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Zaib S, Ahmad S, Khan I, Bin Jardan YA, Fentahun Wondmie G. An evaluation of inflammatory and endothelial dysfunction markers as determinants of peripheral arterial disease in those with diabetes mellitus. Sci Rep 2024; 14:15348. [PMID: 38961103 PMCID: PMC11222457 DOI: 10.1038/s41598-024-65188-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 06/18/2024] [Indexed: 07/05/2024] Open
Abstract
The most serious long-term effects of diabetes is peripheral artery disease (PAD) which increases the chance of developing diabetic foot ulcers, gangrene and even lower limb amputation. The clinical manifestations of PAD which are typically not revealed until symptoms like intermittent claudication, rest pain and ischemic gangrene develop, are not present in majority of diabetes mellitus patients with PAD due to diabetic peripheral neuropathy. Therefore, current study is aimed to evaluate the inflammatory and endothelial dysfunction markers with their correlation to biomarkers that can help for in-time diagnosis and efficient prognosis of developing diabetes-associated PAD. Enzyme-linked immunosorbent assay was used to evaluate the interlukin-6, interlukin-8, intercellular adhesion molecule (ICAM) and vascular cell adhesion molecule (VCAM) in PAD with diabetes group, diabetic group and healthy individual group while biomarkers were measured by kit method. It was observed that serum IL-6, IL-8, ICAM and VCAM levels in type II diabetes mellitus (T2DM) with PAD patients were increased significantly (85.93, 597.08, 94.80 and 80.66) as compared to T2DM patients (59.52, 231.34, 56.88 and 50.19) and healthy individuals (4.81, 16.93, 5.55 and 5.16). The overall means for the parameters, IL-6, IL-8, ICAM, VCAM, urea, S/creatinine, CK-MB, AST, ALT, cholesterol, triglyceride, HDL, LDL, PT, aPTT, INR, HbA1C, and CRP within all groups were significantly (P < 0.05) different from each other. Therefore, it was concluded that the change in IL-6, IL-8, ICAM and VCAM can serve as an accurate diagnostic indicator and successful treatment.
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Affiliation(s)
- Sumera Zaib
- Department of Basic and Applied Chemistry, Faculty of Science and Technology, University of Central Punjab, Lahore, 54590, Pakistan.
| | - Shabbir Ahmad
- Department of Basic and Applied Chemistry, Faculty of Science and Technology, University of Central Punjab, Lahore, 54590, Pakistan
| | - Imtiaz Khan
- Department of Chemistry and Manchester Institute of Biotechnology, The University of Manchester, 131 Princess Street, Manchester, M1 7DN, UK.
| | - Yousef A Bin Jardan
- Department of Pharmaceutics, College of Pharmacy, King Saud University, P.O. Box 11451, Riyadh, Saudi Arabia
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Pekcan A, Roohani I, Stoneburner J, Boudiab E, O'Brien D, Cordero JJ, Carey JN. Comparison of Postoperative Complications in Patients Undergoing Limb Salvage Reconstructive Surgery Based on Estimated Prevalence of Preexisting Peripheral Arterial Disease. Ann Plast Surg 2024; 92:320-326. [PMID: 38170990 DOI: 10.1097/sap.0000000000003732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
BACKGROUND Limb salvage after lower extremity (LE) trauma requires optimal blood flow for successful microsurgical reconstruction. Peripheral arterial disease (PAD) decreases LE perfusion, affecting wound healing. Patients who present with LE trauma may have undiagnosed PAD, particularly those with atherosclerotic risk factors. This study assesses outcomes after LE salvage in patients at risk for PAD. METHODS This retrospective review evaluated patients who underwent LE reconstruction at a level 1 trauma center between 2007 and 2022. Patients with a nontraumatic mechanism of injury, missing postoperative records, and unspecified race were excluded. Demographics, flap characteristics, and postoperative complications were abstracted. The prevalence of LE PAD was calculated using a validated risk assessment tool. RESULTS At our institution, 285 LE flaps performed on 254 patients were included in the study. Patients were categorized by prevalence of PAD, including 12 (4.7%) with high risk, 45 (17.7%) with intermediate risk, and 197 (77.6%) patients with low risk. The high-risk cohort had higher rates of partial flap necrosis ( P = 0.037), flap loss ( P = 0.006), and amputation ( P < 0.001) compared with the low-risk group. Fewer high-risk patients achieved full ambulation compared with the low-risk ( P = 0.005) cohort. Overall flap survival and limb salvage rates were 94.5% and 96.5%, respectively. Among the intermediate- and high-risk cohorts, only 50.9% of patients received a preoperative vascular assessment, and 3.8% received a vascular surgery consultation. CONCLUSIONS Peripheral arterial disease represents a reconstructive challenge to microvascular surgeons. Patients with high-risk for PAD had higher rates of partial flap necrosis, flap loss, and amputation. In the setting of trauma, emphasis should be placed on preoperative vascular assessment for patients at risk of having undiagnosed PAD. Prospective studies collecting ankle-brachial index assessments and/or angiography will help validate this study's findings.
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Affiliation(s)
- Asli Pekcan
- From the Keck School of Medicine, University of Southern California
| | - Idean Roohani
- From the Keck School of Medicine, University of Southern California
| | - Jacqueline Stoneburner
- Division of Plastic and Reconstructive Surgery, Keck School of Medicine of USC, Los Angeles, CA
| | - Elizabeth Boudiab
- Department of General Surgery, Corewell Health William Beaumont University, Royal Oak, MI
| | - Devon O'Brien
- From the Keck School of Medicine, University of Southern California
| | - Justin J Cordero
- University of California Riverside School of Medicine, Riverside
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Rodway AD, Hanna L, Harris J, Jarrett R, Allan C, Pazos Casal F, Field BC, Whyte MB, Ntagiantas N, Walton I, Pankhania A, Skene SS, Maytham GD, Heiss C. Prognostic and predictive value of ultrasound-based estimated ankle brachial pressure index at early follow-up after endovascular revascularization of chronic limb-threatening ischaemia: a prospective, single-centre, service evaluation. EClinicalMedicine 2024; 68:102410. [PMID: 38273891 PMCID: PMC10809069 DOI: 10.1016/j.eclinm.2023.102410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/15/2023] [Accepted: 12/19/2023] [Indexed: 01/27/2024] Open
Abstract
Background Ankle brachial pressure index can be estimated (eABPI) using cuffless ankle Doppler ultrasound. We evaluated the prognostic value of eABPI measured during pre- and post-procedural ultrasound exams to predict the clinical outcome after endovascular revascularisations. Methods In this prospective, single-centre, service evaluation, consecutive patients with symptomatic peripheral artery disease undergoing lower limb endovascular revascularisations between July, 26 2018 and January, 13 2022 at Surrey and Sussex Healthcare NHS Trust (Redhill, UK) were analysed. eABPI was determined using the higher acceleration index measured with angle-corrected duplex ultrasound in ankle arteries before and ≤1 month post-procedure. Clinical outcomes (mortality, major amputations, amputation-free survival [AFS], clinically driven target lesion revascularization [cdTLR], major adverse limb events [MALE; cdTLR and major amputation], wound healing) were assessed over 1 year. Findings Of 246 patients treated, for 219 patients (median 75 [IQR 66-83] years) pre- and post-procedural eABPI (0.50 [0.33-0.59] and 0.90 [0.69-1.0], p < 0.0001) were available, respectively. In n = 199 patients with chronic limb-threatening ischaemia (CLTI) Kaplan-Meier survival analyses showed that higher post-procedural, but not pre-procedural, eABPI was associated with favourable AFS, MALE, cdTLR, and wound healing. This was confirmed in Cox regression analysis and remained significant with adjustment for pre-procedural eABPI, age, sex, co-morbidities, treated levels, wound score, and foot infection. Whereas all clinical outcomes, except for survival, were significantly better at ≥0.7 vs <0.7, wound healing (unadjusted: HR 1.7 (95% CI 1.2-2.6), adjusted: HR 2.1 (95% CI 1.3-3.1), cdTLR, and MALE (unadjusted: HR 0.41 (95% CI 0.18-0.93), adjusted: HR 0.28 (95% CI 0.11-0.74) were significantly improved at ≥0.9 vs <0.9. Interpretation Post-procedural eABPI can provide valid, clinically important prognostic and predictive information. Our data indicate that revascularisations should target values of at least 0.9 to achieve optimal outcomes. Future studies need to confirm generalisability and cost-effectiveness in a wider context. Funding European Partnership on Metrology, co-financed from European Union's Horizon Europe Research and Innovation Programme and UK Research and Innovation.
