a useful predictor of new-onset PAOD in non-AF patients.
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Affiliation(s)
- Po-Chao Hsu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Hao Z, Yang C, Tao W, Liu M. Prognostic implications of the Ankle Brachial Index in patients with acute ischemic stroke: A meta-analysis. Expert Rev Neurother 2016; 16:351-8. [PMID: 26786967 DOI: 10.1586/14737175.2016.1142875] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND The ankle brachial index (ABI) is recognized as a marker of atherosclerotic disease. The detection of ABI may improve the risk stratification. METHODS We systematically searched Pubmed and Embase (from the earliest date to October 2015) for studies evaluating the prognostic value of ABI in patients with acute ischemic stroke. Stroke or cardiovascular events, mortality and functional outcomes were analyzed. RESULTS Seventeen studies, containing 9404 patients, were included. The mean age of participants in each study ranged from 64 to 79 years. The prevalence of low ABI varied from 7.4% to 40.5%. In this quantitative analysis, we found that low ABI increased the risk of composite outcomes (myocardial infarction or stroke or mortality), disability and mortality. CONCLUSION The detection of ABI may help to identify high-risk patients for secondary stroke prevention.
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Affiliation(s)
- Zilong Hao
- a From the Stroke Clinical Research Unit, Department of Neurology, West China Hospital , Sichuan University , Chengdu , China
| | - Chunsong Yang
- b Department of Pharmacy, Evidence-based Pharmacy Center, West China second hospital, Key Laboratory of Birth Defects and Related Diseases of Women and Children , Sichuan University , Chengdu , China
| | - Wendan Tao
- a From the Stroke Clinical Research Unit, Department of Neurology, West China Hospital , Sichuan University , Chengdu , China
| | - Ming Liu
- a From the Stroke Clinical Research Unit, Department of Neurology, West China Hospital , Sichuan University , Chengdu , China
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Lin YS, Tung TH, Wang J, Chen YF, Chen TH, Lin MS, Chi CC, Chen MC. Peripheral arterial disease and atrial fibrillation and risk of stroke, heart failure hospitalization and cardiovascular death: A nationwide cohort study. Int J Cardiol 2016; 203:204-11. [DOI: 10.1016/j.ijcard.2015.10.091] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Revised: 10/06/2015] [Accepted: 10/12/2015] [Indexed: 12/15/2022]
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Hong JB, Leonards CO, Endres M, Siegerink B, Liman TG. Ankle-Brachial Index and Recurrent Stroke Risk: Meta-Analysis. Stroke 2015; 47:317-22. [PMID: 26658450 DOI: 10.1161/strokeaha.115.011321] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 11/09/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND PURPOSE The ankle-brachial index (ABI) is a fast, cheap, noninvasive indicator of atherosclerotic burden that may also be a predictor of stroke recurrence. In this systematic review and meta-analysis, we sought to explore ABI's merit as a marker for stroke recurrence and vascular risk by synthesizing the data currently available in stroke literature. METHODS We searched Embase, MEDLINE, and Pubmed databases for prospective cohort studies that included consecutive patients with stroke and transient ischemic attack, measured ABI at baseline, and performed a follow-up assessment at least 12 months after initial stroke or transient ischemic attack. The following end points were chosen for our analysis: recurrent stroke and combined vascular end point (recurrent vascular event or vascular death). Crude risk ratios and adjusted Cox proportional hazard ratios were combined separately using the random-effects model. Study-level characteristics (eg, percent of cohort with a history of hypertension, average cohort age, level of adjustment, and mean follow-up duration) were included as covariates in a metaregression analysis. RESULTS We identified 11 studies (5374 patients) that were not significantly heterogeneous. Pooling adjusted hazard ratios showed that low ABI was associated with both an increased hazard of recurrent stroke (hazard ratio, 1.70; 95% confidence interval, 1.10-2.64) and an increased risk of vascular events or vascular death (hazard ratio, 2.22; 95% confidence interval, 1.67-2.97). CONCLUSION Our results confirm the positive association between ABI and stroke recurrence. Further studies are needed to see whether inclusion of ABI will help improve the accuracy of prediction models and management of stroke patients.
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Affiliation(s)
- Ja Bin Hong
- From the Center for Stroke Research Berlin (CSB) (J.B.H., C.O.L., M.E., B.S., T.G.L.), Klinik und Poliklinik für Neurologie (M.E., T.G.L.), German Center for Neurodegenerative Disease (DZNE) (M.E.), and German Center for Cardiovascular Research (DZHK) (M.E.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany (M.E.); and Department of Neurology, Columbia University, College of Physicians and Surgeons, New York, NY (T.G.L.)
| | - Christopher O Leonards
- From the Center for Stroke Research Berlin (CSB) (J.B.H., C.O.L., M.E., B.S., T.G.L.), Klinik und Poliklinik für Neurologie (M.E., T.G.L.), German Center for Neurodegenerative Disease (DZNE) (M.E.), and German Center for Cardiovascular Research (DZHK) (M.E.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany (M.E.); and Department of Neurology, Columbia University, College of Physicians and Surgeons, New York, NY (T.G.L.)
| | - Matthias Endres
- From the Center for Stroke Research Berlin (CSB) (J.B.H., C.O.L., M.E., B.S., T.G.L.), Klinik und Poliklinik für Neurologie (M.E., T.G.L.), German Center for Neurodegenerative Disease (DZNE) (M.E.), and German Center for Cardiovascular Research (DZHK) (M.E.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany (M.E.); and Department of Neurology, Columbia University, College of Physicians and Surgeons, New York, NY (T.G.L.)
| | - Bob Siegerink
- From the Center for Stroke Research Berlin (CSB) (J.B.H., C.O.L., M.E., B.S., T.G.L.), Klinik und Poliklinik für Neurologie (M.E., T.G.L.), German Center for Neurodegenerative Disease (DZNE) (M.E.), and German Center for Cardiovascular Research (DZHK) (M.E.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany (M.E.); and Department of Neurology, Columbia University, College of Physicians and Surgeons, New York, NY (T.G.L.)
| | - Thomas G Liman
- From the Center for Stroke Research Berlin (CSB) (J.B.H., C.O.L., M.E., B.S., T.G.L.), Klinik und Poliklinik für Neurologie (M.E., T.G.L.), German Center for Neurodegenerative Disease (DZNE) (M.E.), and German Center for Cardiovascular Research (DZHK) (M.E.), Charité-Universitätsmedizin Berlin, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany (M.E.); and Department of Neurology, Columbia University, College of Physicians and Surgeons, New York, NY (T.G.L.)
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Kostenko EV, Petrova LV, Eneeva MA, Kamchatnov PR. [Sleep disorders and circadian rhythms in diseases of the cardiovascular system]. Zh Nevrol Psikhiatr Im S S Korsakova 2015; 115:30-36. [PMID: 26120978 DOI: 10.17116/jnevro20151153130-36] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To study disturbances of sleep and circadian rhythms in patients with cardiovascular diseases taking into account the level of melatonin secretion and to optimize a complex approach to their treatment. MATERIALS AND METHODS The study included patients with cardiovascular diseases with- (n=121) and without (n=105) cerebrovascular diseases (CVD). All patients received melaxen in dose 3 mg daily 30-40 min before sleep. Examination of patients included assessment of neurological status, psychometric scales, the definition of circadian rhythm of the heart and blood pressure, determination of 6-SOMT in daily urine. RESULTS Pathological changes in circadian rhythms affected sleep disturbances, emotional and cognitive disorders and were associated with a reduction in the level of 6-SOMT in the urine. These changes were most pronounced in patients with CVD and stroke. The inclusion of melaxen in the comprehensive regimen of treatment improved sleep, reduced mood disorders and normalized the circadian heart rate profile and blood pressure. CONCLUSION The data obtained allowed to consider melaxen as an effective tool in the complex therapy of patients with CVD.