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Affiliation(s)
- Alexander D. Rodway
- Vascular Medicine Department, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | | | - Jenny Harris
- School of Health Sciences, University of Surrey, Guildford, UK
| | - Rachael Jarrett
- Vascular Medicine Department, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - Charlotte Allan
- Vascular Medicine Department, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - Felipe Pazos Casal
- Vascular Medicine Department, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - Benjamin C.T. Field
- Vascular Medicine Department, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Martin B. Whyte
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Nikolaos Ntagiantas
- Vascular Medicine Department, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
- St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Ivan Walton
- Vascular Medicine Department, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
- St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Ajay Pankhania
- Vascular Medicine Department, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - Simon S. Skene
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
| | - Gary D. Maytham
- Vascular Medicine Department, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
- St. George's University Hospitals NHS Foundation Trust, London, UK
| | - Christian Heiss
- Vascular Medicine Department, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
- Department of Clinical and Experimental Medicine, University of Surrey, Guildford, UK
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Nordanstig J, Behrendt CA, Baumgartner I, Belch J, Bäck M, Fitridge R, Hinchliffe R, Lejay A, Mills JL, Rother U, Sigvant B, Spanos K, Szeberin Z, van de Water W, Antoniou GA, Björck M, Gonçalves FB, Coscas R, Dias NV, Van Herzeele I, Lepidi S, Mees BME, Resch TA, Ricco JB, Trimarchi S, Twine CP, Tulamo R, Wanhainen A, Boyle JR, Brodmann M, Dardik A, Dick F, Goëffic Y, Holden A, Kakkos SK, Kolh P, McDermott MM. Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Asymptomatic Lower Limb Peripheral Arterial Disease and Intermittent Claudication. Eur J Vasc Endovasc Surg 2024; 67:9-96. [PMID: 37949800 DOI: 10.1016/j.ejvs.2023.08.067] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 11/12/2023]
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Taharboucht S, Guermaz R, Brouri M, Bengherbia L, Chibane A. Ankle systolic pressure index in non-diabetic non-alcoholic fatty liver disease: A case-control study. JOURNAL DE MEDECINE VASCULAIRE 2023; 48:154-162. [PMID: 38035921 DOI: 10.1016/j.jdmv.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 10/19/2023] [Indexed: 12/02/2023]
Abstract
INTRODUCTION Several studies have shown that mortality in Non-alcoholic Fatty Liver Disease (NAFLD) or metabolic steatopathy is more related to cardiovascular diseases than to hepatic complications. Our work aimed to verify the relationship between this liver disease and the ankle-brachial pressure index (ABPI), which is a good screening tool for peripheral arterial disease (PAD) and a reliable marker of cardiovascular risk. PATIENTS AND METHODS A prospective sex- and age-matched case-control study was conducted in non-diabetic patients aged 30 to 70 years. All patients underwent a clinical and biological evaluation. Hepatic steatosis was diagnosed by ultrasound. All participants had their ankle-brachial pressure index measured using a Dopplex® Pocket Doppler in addition to arterial ultrasound of the supra-aortic trunk and a carotid-femoral pulse wave velocity (CfPWV) measurement. An ABPI<0.9 was considered pathological (suggestive of PAD). Statistical analyses were performed using SPSS 21.0 software (IBM). RESULTS In total, 213 NAFLD patients (100 men/113 women) with a mean age of 48.5±10.14 years were matched to 213 controls. Metabolic syndrome (MS) was more common in NAFLD than in controls, regardless of the International Diabetes Federation (IDF 2005) criteria used (P<0.001). Low ABPI (<0.90) was noted in 19 (8.9%) NAFLD patients vs. 5 (2.3%) in controls (P=0.003). The mean age of these patients was 48.8±8.6 years with a female predominance (20 patients). 62.5% reported dyslipidemia on questioning, 70.8% a metabolic syndrome according to the IDF and 12.5% (3/24) of them were active smokers. There were no records of mediacalcosis. PAD was significantly associated with NAFLD in univariate analysis (OR=4.0 CI 95% (1.4-11.1)). Factors independently associated with PAD in NAFLD patients were nocturnal systolic blood pressure, smoking, thigh circumference, and being a female. CONCLUSION The findings of our study show a significant association between NAFLD and low ABPI, likely reflecting the high vascular risk of this patient population.
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Affiliation(s)
| | | | | | | | - Ahcene Chibane
- Service de médecine interne, CHU de Douera, Alger, Algeria
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Dorn A, Dorweiler B, Ahmad W, Mylonas S, Becker I, Majd P. Low and High Ankle-Brachial Index Are Both Associated with Mortality in German Nursing Home Residents-The Five-Year Follow-Up of the "Allo-Study" Cohort. J Clin Med 2023; 12:4411. [PMID: 37445445 PMCID: PMC10343002 DOI: 10.3390/jcm12134411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/20/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Peripheral arterial disease (PAD) is associated with high cardiovascular morbidity and mortality. We aimed to examine this relation in a population that tends to be under-represented in research on the topic. In a prospective observational cohort study, residents of 45 nursing homes in Germany were screened for pathological ankle-brachial index (ABI) and observed for five years. Of 1333 participants (median age 84 years), 55.5% had a pathological ABI (≤0.9 or >1.4) on one or both legs. 84.7% of the probands with a low ABI (indicating PAD) had no previously known PAD diagnosis. The five-year mortality was 73.0%. Mortality was higher in individuals with a pathological ABI (76.5%) than in those with a normal ABI (68.7%, p = 0.003). An ABI > 1.4 was associated with a higher mortality (79.4%) than a reduced (74.7%) or normal ABI (68.7%, p = 0.011). Pathological ABI values were associated with an increase in mortality after correction for age, sex and all recorded comorbidities, including cardiac disease. Although PAD is highly prevalent in nursing home residents, it is underdiagnosed and undertreated. In the study cohort, both high and low ABI were important predictors of mortality. PAD deserves more attention in this high-risk population.
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Affiliation(s)
- Anna Dorn
- Vascular Surgery Department, Protestant Hospital, 51465 Bergisch Gladbach, Germany;
| | - Bernhard Dorweiler
- Vascular Surgery Department, University Hospital of Cologne, 50937 Cologne, Germany; (B.D.); (W.A.); (S.M.)
| | - Wael Ahmad
- Vascular Surgery Department, University Hospital of Cologne, 50937 Cologne, Germany; (B.D.); (W.A.); (S.M.)
| | - Spyridon Mylonas
- Vascular Surgery Department, University Hospital of Cologne, 50937 Cologne, Germany; (B.D.); (W.A.); (S.M.)
| | - Ingrid Becker
- Institute of Medical Statistics and Computational Biology, University Hospital of Cologne, 50937 Cologne, Germany;
| | - Payman Majd
- Vascular Surgery Department, Protestant Hospital, 51465 Bergisch Gladbach, Germany;
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Ramírez-Torres JM, López-Téllez A, Ariza MJ, Rioja J, García-Casares N, Rodríguez EEG, García JAR, Chaparro MAS, Barbancho MA, Valdivielso P. Subclinical atherosclerosis burden in non-diabetic hypertensives treated in primary care center: the IMTABI study. BMC PRIMARY CARE 2023; 24:43. [PMID: 36759767 PMCID: PMC9912653 DOI: 10.1186/s12875-023-01997-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/30/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Identifying patients at high risk of cardiovascular disease in primary prevention is a challenging task. This study aimed at detecting subclinical atherosclerosis burden in non-diabetic hypertensive patients in a primary care centre. METHODS Clinical, anthropometric and analytical data were collected from patients with hypertension who were free from clinical vascular disease and diabetes. The cardiovascular risk was assessed using the SCORE system. Subclinical atherosclerosis burden was assessed by carotid ultrasonography (intima-medial thickness [IMT] and plaque) and measurement of the ankle-brachial index (ABI). RESULTS Out of 140 patients, 59 (42%) have carotid plaque, 32 (23%) have IMT higher than 75% and 12 (9%) have an ABI < 0.9. Total atherosclerosis burden was present in 91 (65%) of the subjects. Consequently, 59 (42%) patients were re-classified into the very high-risk category. In multivariate analyses, smoking, creatinine levels and duration of hypertension were associated with atherosclerosis burden. In contrast, only smoking and age were associated with the presence of carotid plaque. Almost 90% of patients were treated with hypotensive drugs, half of them combined several drugs and 60% were well-controlled. Only 30% received statins in monotherapy and only less than 20% had an LDL cholesterol < 100 mg/dL. CONCLUSIONS In non-diabetic hypertensive patients managed at a primary care centre, 4 out of 10 had subclinical atherosclerosis burden and were re-classified into the very high- risk category. There was clear undertreatment with lipid-lowering drugs of most LDL cholesterol inappropriate levels, according to current clinical guidelines.
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Affiliation(s)
| | - Antonio López-Téllez
- grid.418355.eCentro de Salud Puerta Blanca, Servicio Andaluz de Salud, Málaga, Spain
| | - María J. Ariza
- grid.10215.370000 0001 2298 7828Lipids and Atherosclerosis Laboratory, Department of Medicine and Dermatology, Centro de Investigaciones Medico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain
| | - José Rioja
- grid.10215.370000 0001 2298 7828Lipids and Atherosclerosis Laboratory, Department of Medicine and Dermatology, Centro de Investigaciones Medico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain
| | - Natalia García-Casares
- grid.10215.370000 0001 2298 7828Lipids and Atherosclerosis Laboratory, Department of Medicine and Dermatology, Centro de Investigaciones Medico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain
| | | | | | - Miguel A. Sánchez Chaparro
- grid.10215.370000 0001 2298 7828Lipids and Atherosclerosis Laboratory, Department of Medicine and Dermatology, Centro de Investigaciones Medico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain ,grid.411062.00000 0000 9788 2492Servicio de Medicina Interna, Hospital Universitario Virgen de La Victoria, Málaga, Spain
| | - Miguel A. Barbancho
- grid.10215.370000 0001 2298 7828Departamento de Fisiología Humana, Universidad de Málaga, Málaga, Spain
| | - Pedro Valdivielso
- Lipids and Atherosclerosis Laboratory, Department of Medicine and Dermatology, Centro de Investigaciones Medico Sanitarias (CIMES), Instituto de Investigación Biomédica de Málaga (IBIMA), University of Málaga, Málaga, Spain. .,Servicio de Medicina Interna, Hospital Universitario Virgen de La Victoria, Málaga, Spain.
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8
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Martin-Ventura JL, Roncal C, Orbe J, Blanco-Colio LM. Role of Extracellular Vesicles as Potential Diagnostic and/or Therapeutic Biomarkers in Chronic Cardiovascular Diseases. Front Cell Dev Biol 2022; 10:813885. [PMID: 35155428 PMCID: PMC8827403 DOI: 10.3389/fcell.2022.813885] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/10/2022] [Indexed: 12/12/2022] Open
Abstract
Cardiovascular diseases (CVDs) are the first cause of death worldwide. In recent years, there has been great interest in the analysis of extracellular vesicles (EVs), including exosomes and microparticles, as potential mediators of biological communication between circulating cells/plasma and cells of the vasculature. Besides their activity as biological effectors, EVs have been also investigated as circulating/systemic biomarkers in different acute and chronic CVDs. In this review, the role of EVs as potential diagnostic and prognostic biomarkers in chronic cardiovascular diseases, including atherosclerosis (mainly, peripheral arterial disease, PAD), aortic stenosis (AS) and aortic aneurysms (AAs), will be described. Mechanistically, we will analyze the implication of EVs in pathological processes associated to cardiovascular remodeling, with special emphasis in their role in vascular and valvular calcification. Specifically, we will focus on the participation of EVs in calcium accumulation in the pathological vascular wall and aortic valves, involving the phenotypic change of vascular smooth muscle cells (SMCs) or valvular interstitial cells (IC) to osteoblast-like cells. The knowledge of the implication of EVs in the pathogenic mechanisms of cardiovascular remodeling is still to be completely deciphered but there are promising results supporting their potential translational application to the diagnosis and therapy of different CVDs.
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Affiliation(s)
- Jose Luis Martin-Ventura
- Vascular Research Laboratory, IIS-Fundación Jiménez-Díaz, Madrid, Spain
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- *Correspondence: Jose Luis Martin-Ventura, ; Carmen Roncal,
| | - Carmen Roncal
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Laboratory of Atherothrombosis, Program of Cardiovascular Diseases, Cima Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra, IdiSNA, Pamplona, Spain
- *Correspondence: Jose Luis Martin-Ventura, ; Carmen Roncal,
| | - Josune Orbe
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
- Laboratory of Atherothrombosis, Program of Cardiovascular Diseases, Cima Universidad de Navarra, Instituto de Investigación Sanitaria de Navarra, IdiSNA, Pamplona, Spain
| | - Luis Miguel Blanco-Colio
- Vascular Research Laboratory, IIS-Fundación Jiménez-Díaz, Madrid, Spain
- CIBER de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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Bakhshi H, Bagchi P, Meyghani Z, Tehrani B, Qian X, Garg PK, Ambale-Venkatesh B, Bhatia HS, Ohyama Y, Wu CO, Budoff M, Allison M, Criqui MH, Bluemke DA, Lima JAC, deFilippi CR. Association of coronary artery calcification and thoracic aortic calcification with incident peripheral arterial disease in the Multi-Ethnic Study of Atherosclerosis (MESA). EUROPEAN HEART JOURNAL OPEN 2021; 1:oeab042. [PMID: 35005719 PMCID: PMC8717048 DOI: 10.1093/ehjopen/oeab042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 11/18/2021] [Indexed: 11/14/2022]
Abstract
Abstract
Aims
The association of subclinical atherosclerotic disease in the coronary arteries and thoracic aorta with incident peripheral arterial disease (PAD) is unknown. We investigated the association between coronary artery calcium score (CACs) and thoracic aortic calcium score (TACs) with incident clinical and subclinical PAD.
Methods and results
The Multi-Ethnic Study of Atherosclerosis (MESA) recruited 6814 men and women aged 45–84 from four ethnic groups who were free of clinical cardiovascular disease at enrolment. Coronary artery calcium score and thoracic aortic calcium score were measured from computed tomography scans. Participants with a baseline ankle-brachial index (ABI) ≤0.90 or >1.4 were excluded. Abnormal ABI was defined as ABI ≤0.9 or >1.4 at follow-up exam. Multivariable logistic regression and Cox proportional hazards models were used to test the associations between baseline CACs and TACs with incident abnormal ABI and clinical PAD, respectively. A total of 6409 participants (female: 52.8%) with a mean age of 61 years were analysed. Over a median follow-up of 16.7 years, 91 participants developed clinical PAD. In multivariable analysis, each unit increase in log (CACS + 1) and log (TACs + 1) were associated with 23% and 13% (P < 0.01for both) higher risk of incident clinical PAD, respectively. In 5725 (female: 52.6%) participants with an available follow-up ABI over median 9.2 years, each 1-unit increase in log (CACs + 1) and log (TACs + 1) were independently associated with 1.15-fold and 1.07-fold (P < 0.01for both) higher odds of incident abnormal ABI, respectively.
Conclusion
Higher baseline CACs and TACs predict abnormal ABI and clinical PAD independent of traditional cardiovascular risk factors and baseline ABI.