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Affiliation(s)
- E V Kostenko
- Pirogov Russian National Research Medical University, Moscow; Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine, Moscow
| | - L V Petrova
- Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine, Moscow
| | - M A Eneeva
- Moscow Centre for Research and Practice in Medical Rehabilitation, Restorative and Sports Medicine, Moscow
| | - P R Kamchatnov
- Pirogov Russian National Research Medical University, Moscow
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Serena J, Segura T, Roquer J, García-Gil M, Castillo J. The ARTICO study: identification of patients at high risk of vascular recurrence after a first non-cardioembolic stroke. BMC Neurol 2015; 15:28. [PMID: 25884666 PMCID: PMC4369369 DOI: 10.1186/s12883-015-0278-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 02/20/2015] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND About 20% of patients with a first ischaemic stroke will experience a new vascular event within the first year. The atherosclerotic burden, an indicator of the extension of atherosclerosis in a patient, has been associated with the risk of new cardiovascular events in the general population. However, no predictive models reliably identify groups at a high risk of recurrence. The ARTICO study prospectively analysed the predictive value for the risk of recurrence of specific atherosclerotic markers. METHODS The multicentre ARTICO study included 620 consecutive independent patients older than 60 years suffering from a first non-cardioembolic stroke. We analysed classical stroke risk factors; duplex study of supraaortic trunk including intima-media thickness (IMT) measurement; quantification of internal carotid (ICA) stenosis; number, morphology and surface characteristics of carotid plaques; ankle brachial index (ABI); and the presence of microalbuminuria. Patients were followed up at 6 and 12 months after inclusion. The primary end-point was death or major cardiovascular events. RESULTS Any vascular event or death at 12 months occurred in 78 (13.8%) patients. In 40 (7.1%) of these the vascular event was a stroke recurrence. Weight, history of diabetes mellitus, history of symptomatic PAD, ABI <0.9 and significant ICA stenosis (>50%) were associated with a higher risk of vascular events on follow-up in the bivariate analysis. In the final Cox regression analysis, body mass index (BMI), systolic blood pressure, history of diabetes mellitus, symptomatic PAD (HR, 2.76; 95% CI, 1.10-6.95; p=0.03), and particularly patients with both ICA stenosis >50% and PAD (HR 4.52; 95% CI, 2.14-9.53; p<0.001) were independently associated with an increased risk of vascular events. Neither isolated ICA stenosis >50% nor isolated abnormal ABI remained associated with an increased risk of recurrence in comparison with the whole population. CONCLUSIONS Symptomatic PAD identifies a high risk group of vascular recurrence after a first non-cardioembolic stroke. The associated increased risk was particularly high in patients with both ICA stenosis and either symptomatic or asymptomatic PAD. Neither asymptomatic PAD alone nor isolated ICA stenosis >50% were associated with an increased risk of recurrence in this particularly high-risk group of non-cardioembolic stroke.
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Affiliation(s)
- Joaquín Serena
- Department of Neurology, Hospital Universitario Dr. Josep Trueta, IdIBGi (Institut d'Investigació Biomèdica de Girona), 17007, Girona, Spain.
| | - Tomás Segura
- Department of Neurology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.
| | - Jaume Roquer
- Department of Neurology, Hospital Universitari del Mar, Barcelona, Spain.
| | - María García-Gil
- Institut d'Investigació en Atenció Primària (IDIAP Jordi Gol), Girona, Spain.
| | - José Castillo
- Department of Neurology, Hospital Clínico Universitario, University of Santiago de Compostela, Santiago de Compostela, Spain.
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Hsu PC, Lee WH, Chu CY, Lin TH, Su HM, Lee CS, Voon WC, Lai WT, Sheu SH. Heart rate significantly influences the relationship between atrial fibrillation and ankle-brachial index. J Cardiol 2014; 66:143-7. [PMID: 25500429 DOI: 10.1016/j.jjcc.2014.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Revised: 07/28/2014] [Accepted: 10/09/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Both atrial fibrillation (AF) and vascular disease share several risk factors and the two diseases often coexist. The patients with AF were reported to have a decreased ankle-brachial index (ABI). However, ABI was also reported to have an inverse relationship with heart rate (HR). Because AF patients often have a transiently or persistently rapid HR, this study aimed to assess whether AF was significantly associated with decreased ABI and whether HR could significantly influence the relationship between AF and ABI. METHODS We included 166 AF and 1336 non-AF patients from subjects undergoing echocardiographic examinations. ABI was measured using an ABI-form device. RESULTS Compared to non-AF patients, AF patients had a decreased ABI (p<0.001). In a multivariate model, including covariates of age, sex, blood pressures, etc., the presence of AF was significantly associated with low ABI (β=-0.069, p=0.026). However, further adjustment for HR made this association disappear (p=0.971). CONCLUSION This study demonstrated that the presence of AF was associated with decreased ABI, but this association became insignificant after further adjustment for HR, which suggested HR could significantly influence the relationship between AF and ABI.
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Affiliation(s)
- Po-Chao Hsu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Hsien Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chun-Yuan Chu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Tsung-Hsien Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ho-Ming Su
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, Kaohsiung Municipal Hsiao-Kang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.