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Affiliation(s)
- Hooman Bakhshi
- Inova Heart and Vascular Institute , 3300 Gallows Road, 1st Floor Suite I—1225, Falls Church, VA 22042, USA
| | - Pramita Bagchi
- Department of Statistics, George Mason University , Fairfax, VA, USA
| | - Zahra Meyghani
- Department of Medicine, Inova Fairfax Medical Campus , Falls Church, VA, USA
| | - Behnam Tehrani
- Inova Heart and Vascular Institute , 3300 Gallows Road, 1st Floor Suite I—1225, Falls Church, VA 22042, USA
| | - Xiaoxiao Qian
- Inova Heart and Vascular Institute , 3300 Gallows Road, 1st Floor Suite I—1225, Falls Church, VA 22042, USA
| | - Parveen K Garg
- Division of Cardiology, University of Southern California Keck School of Medicine , Los Angeles, CA, USA
| | | | - Harpreet S Bhatia
- Division of Cardiovascular Medicine, Department of Medicine, University of California, San Diego , La Jolla, CA, USA
| | - Yoshiaki Ohyama
- Clinical Investigation and Research Unit, Gunma University Hospital , Maebashi, Japan
| | - Colin O Wu
- Office of Biostatistics Research, National Heart Lung and Blood Institute , Bethesda, MD, USA
| | - Matthew Budoff
- Lundquist Institute at Harbor UCLA Medical Center , Torrance, CA, USA
| | - Matthew Allison
- Department of Family Medicine and Public Health, University of California, San Diego , La Jolla, CA, USA
| | - Michael H Criqui
- Department of Family Medicine and Public Health, University of California, San Diego , La Jolla, CA, USA
| | - David A Bluemke
- Department of Radiology, University of Wisconsin School of Medicine and Public Health , Madison, WI, USA
| | - Joao A C Lima
- Division of Cardiology, Johns Hopkins University , Baltimore, MD, USA
| | - Christopher R deFilippi
- Inova Heart and Vascular Institute , 3300 Gallows Road, 1st Floor Suite I—1225, Falls Church, VA 22042, USA
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Shi L, Zhang Q, Song SN, Ma L, Chang Q, Zhang SY. Correlation between 25-hydroxyvitamin D level and arterial elasticity in middle-aged and elderly cadres in Guiyang, China: A retrospective observational study. Medicine (Baltimore) 2021; 100:e25826. [PMID: 33950991 PMCID: PMC8104250 DOI: 10.1097/md.0000000000025826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 04/11/2021] [Indexed: 01/04/2023] Open
Abstract
There is evidence that serum 25-hydroxyvitamin D [25-(OH) D] levels may be associated with cardiovascular disease and its risk factors. This study aimed to investigate the relationship between 25-(OH) D levels and blood pressure (BP), blood lipids, and arterial elasticity in middle-aged and elderly cadres in China.In this retrospective study, we included 401 civil servants and cadres aged >42 years who underwent medical examinations at Guiyang Municipal First People's Hospital, China in 2018. The participants were assigned to deficiency (≤20 ng/mL), insufficiency (20-30 ng/mL), and sufficiency (≥30 ng/mL) groups according to 25-(OH) D levels in their blood. Demographics, brachial-ankle pulse wave velocity (baPWV), BP, ankle-brachial index (ABI), and blood lipids were compared among groups. The associations between 25-(OH) D and other parameters were evaluated using linear regression analysis.Median (range) 25-(OH) D levels in the deficiency (n = 162), insufficiency (n = 162), and sufficiency (n = 77) groups were 15.32 (2.93-19.88), 25.12 (20.07-29.91), and 33.91 (30.23-82.42) ng/mL, respectively. There were significant differences in systolic BP, pulse pressure, baPWV (left and right sides), ABI (left side), high-density lipoprotein-cholesterol, and triglycerides (TGs; all P < .05) among groups. Multivariate linear regression revealed that TG, left baPWV, and right baPWV were significantly negatively correlated with 25-(OH) D levels (all P < .05).In this study, 25-(OH) D levels were found to be associated with TG, left baPWV, and right baPWV values. 25-(OH) D deficiency may be associated with reduced arterial elasticity.
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Affiliation(s)
- Lan Shi
- Department of General Medicine, Guiyang First People's Hospital
| | - Qiao Zhang
- Department of Endocrinology, Guizhou Medical University, Guiyang, Guizhou, China
| | - Sai-Nan Song
- Department of General Medicine, Guiyang First People's Hospital
| | - Lin Ma
- Department of General Medicine, Guiyang First People's Hospital
| | - Qing Chang
- Department of General Medicine, Guiyang First People's Hospital
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11
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Nie F, He J, Cao H, Hu X. Predictive value of abnormal ankle-brachial index in patients with diabetes: A meta-analysis. Diabetes Res Clin Pract 2021; 174:108723. [PMID: 33647330 DOI: 10.1016/j.diabres.2021.108723] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 01/11/2021] [Accepted: 02/09/2021] [Indexed: 11/17/2022]
Abstract
AIMS This meta-analysis aimed to examine the association of abnormal ankle brachial index (ABI) with adverse prognosis in patients with diabetes. METHODS We systematically searched PubMed and Embase databases from inception to October 31, 2020 for observational studies investigating the predictive utility of abnormal ABI in patients with diabetes. The normal ABI is usually defined by 0.9-1.3 or 1.4. RESULTS Data were collected from 9 studies involving 9673 patients. When compared with the reference normal ABI, abnormal ABI was associated with a higher risk of cardiovascular mortality (risk ratio [RR] 1.98; 95% confidence intervals [CI] 1.66-2.37), all-cause mortality (RR 2.12; 95% CI 1.81-2.49), and major adverse cardiovascular events ([MACEs] RR 2.37; 95% CI 1.73-3.26). Subgroup analysis indicated that the pooled RR of cardiovascular mortality was similar in individuals with abnormally low ABI (RR 1.98; 95% CI 1.64-2.39) or high ABI (RR 2.00; 95% CI 1.12-3.59). CONCLUSIONS Abnormal ABI independently predicts subsequent risk of cardiovascular or all-cause mortality and MACEs in patients with diabetes. However, the predictive role of abnormal ABI is largely dominated by the low ABI rather than the high ABI.
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Affiliation(s)
- Fengze Nie
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang 110001, PR China
| | - Jiaan He
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang 110001, PR China
| | - Hui Cao
- Department of Endovascular Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, PR China
| | - Xinhua Hu
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang 110001, PR China.
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12
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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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13
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Saenz-Pipaon G, Martinez-Aguilar E, Orbe J, González Miqueo A, Fernandez-Alonso L, Paramo JA, Roncal C. The Role of Circulating Biomarkers in Peripheral Arterial Disease. Int J Mol Sci 2021; 22:ijms22073601. [PMID: 33808453 PMCID: PMC8036489 DOI: 10.3390/ijms22073601] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 03/25/2021] [Accepted: 03/26/2021] [Indexed: 12/18/2022] Open
Abstract
Peripheral arterial disease (PAD) of the lower extremities is a chronic illness predominantly of atherosclerotic aetiology, associated to traditional cardiovascular (CV) risk factors. It is one of the most prevalent CV conditions worldwide in subjects >65 years, estimated to increase greatly with the aging of the population, becoming a severe socioeconomic problem in the future. The narrowing and thrombotic occlusion of the lower limb arteries impairs the walking function as the disease progresses, increasing the risk of CV events (myocardial infarction and stroke), amputation and death. Despite its poor prognosis, PAD patients are scarcely identified until the disease is advanced, highlighting the need for reliable biomarkers for PAD patient stratification, that might also contribute to define more personalized medical treatments. In this review, we will discuss the usefulness of inflammatory molecules, matrix metalloproteinases (MMPs), and cardiac damage markers, as well as novel components of the liquid biopsy, extracellular vesicles (EVs), and non-coding RNAs for lower limb PAD identification, stratification, and outcome assessment. We will also explore the potential of machine learning methods to build prediction models to refine PAD assessment. In this line, the usefulness of multimarker approaches to evaluate this complex multifactorial disease will be also discussed.
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Affiliation(s)
- Goren Saenz-Pipaon
- Laboratory of Atherothrombosis, Program of Cardiovascular Diseases, Cima Universidad de Navarra, 31008 Pamplona, Spain; (G.S.-P.); (J.O.); (J.A.P.)
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain; (E.M.-A.); (A.G.M.); (L.F.-A.)
| | - Esther Martinez-Aguilar
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain; (E.M.-A.); (A.G.M.); (L.F.-A.)
- Departamento de Angiología y Cirugía Vascular, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain
| | - Josune Orbe
- Laboratory of Atherothrombosis, Program of Cardiovascular Diseases, Cima Universidad de Navarra, 31008 Pamplona, Spain; (G.S.-P.); (J.O.); (J.A.P.)
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain; (E.M.-A.); (A.G.M.); (L.F.-A.)
- CIBERCV, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Arantxa González Miqueo
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain; (E.M.-A.); (A.G.M.); (L.F.-A.)
- CIBERCV, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Laboratory of Heart Failure, Program of Cardiovascular Diseases, Cima Universidad de Navarra, 31008 Pamplona, Spain
| | - Leopoldo Fernandez-Alonso
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain; (E.M.-A.); (A.G.M.); (L.F.-A.)
- Departamento de Angiología y Cirugía Vascular, Complejo Hospitalario de Navarra, 31008 Pamplona, Spain
| | - Jose Antonio Paramo
- Laboratory of Atherothrombosis, Program of Cardiovascular Diseases, Cima Universidad de Navarra, 31008 Pamplona, Spain; (G.S.-P.); (J.O.); (J.A.P.)
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain; (E.M.-A.); (A.G.M.); (L.F.-A.)
- CIBERCV, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Hematology Service, Clínica Universidad de Navarra, 31008 Pamplona, Spain
| | - Carmen Roncal
- Laboratory of Atherothrombosis, Program of Cardiovascular Diseases, Cima Universidad de Navarra, 31008 Pamplona, Spain; (G.S.-P.); (J.O.); (J.A.P.)
- IdiSNA, Instituto de Investigación Sanitaria de Navarra, 31008 Pamplona, Spain; (E.M.-A.); (A.G.M.); (L.F.-A.)
- CIBERCV, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-948194700
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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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Hajibandeh S, Hajibandeh S, Hussain I, Zubairu A, Akbar F, Maw A. Comparison of treatment strategies for splenic flexure colon cancer: reply to Wang et al. Colorectal Dis 2020; 22:2331-2332. [PMID: 32867000 DOI: 10.1111/codi.15340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 08/20/2020] [Indexed: 02/08/2023]
Affiliation(s)
- S Hajibandeh
- Department of Colorectal and General Surgery, Glan Clwyd Hospital, Rhyl, UK
| | - S Hajibandeh
- Department of General Surgery, Sandwell and West, Birmingham Hospitals NHS Trust, Birmingham, UK
| | - I Hussain
- Department of General Surgery, North Manchester General Hospital, Manchester, UK
| | - A Zubairu
- Department of General Surgery, North Manchester General Hospital, Manchester, UK
| | - F Akbar
- Department of Colorectal and General Surgery, Glan Clwyd Hospital, Rhyl, UK
| | - A Maw
- Department of Colorectal and General Surgery, Glan Clwyd Hospital, Rhyl, UK
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Sartipy F, Lundin F, Wahlberg E, Sigvant B. Cardiovascular long-term outcome and prophylactic treatment patterns in peripheral arterial disease in a population-based cohort. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2020; 5:310-320. [PMID: 31304962 DOI: 10.1093/ehjqcco/qcz037] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 07/08/2019] [Accepted: 07/12/2019] [Indexed: 12/31/2022]
Abstract
AIMS This study evaluates 10-year follow-up data on associated comorbidity, mortality, and pharmacological treatment patterns for men and women with different stages of peripheral arterial disease (PAD) in a population-based setting. METHODS AND RESULTS This was a prospective observational population-based cohort study, based on physical examinations and questionnaires at baseline supplemented with national register data between 2005 and 2015. Subjects were placed in subgroups defined by ankle-brachial index levels and reported symptoms; asymptomatic PAD (APAD), intermittent claudication (IC), severe limb ischaemia (SLI), or references (Ref). Cox proportional hazards regression models were used for analysis with adjustments for sex and baseline age and comorbidity. The cohort consisted of 5080 subjects (45% males). At baseline, APAD, IC, and SLI were prevalent in 559 (11%), 320 (6.3%), and 78 (1.5%) subjects, respectively. A significant increased risk for cardiovascular (CV) death, even when adjusted for age and baseline morbidity, were noted in all PAD stages as compared with reference group with a small difference between APAD and IC, an adjusted hazard ratio 1.80 (confidence interval 1.45-2.22) and 1.95 (1.50-2.53), respectively. Only about 60% of PAD subjects received medical prophylactic treatment as recommended in guidelines. CONCLUSION Peripheral arterial disease subjects had significantly increased CV morbidity and mortality risks, especially males. Asymptomatic PAD subjects confer similar risk for CV events as symptomatic patients. Our findings motivate enhanced preventive efforts of all PAD stages, including in asymptomatic disease.
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Affiliation(s)
- Fredrik Sartipy
- Department of Clinical Science and Education, Section of Vascular Surgery, Karolinska Institutet at Södersjukhuset, Kirurgkliniken, Sjukhusbacken 10, Stockholm, Sweden
| | - Fredrik Lundin
- Centre of Clinical Research, County Council of Värmland, Älvgatan 49, Karlstad, Sweden
| | - Eric Wahlberg
- Department of Medicine and Health, Linköping University, Linkoping University Hospital, SE Linköping, Sweden
| | - Birgitta Sigvant
- Department of Surgical Sciences, Uppsala University, Uppsala, Dag Hammarskjölds väg 38, Sweden
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17
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Cantú-Brito C, Chiquete E, Antezana-Castro JF, Toapanta-Yanchapaxi L, Ochoa-Guzmán A, Ruiz-Sandoval JL. Peripheral artery disease in outpatients with a recent history of acute coronary syndrome or at high atherothrombotic risk. Vascular 2020; 29:92-99. [PMID: 32638661 DOI: 10.1177/1708538120938921] [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] [Indexed: 01/28/2023]
Abstract
OBJECTIVES The frequency and implications of peripheral artery disease (PAD) in some risk groups are not entirely characterized in Latin America. We studied PAD prevalence, risk factors, and six-month outcomes in stable outpatients with a history of a recent acute coronary syndrome (ACS), or at high coronary risk. METHODS We recruited 830 outpatients in 43 Mexican sites (median age: 64.8 years; 57.8% men). Inclusion criteria were age >18 years, and ACS within 30 days, or age <55 years plus ≥2 major vascular risk factors, or age ≥55 years plus ≥1 vascular risk factors. Patients received standardized assessments at baseline and six-month follow-up for medical history, ankle-brachial index (ABI), and the Edinburgh Claudication Questionnaire (ECQ). RESULTS ABI <0.8 was found in 10.5%, <0.9 in 22.5%, >1.3 in 4.8%, and >1.4 in 3.6%, without differences according to sex or selection criteria. Positive ECQ was found in 7.6%. ABI <0.9 was directly associated with age, diabetes, ACS, and chronic kidney disease, but inversely associated with BMI >27. The six-month case-fatality and atherothrombotic events rates were 1.6% and 3.6%, respectively. In patients with ABI <0.9 and ABI <0.8, the six-month case-fatality rates were 2.5% (p = 0.27) and 5.4% (p = 0.03), respectively. In a Cox proportional-hazards model, baseline factors associated with death were age ≥65, ABI <0.8, and ACS. CONCLUSIONS Subclinical PAD is more common than symptomatic claudication in high-risk coronary outpatients. Low ABI is associated with reduced short-term survival in patients with recent ACS or at high coronary risk.
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Affiliation(s)
- Carlos Cantú-Brito
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Erwin Chiquete
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | | | - Liz Toapanta-Yanchapaxi
- Department of Neurology and Psychiatry, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - Ana Ochoa-Guzmán
- Molecular Biology Unit, Instituto Nacional de Ciencias Médicas y Nutrición "Salvador Zubirán", Mexico City, Mexico
| | - José Luis Ruiz-Sandoval
- Department of Neurology, Hospital Civil de Guadalajara "Fray Antonio Alcalde", Guadalajara, Mexico
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Liu L, Sun H, Nie F, Hu X. Prognostic Value of Abnormal Ankle–Brachial Index in Patients With Coronary Artery Disease: A Meta-Analysis. Angiology 2020; 71:491-497. [PMID: 32166959 DOI: 10.1177/0003319720911582] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The prognostic value of the ankle–brachial index (ABI) in patients with coronary artery disease (CAD) remains undefined. This meta-analysis sought to investigate the association of abnormal ABI and adverse outcomes in patients with CAD. PubMed, Embase, China National Knowledge Infrastructure, VIP, and Wanfang databases were comprehensively searched for studies published from inception to September 10, 2019. All observational studies investigating the association of abnormal baseline ABI and risk of major adverse cardiovascular events (MACE) or all-cause mortality were selected. Normal ABI is usually defined as between 0.9 and 1.4. The prognostic values were summarized by pooling risk ratio (RR) with 95% confidence intervals (CIs) for abnormal versus normal ABI category. Nine (9384 patients with CAD) studies were included. Abnormal ABI was independently associated with MACE (RR: 2.46; 95% CI: 2.02-2.99) and all-cause mortality (RR: 1.74; 95% CI: 1.32-2.30). Subgroup analysis showed that the pooled RR for MACE was 2.34 (95% CI: 1.73-3.16) for an abnormal low ABI. Abnormal ABI predicts MACE and all-cause mortality in patients with CAD, even after adjusting conventional confounding factors. However, the prognostic value of abnormal ABI is mainly dominated by a low ABI rather than a high ABI.
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Affiliation(s)
- Longguang Liu
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Hongxiao Sun
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Fengze Nie
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Xinhua Hu
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang, China
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Gaddi AV, Capello F, Gheorghe-Fronea OF, Fadda S, Darabont RO. Sulodexide improves pain-free walking distance in patients with lower extremity peripheral arterial disease: A systematic review and meta-analysis. JRSM Cardiovasc Dis 2020; 9:2048004020907002. [PMID: 32110390 PMCID: PMC7025427 DOI: 10.1177/2048004020907002] [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: 06/23/2019] [Revised: 12/22/2019] [Accepted: 01/07/2020] [Indexed: 01/22/2023] Open
Abstract
Peripheral arterial disease is associated with very high cardiovascular risk. The main symptom is intermittent claudication, which strongly affects the quality of life. Therefore, treatment goals in peripheral arterial disease consist of the reduction of cardiovascular events and the relief of symptoms. An increase in pain-free walking distance, evaluated based on the Initial Claudication Distance, was also a strong positive prognostic factor in patients with peripheral arterial disease. Our objective was to reassess whether sulodexide is effective in improving Initial Claudication Distance. For this, we searched the literature according to the PRISMA checklist for double blind clinical trials assessing the improvement in the Initial Claudication Distance after 90 days of standard therapeutic regimen with sulodexide in adult patients with peripheral arterial disease. We found and assessed for bias in 11 studies eligible for review and meta-analysis. Data extracted from those studies favoured the sulodexide group, showing an overall difference in Initial Claudication Distance of +68.9 (CI 95%; ± 11.9 m) at the end of treatment (p < 0.001). According to this review, sulodexide is effective in improving Initial Claudication Distance and consequently the quality of life in patients with peripheral arterial disease. Further studies are needed to assess the effects of this drug on disease progression in asymptomatic patients with peripheral arterial disease.