| | - Chee-Siong Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Chol Voon
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wen-Ter Lai
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Sheng-Hsiung Sheu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Barlinn K, Kolieskova S, Shahripour RB, Kepplinger J, Boehme AK, Siepmann T, Puetz V, Bodechtel U, Jordan WD, Alexandrov AV. Increased pulsatility of the intracranial blood flow spectral waveform on transcranial Doppler does not point to peripheral arterial disease in stroke patients. J Stroke Cerebrovasc Dis 2014; 24:189-95. [PMID: 25440327 DOI: 10.1016/j.jstrokecerebrovasdis.2014.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Revised: 08/12/2014] [Accepted: 08/16/2014] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Peripheral arterial disease (PAD) is common in patients with acute cerebral ischemia. Indexes of resistance derived from the systolic and diastolic velocities are routinely used in diagnostic transcranial Doppler (TCD) to detect intracranial arterial disease. We sought to explore whether these indexes can predict the presence of PAD in acute cerebral ischemia. METHODS We prospectively evaluated consecutive patients with acute cerebral ischemia. On TCD, peak-systolic and end-diastolic velocities in both middle cerebral and basilar arteries were manually measured to calculate pulsatility index (PI) and resistance index (RI). Increased resistance was defined as PI equal to 1.2 or more and RI equal to .75 or more. Ankle-brachial index (ABI) measurements were performed and an ABI equal to .9 or more was considered predictive of definite PAD. RESULTS We included 95 patients (45 male, 50 female) aged 66 ± 9 years with a median National Institutes Health Stroke Scale score of 3 (interquartile range, 8) points. The ABI was abnormal and consistent with definite PAD in 24 of 95 (25.3%; 95% confidence interval [CI], 16.4-34.2) patients. Increased PI did not differ among patients with and without PAD (20.8% vs. 28.2%, P = .60). Only 1 patient with PAD had increased RI as opposed to 4 patients without PAD (4.2% vs. 5.6%, P = 1.0). Increased PI was not found to be an independent predictor of PAD (odds ratio [OR], .68; 95% CI, .22-2.12; P = .51). Increases in both PI and RI independently predicted arterial hypertension (OR, 1.62; 95% CI, 1.19-2.21; P = .002 and OR, 3.20; 95% CI, 1.51-6.77; P = .002, respectively). CONCLUSIONS Our findings indicate that PAD cannot be inferred from intracranial flow parameters predictive of arterial disease and risk factors such as hypertension among patients with acute cerebral ischemia.
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Affiliation(s)
- Kristian Barlinn
- Department of Neurology, Comprehensive Stroke Center, University of Alabama Hospital, Birmingham, Alabama; Dresden University Stroke Center, Department of Neurology, University Hospital Carl Gustav Carus Dresden, University of Technology Dresden, Dresden, Germany.
| | - Stanislava Kolieskova
- Department of Neurology, Comprehensive Stroke Center, University of Alabama Hospital, Birmingham, Alabama; International Clinical Research Centre, St. Anne's University Hospital, Brno, Czech Republic; Neurology Department, Masaryk University, Brno, Czech Republic
| | - Reza Bavarsad Shahripour
- Department of Neurology, Comprehensive Stroke Center, University of Alabama Hospital, Birmingham, Alabama
| | - Jessica Kepplinger
- Dresden University Stroke Center, Department of Neurology, University Hospital Carl Gustav Carus Dresden, University of Technology Dresden, Dresden, Germany
| | - Amelia K Boehme
- Department of Epidemiology, School of Public Health, University of Alabama Hospital, Birmingham, Alabama
| | - Timo Siepmann
- Dresden University Stroke Center, Department of Neurology, University Hospital Carl Gustav Carus Dresden, University of Technology Dresden, Dresden, Germany
| | - Volker Puetz
- Dresden University Stroke Center, Department of Neurology, University Hospital Carl Gustav Carus Dresden, University of Technology Dresden, Dresden, Germany
| | - Ulf Bodechtel
- Dresden University Stroke Center, Department of Neurology, University Hospital Carl Gustav Carus Dresden, University of Technology Dresden, Dresden, Germany
| | - William D Jordan
- Department of Vascular Surgery, University of Alabama Hospital, Birmingham, Alabama
| | - Andrei V Alexandrov
- Department of Neurology, Comprehensive Stroke Center, University of Alabama Hospital, Birmingham, Alabama; Department of Neurology, The University of Tennessee Health Science Center, Memphis, Tennessee
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O'Neal WT, Efird JT, Nazarian S, Alonso A, Heckbert SR, Soliman EZ. Peripheral arterial disease and risk of atrial fibrillation and stroke: the Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc 2014; 3:e001270. [PMID: 25404190 PMCID: PMC4338716 DOI: 10.1161/jaha.114.001270] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Peripheral arterial disease (PAD) shares several risk factors with atrial fibrillation (AF), and persons with PAD have an increased risk of stroke. It is unclear if PAD is associated with an increased risk for AF and whether this potential association explains the increased risk of stroke observed in those with PAD. METHODS AND RESULTS We examined the association between PAD, measured by ankle-brachial index (ABI), and incident AF and incident stroke, separately, in 6568 participants (mean age 62±10 years, 53% women, 62% nonwhite) from the Multi-Ethnic Study of Atherosclerosis (MESA). ABI values <1.0 or >1.4 defined PAD. AF was ascertained through review of hospital discharge records and from Medicare claims data until December 31, 2010. An independent adjudication committee ascertained stroke events. Cox regression was used to estimate hazard ratios and 95% CIs for the association between PAD and AF and stroke. Over a median follow-up of 8.5 years, 301 (4.6%) participants developed AF and 140 (2.1%) developed stroke. In a model adjusted for sociodemographics, cardiovascular risk factors, and potential confounders, PAD was associated with an increased risk of AF (hazard ratio 1.5, 95% CI 1.1 to 2.0). In a similar model, PAD was associated with incident stroke (hazard ratio 1.7, 95% CI 1.1 to 2.5), and the magnitude of risk was not different after inclusion of AF as a time-dependent covariate (hazard ratio 1.7, 95% CI 1.1 to 2.5). CONCLUSIONS PAD is associated with an increased risk of AF and stroke in MESA. Potentially, the relationship between PAD and stroke is not mediated by AF.