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Affiliation(s)
| | - Fabio Capello
- Department of Paediatrics, AUSL della Romagna, Ospedale Morgagni-Pierantoni, Forlì, Italy
| | - Oana Florentina Gheorghe-Fronea
- Discipline of Cardiology, Clinical Emergency Hospital Bucharest, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | | | - Roxana Oana Darabont
- Discipline of Internal Medicine and Cardiology, University Emergency Hospital Bucharest, University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
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20
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Yang Y, Liu L, Sun H, Nie F, Hu X. Relation between high Ankle-Brachial Index and cardiovascular outcomes in the general population and cardiovascular disease: a meta-analysis. INT ANGIOL 2019; 39:131-138. [PMID: 31814377 DOI: 10.23736/s0392-9590.19.04276-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Conflicting findings have been reported on the association between high Ankle-Brachial Index (ABI) and cardiovascular outcomes. This meta-analysis aimed to assess the association of abnormally high ABI and cardiovascular outcomes in the general population and suspected or established cardiovascular disease (CVD) patients. EVIDENCE ACQUISITION A comprehensive literature search was conducted in PubMed and Embase databases through November 10th, 2018. All observational studies evaluating the association of high ABI with cardiovascular events including stroke, coronary heart disease (CHD), congestive heart failure, and composite of CVD/all-cause mortality in the general population and suspected or established CVD patients were included. We pooled risk ratios (RR) with 95% confidence intervals (CI) for the abnormally high ABI (> 1.3 or >1.4) versus the reference normal ABI category. EVIDENCE SYNTHESIS We identified 10 cohort studies enrolling 39,421 participants. A random effect model meta-analysis indicated that the pooled RR of composite of CVD/all-cause mortality was 1.07 (95% CI 0.83-1.38) in the general population and 1.26 (95% CI 1.03-1.55) in suspected or established CVD patients. Moreover, participants with abnormally high ABI did not increase the risk of stroke (RR 1.60; 95% CI 0.83-3.06) and CHD (RR 1.40; 95% CI 0.87-2.24) in the general population. CONCLUSIONS Abnormally high ABI appears to be associated with an increased risk of a composite of CVD/all-cause mortality in suspected or established CVD patients but not in the general population. However, additional well-designed studies are required to support the current findings.
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Affiliation(s)
- Yu Yang
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Longguang Liu
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Hongxiao Sun
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Fengze Nie
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang, China
| | - Xinhua Hu
- Department of Vascular and Thyroid Surgery, The First Affiliated Hospital, China Medical University, Shenyang, China -
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Ruscica M, Macchi C, Fogacci F, Ferri N, Grandi E, Rizzoli E, D'Addato S, Borghi C, Cicero AF. Angiopoietin-like 3 and subclinical peripheral arterial disease: Evidence from the Brisighella Heart Study. Eur J Prev Cardiol 2019; 27:2251-2254. [PMID: 31648549 DOI: 10.1177/2047487319884378] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- Massimiliano Ruscica
- Pharmacological and Biomolecular Sciences Department, University of Milan, Italy
| | - Chiara Macchi
- Pharmacological and Biomolecular Sciences Department, University of Milan, Italy
| | - Federica Fogacci
- Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, Italy
| | - Nicola Ferri
- Department of Pharmaceutical and Pharmacological Sciences, University of Padova, Italy
| | - Elisa Grandi
- Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, Italy
| | - Elisabetta Rizzoli
- Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, Italy
| | - Sergio D'Addato
- Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, Italy
| | - Claudio Borghi
- Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, Italy
| | - Arrigo Fg Cicero
- Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, Italy
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Valdivielso JM, Rodríguez-Puyol D, Pascual J, Barrios C, Bermúdez-López M, Sánchez-Niño MD, Pérez-Fernández M, Ortiz A. Atherosclerosis in Chronic Kidney Disease: More, Less, or Just Different? Arterioscler Thromb Vasc Biol 2019; 39:1938-1966. [PMID: 31412740 DOI: 10.1161/atvbaha.119.312705] [Citation(s) in RCA: 152] [Impact Index Per Article: 30.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Patients with chronic kidney disease (CKD) are at an increased risk of premature mortality, mainly from cardiovascular causes. The association between CKD on hemodialysis and accelerated atherosclerosis was described >40 years ago. However, more recently, it has been suggested that the increase in atherosclerosis risk is actually observed in early CKD stages, remaining stable thereafter. In this regard, interventions targeting the pathogenesis of atherosclerosis, such as statins, successful in the general population, have failed to benefit patients with very advanced CKD. This raises the issue of the relative contribution of atherosclerosis versus other forms of cardiovascular injury such as arteriosclerosis or myocardial injury to the increased cardiovascular risk in CKD. In this review, the pathophysiogical contributors to atherosclerosis in CKD that are shared with the general population, or specific to CKD, are discussed. The NEFRONA study (Observatorio Nacional de Atherosclerosis en NEFrologia) prospectively assessed the prevalence and progression of subclinical atherosclerosis (plaque in vascular ultrasound), confirming an increased prevalence of atherosclerosis in patients with moderate CKD. However, the adjusted odds ratio for subclinical atherosclerosis increased with CKD stage, suggesting a contribution of CKD itself to subclinical atherosclerosis. Progression of atherosclerosis was closely related to CKD progression as well as to the baseline presence of atheroma plaque, and to higher phosphate, uric acid, and ferritin and lower 25(OH) vitamin D levels. These insights may help design future clinical trials of stratified personalized medicine targeting atherosclerosis in patients with CKD. Future primary prevention trials should enroll patients with evidence of subclinical atherosclerosis and should provide a comprehensive control of all known risk factors in addition to testing any additional intervention or placebo.
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Affiliation(s)
- José M Valdivielso
- From the Vascular & Renal Translational Research Group and UDETMA, IRBLleida. Spanish Research Network for Renal Diseases (RedInRen. ISCIII), Lleida, Spain (J.M.V., M.B.-L.)
| | - Diego Rodríguez-Puyol
- Nephrology Unit, Fundación para la investigación del Hospital Universitario Príncipe de Asturias, RedInRen, Alcalá de Henares, Madrid, Spain (D.R.-P.)
| | - Julio Pascual
- Department of Nephrology, Institute Mar for Medical Research, Hospital del Mar, RedInRen, Barcelona, Spain (J.P., C.B.)
| | - Clara Barrios
- Department of Nephrology, Institute Mar for Medical Research, Hospital del Mar, RedInRen, Barcelona, Spain (J.P., C.B.)
| | - Marcelino Bermúdez-López
- From the Vascular & Renal Translational Research Group and UDETMA, IRBLleida. Spanish Research Network for Renal Diseases (RedInRen. ISCIII), Lleida, Spain (J.M.V., M.B.-L.)
| | - Maria Dolores Sánchez-Niño
- IIS-Fundacion Jimenez Diaz, School of Medicine, University Autonoma of Madrid, FRIAT and RedInRen, Madrid, Spain (M.D.S.-N., A.O.)
| | | | - Alberto Ortiz
- IIS-Fundacion Jimenez Diaz, School of Medicine, University Autonoma of Madrid, FRIAT and RedInRen, Madrid, Spain (M.D.S.-N., A.O.)