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Affiliation(s)
- Wesley T O'Neal
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC (W.T.N.)
| | - Jimmy T Efird
- Department of Cardiovascular Sciences, East Carolina Heart Institute, Brody School of Medicine, East Carolina University, Greenville, NC (J.T.E.)
| | - Saman Nazarian
- Departments of Medicine and Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD (S.N.)
| | - Alvaro Alonso
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN (A.A.)
| | - Susan R Heckbert
- Cardiovascular Health Research Unit and Department of Epidemiology, University of Washington and Group Health Research Institute, Seattle, WA (S.R.H.)
| | - Elsayed Z Soliman
- Epidemiological Cardiology Research Center (EPICARE), Departments of Epidemiology and Prevention and Internal Medicine, Section on Cardiology, Wake Forest School of Medicine, Winston Salem, NC (E.Z.S.)
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50
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Jeng JS, Sun Y, Lee JT, Lin RT, Chen CH, Po HL, Lin HJ, Liu CH, Sun MH, Sun MC, Chern CM, Lien LM, Chiu HC, Hu HH, Chiou HY, Chen ST, Ma H, Hsu CY. The efficacy and safety of cilostazol in ischemic stroke patients with peripheral arterial disease (SPAD): protocol of a randomized, double-blind, placebo-controlled multicenter trial. Int J Stroke 2014; 10:123-7. [PMID: 25394855 DOI: 10.1111/ijs.12384] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 08/15/2014] [Indexed: 12/23/2022]
Abstract
RATIONALE It is not uncommon for patients with ischemic stroke to have peripheral arterial disease (PAD). Patients with polyvascular diseases carry greater burden of atherosclerosis and higher risks of developing vascular events and death. More effective regimens, such as dual antiplatelet agents, may be more effective for controlling progression of atherosclerosis in secondary prevention. AIM This study aims to evaluate whether cilostazol plus aspirin is more efficacious than aspirin alone for preventing progression of atherosclerosis in patients with ischemic stroke or transient ischemic attack (TIA) who also have peripheral arterial disease. DESIGN The Safety and Efficacy of Cilostazol in Ischemic Stroke Patients with Peripheral Arterial Disease (SPAD) study is a randomized double-blinded placebo-controlled trial. Patients with previous ischemic stroke or TIA who had been taking aspirin (100 mg per day), aged 50 years or older, with PAD in the lower limbs based on ankle-brachial index (ABI) <1·0 will be randomized into the treatment group with cilostazol (200 mg/day) or the placebo group on 1:1 basis. STUDY OUTCOMES Patients will be evaluated at 1, 3, 6, 9 and 12 months after randomization. The primary endpoint is difference in change in ABI between groups. The secondary and tertiary endpoints are the difference between groups in change in carotid intima-media thickness (IMT) and incidence rate of major cardiovascular events, including recurrent stroke, myocardial infarction, unstable angina, other vascular events, and death; and the safety measures, including major bleeding events, hemorrhagic stroke and death of any cause. CONCLUSION The SPAD trial is the first study to evaluate the safety and efficacy of dual antiplatelet agents, aspirin plus cilostazol, in comparison with aspirin alone in patients with both ischemic stroke or TIA and PAD. Results from this trial will provide important information on the merit of adding cilostazol to aspirin for slowing down progression of atherosclerosis in patients with ischemic stroke and PAD.
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Affiliation(s)
- Jiann-Shing Jeng
- Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
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