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Ramírez Torres JM, López Téllez A, Valdivielso P, Barbancho Fernández MÁ. Evaluation of the atherosclerotic burden in hypertensive patients with prediabetes. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2019; 31:160-165. [PMID: 30971375 DOI: 10.1016/j.arteri.2019.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 12/24/2018] [Accepted: 01/04/2019] [Indexed: 06/09/2023]
Abstract
AIM To assess the atherosclerotic burden in hypertensive patients with prediabetes without cardiovascular disease. PATIENTS AND METHODS We included patients with hypertension and prediabetes (fasting blood glucose: 100-125mg/dL and/or glycohemoglobin A1c: 5.7-6.4%), excluding those with established cardiovascular disease or those at very high risk. We recorded major vascular risk factors. Subclinical arteriosclerosis was measured by the ankle/brachial index (ABI) and carotid intima-medial thickness (IMT). Subclinical arteriosclerosis was mild if IMT was >75p adjusted by age and sex and/or ABI was 0.7-0.9 and was considered moderate-severe when there was plaque and/or ABI<0.7. RESULTS We included 53 patients, 63±7 years-old; women: 50,9% (95%CI: 36.8-64.9). Atherosclerotic burden was detected in 66.0% (95%CI: 51.7-78.5) of subjects. 24,5% (95%CI: 13.8-38.3) of patients had mild arteriosclerosis disease and 41.5% (95%CI: 28.1-55.9) had moderate-severe. This allowed us to re-stratified as very high vascular risk the 41.5% (95%CI: 28.1-55.9) of patients. 45.4% (95%CI: 16-74.8) of subjects with moderate initial risk were considered high or very high risk. In multivariate analyses, only smoking was associated with atherosclerotic burden (P=.07). CONCLUSIONS Two thirds of hypertensive patients with prediabetes had subclinical arteriosclerotic disease when they were evaluated by the ankle/brachial index and carotid ultrasonography. Approximately forty percent of patients were re-stratified as very high vascular risk. Nearly half of the prediabetic hypertensive patients initially classified as moderate risk were considered high or very high risk.
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Affiliation(s)
| | | | - Pedro Valdivielso
- Medicina Interna, Hospital Virgen de la Victoria, Departamento de Medicina y Dermatología, Universidad de Málaga, IBIMA, Málaga, España
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Samba H, Guerchet M, Ndamba-Bandzouzi B, Kehoua G, Mbelesso P, Desormais I, Aboyans V, Preux PM, Lacroix P. Ankle Brachial Index (ABI) predicts 2-year mortality risk among older adults in the Republic of Congo: The EPIDEMCA-FU study. Atherosclerosis 2019; 286:121-127. [PMID: 31136913 DOI: 10.1016/j.atherosclerosis.2019.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 04/15/2019] [Accepted: 05/09/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND AIMS Peripheral artery disease (PAD) is known to be associated with mortality in high income countries but no data regarding Sub-Saharan Africa (SSA) populations are documented. This study aimed at assessing the prognostic value of the Ankle Brachial Index (ABI) among older adults in the Republic of Congo. METHODS Congolese subjects ≥65 years were included in a longitudinal population-based survey (EPIDEMCA-FU). Demographic, biological, and clinical data were collected at baseline. PAD was defined by an ABI≤0.90. Information on mortality was collected from key informants in participants' households. Cox proportional hazard models, adjusted for traditional and cardiovascular risk factors, were fitted to evaluate the association between an ABI≤0.90 and death. RESULTS 1029 participants were recruited at baseline. ABI measurement was obtained from 927 participants, of whom 17.4% presented an ABI≤0.90. During a 2-year follow-up, a total of 83 (9.1%) deaths were recorded. Mortality was higher in the low-ABI group with 23 deaths (14.7%) vs. 57 (7.8%) and 3 (12.0%), respectively among those with 0.90 < ABI<1.4 and ABI≥1.40 (p = 0.039). After adjustment, an ABI≤0.90 was associated with an increased risk of mortality (HR = 1.86; 95%CI 1.04-3.87). Mortality was also independently associated with increasing age (HR = 1.05; 95%CI 1.02-1.09), dementia (HR = 2.73; 95% CI 1.15-8.05), alcohol use (HR = 0.51; 95%CI 0.29-0.88) and female sex (HR = 0.37; 95%CI 0.19-0.72). CONCLUSIONS In this study, a low ABI predicted an increased mortality risk among older people. ABI may represent a simple and inexpensive tool to identify older people at high risk of death in SSA.
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Affiliation(s)
- Harielle Samba
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Univ. Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000, Limoges, France
| | - Maëlenn Guerchet
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Univ. Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000, Limoges, France; King's College London, Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, United Kingdom.
| | - Bébène Ndamba-Bandzouzi
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Department of Neurology, Brazzaville University Hospital, Brazzaville, Congo
| | - Gilles Kehoua
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Univ. Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000, Limoges, France
| | - Pascal Mbelesso
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Department of Neurology, Amitié Hospital, Bangui, Central African Republic
| | - Ileana Desormais
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Univ. Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000, Limoges, France; Department of Vascular Medicine, Limoges University Hospital, Limoges, France
| | - Victor Aboyans
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Univ. Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000, Limoges, France; Department of Cardiology, Limoges University Hospital, Limoges, France
| | - Pierre-Marie Preux
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Univ. Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000, Limoges, France; CHU, CEBIMER, Limoges, France
| | - Philippe Lacroix
- INSERM, U1094, Tropical Neuroepidemiology, Limoges, France; Univ. Limoges, UMR_S 1094, Tropical Neuroepidemiology, Institute of Neuroepidemiology and Tropical Neurology, CNRS FR 3503 GEIST, F-87000, Limoges, France; Department of Vascular Medicine, Limoges University Hospital, Limoges, France
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Ito H, Tominari S, Tabara Y, Nakayama T, Furu M, Kawata T, Azukizawa M, Setoh K, Kawaguchi T, Matsuda F, Matsuda S. Low back pain precedes the development of new knee pain in the elderly population; a novel predictive score from a longitudinal cohort study. Arthritis Res Ther 2019; 21:98. [PMID: 30987680 PMCID: PMC6466785 DOI: 10.1186/s13075-019-1884-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 04/01/2019] [Indexed: 01/09/2023] Open
Abstract
Background To investigate the association between knee pain and risk factors including low back pain and to develop a score to predict new knee pain in an older population, using population-based longitudinal cohort data. Methods We collected a questionnaire on self-reported knee pain and demographic data in a systematic manner from community residents aged ≥ 50 years twice, at baseline, and after 5 years. Multivariate logistic regression analyses were performed to investigate the association between knee pain and risk factors and to build a predictive model that would enable calculation of the risk of the development of knee pain within 5 years. The model is presented in the form of score charts. Results A total of 5932 residents aged ≥ 50 years from the cohort of 9764 that completed the first questionnaire were enrolled in the second survey. After exclusions, paired data for the two time points an average of 5.4 years apart were analyzed for 4638 participants. Multivariate analyses showed older age, female sex, higher BMI, weight increase, lower mental health score, and higher back pain/disability score were independent risk factors for knee pain. The predictive score comprised six factors: age, sex, BMI, weight increase, mental health, and low back pain/disability. The risk of developing knee pain ranged from 11.0 to 63.2% depending on the total score. Conclusion This study demonstrated a significant association between knee and low back pain/disability along with other risk factors. The score we developed can be used to identify a population without any imaging modality who are at high risk of developing knee pain. Electronic supplementary material The online version of this article (10.1186/s13075-019-1884-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hiromu Ito
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto, 606-8507, Japan.
| | - Shinjiro Tominari
- Department of Health Informatics, Kyoto University Graduate School of Medicine, Konoe-cho, Yoshida, Kyoto, 606-8501, Japan
| | - Yasuharu Tabara
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Konoe-cho, Yoshida, Kyoto, 606-8501, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University Graduate School of Medicine, Konoe-cho, Yoshida, Kyoto, 606-8501, Japan
| | - Moritoshi Furu
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto, 606-8507, Japan
| | - Tomotoshi Kawata
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto, 606-8507, Japan
| | - Masayuki Azukizawa
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto, 606-8507, Japan
| | - Kazuya Setoh
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Konoe-cho, Yoshida, Kyoto, 606-8501, Japan
| | - Takahisa Kawaguchi
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Konoe-cho, Yoshida, Kyoto, 606-8501, Japan
| | - Fumihiko Matsuda
- Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Konoe-cho, Yoshida, Kyoto, 606-8501, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto, 606-8507, Japan
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Gu X, Man C, Zhang H, Fan Y. High ankle-brachial index and risk of cardiovascular or all-cause mortality: A meta-analysis. Atherosclerosis 2019; 282:29-36. [DOI: 10.1016/j.atherosclerosis.2018.12.028] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 12/12/2018] [Accepted: 12/20/2018] [Indexed: 11/16/2022]
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Liu S, Li P, Su H. Four-Limb Blood Pressure Measurement with an Oscillometric Device: a Tool for Diagnosing Peripheral Vascular Disease. Curr Hypertens Rep 2019; 21:15. [PMID: 30747289 DOI: 10.1007/s11906-019-0917-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Traditionally, the term peripheral vascular disease (PAD) is restricted to the occlusive arterial disease in the leg, but now, the connotation of PAD is more widespread as it encompasses all extracoronary and extracerebral vascular disease. The incidence of PAD is increasing worldwide; therefore, it is necessary to diagnose PAD at an early stage. RECENT FINDINGS Oscillometric BP device is widely used for four-limb measurement in clinical practice and provides several parameters for evaluating inter-limb BP difference, such as ankle-brachial index (OS-ABI), inter-arm BP differences (IAD), and inter-ankle BP difference (IAND). Using angiographic results as reference, the ABI, IAD, and IAND from an oscillometric BP device have been demonstrated having high accuracy for diagnosis of PAD. Meanwhile, combination of these parameters could further improve the accuracy of PAD, including the occlusive artery disease in the arm, leg, and aorta. For example, some patients with severe PAD in the leg have normal ABI; in this situation, an increased sIAND could confirm the diagnosis of PAD in the leg. Because ABI, IAD, and IAND from inter-limb oscillometric BP measurement can also predict adverse prognosis, we encourage the use of an oscillometric device to measure four-limb BP and to evaluate the inter-limb BP difference.
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Affiliation(s)
- Songtao Liu
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, 330006, NO 1 Mingde Road, Nanchang, Jiangxi, China
| | - Ping Li
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, 330006, NO 1 Mingde Road, Nanchang, Jiangxi, China
| | - Hai Su
- Department of Cardiovascular Medicine, the Second Affiliated Hospital of Nanchang University, 330006, NO 1 Mingde Road, Nanchang, Jiangxi, China.
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Low, borderline and normal ankle-brachial index as a predictor of incidents outcomes in the Mediterranean based-population ARTPER cohort after 9 years follow-up. PLoS One 2019; 14:e0209163. [PMID: 30673706 PMCID: PMC6343871 DOI: 10.1371/journal.pone.0209163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 12/02/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Guidelines recommended adopting the same cardiovascular risk modification strategies used for coronary disease in case of low Ankle-brachial index (ABI), but here exist few studies on long-term cardiovascular outcomes in patients with borderline ABI and even fewer on the general population. AIM The aim of the present study was to analyze the relationship between long-term cardiovascular events and low, borderline and normal ABI after a 9-year follow up of a Mediterranean population with low cardiovascular risk. DESIGN AND SETTING A population-based prospective cohort study was performed in the province of Barcelona, Spain. METHOD A total of 3,786 subjects >49 years were recruited from 2006-2008. Baseline ABI was 1.08 ± 0.16. Subjects were followed from the time of enrollment to the end of follow-up in 2016 via phone calls every 6 months, systematic reviews of primary-care and hospital medical records and analysis of the SIDIAP (Information System for Primary Care Research) database to confirm the possible appearance of cardiovascular events. RESULTS 3146 individuals participated in the study. 2,420 (77%) subjects had normal ABI, 524 (17%) had borderline ABI, and 202 (6.4%) had low ABI. In comparison with normal and borderline subjects, patients with lower ABI had more comorbidities, such as hypertension, hypercholesterolemia and diabetes. Cumulative MACE incidence at 9 years was 20% in patients with low ABI, 6% in borderline ABI and 5% in normal ABI. The annual MACE incidence after 9 years follow-up was significantly higher in people with low ABI (26.9/1000py) (p<0.001) than in borderline (6.6/1000py) and in normal ABI (5.6/1000py). Subjects with borderline ABI are at significantly higher risk for coronary disease (HR: 1.58; 95% CI: 1.02-2, 43; p = 0,040) compared to subjects with normal ABI, after adjustment. CONCLUSION The results of the present study support that low ABI was independently associated with higher incidence of MACE, ICE, cardiovascular and no cardiovascular mortality; while borderline ABI had significantly moderate risk for coronary disease than normal ABI.
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da Cunha GR, Brugnarotto RJ, Halal VAE, Menezes MG, Bartholomay E, Albuquerque LC, Danzmann LC. Prevalence of peripheral arterial disease in patients with heart failure with preserved ejection fraction. Clinics (Sao Paulo) 2019; 74:e978. [PMID: 31618323 PMCID: PMC6784612 DOI: 10.6061/clinics/2019/e978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 05/03/2019] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES To describe the prevalence of the reduced ankle-brachial index (ABI) in patients with heart failure (HF) with preserved ejection fraction (HFpEF) attended at a HF clinic in the metropolitan region of Porto Alegre, and to compar the patients to those with reduced ejection fraction (HFrEF). METHODS A descriptive observational study, included patients referred to the heart failure clinic in HU-Ulbra with HFpEF or HFrEF and diastolic dysfunction, and measurements of ABIs using vascular Doppler equipment were performed in both groups. RESULTS The sample consisted of 106 patients with HF, 53.9% of the patients had HFpEF, and 19.4% had a diagnosis of peripheral arterial disease (PAD) (ABI less than 0.9). PAD was identified in 24.1% of the patients with HFpEF, while15.8% of patients in the HFrEF group were diagnosed with PAD. CONCLUSION Our results did not identify a significantly different prevalence of altered and compatible PAD values in patients with HFpEF. However, we showed a prevalence of 19.4%, a high value if we consider similar populations.
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Basyouni MW, Shabana AM, El Kilani WM. Prevalence of lower extremities peripheral arterial disease among Egyptian ischemic patients attending cardiac rehabilitation unit. Egypt Heart J 2018; 70:295-299. [PMID: 30591746 PMCID: PMC6303360 DOI: 10.1016/j.ehj.2018.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 06/07/2018] [Indexed: 12/03/2022] Open
Abstract
Background Atherosclerosis is progressive and diffuse pathological disorders which can simultaneously affect multiple vascular beds. Diagnosing Lower extremities peripheral arterial disease (PAD) in patients with Coronary artery disease (CAD) admitted to cardiac rehabilitation program can help to tailor exercise regimen to fit these patients, in addition, early treatment and/or intervention may help to control progression of the disease. Aim The study is to search for the prevalence of undiagnosed PAD using ankle brachial index (ABI) in Egyptian patients with documented CAD undergoing cardiac rehabilitation program. Patients and Methods The study included 200 patients with documented CAD scheduled for cardiac rehabilitation in Cardiology department, Ain Shams University, with exclusion of patients with known (diagnosed) PAD. All patients underwent ABI using Doppler ultrasonography. The patients were divided into two groups; Study group with positive ABI (≤ 0.9) and Control group with negative ABI (> 0.9). Results We found that the prevalence of undiagnosed PAD in those patients was 14.5% (29 patients). The incidence of PAD is increased in patients above 60 years (p = 0.001) and in presence of hypertension/uncontrolled systolic blood pressure (p = 0.002), Dyslipidemia (p = 0.005), or family history of ischemic heart disease (p = 0.035). PAD is associated also with impaired left ventricular systolic function and presence of segmental wall motion abnormalities at rest. Impaired eGFR increased the risk of development of PAD (p = 0.016). PAD was associated more with patients presented by multivessel lesions by coronary angiography and in presence of ischemic ECG changes. Conclusion This study shows that significant PAD is present in almost 15% of ischemic Egyptian patients. We recommend ABI to be done routinely in patients with significant CAD for exclusion or diagnosis of PAD to help in treatment and improving quality of life in addition to modification of cardiac rehabilitation program in presence of PAD according to its severity.
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Ankle-brachial index measured by oscillometry is predictive for cardiovascular disease and premature death in the Japanese population: An individual participant data meta-analysis. Atherosclerosis 2018; 275:141-148. [DOI: 10.1016/j.atherosclerosis.2018.05.048] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 05/25/2018] [Accepted: 05/30/2018] [Indexed: 01/13/2023]
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Ten Year Mortality in Different Peripheral Arterial Disease Stages: A Population Based Observational Study on Outcome. Eur J Vasc Endovasc Surg 2018; 55:529-536. [DOI: 10.1016/j.ejvs.2018.01.019] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 01/23/2018] [Indexed: 11/21/2022]
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Herráiz-Adillo Á, Cavero-Redondo I, Álvarez-Bueno C, Martínez-Vizcaíno V, Pozuelo-Carrascosa DP, Notario-Pacheco B. The accuracy of an oscillometric ankle-brachial index in the diagnosis of lower limb peripheral arterial disease: A systematic review and meta-analysis. Int J Clin Pract 2017; 71. [PMID: 28851093 DOI: 10.1111/ijcp.12994] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 07/30/2017] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Peripheral arterial disease (PAD) remains underdiagnosed and undertreated, partly because of limitations in the Doppler ankle-brachial index (ABI), the non-invasive gold standard. OBJECTIVE This systematic review and meta-analysis aims to compare the diagnostic accuracy of the oscillometric ABI and the Doppler ABI, and to examine the influence of two approaches to analysis: legs vs subjects and inclusion of oscillometric errors as PAD equivalents vs exclusion. METHODS Systematic searches in EMBASE, MEDLINE, Web of Science and the Cochrane Library databases were performed, from inception to February 2017. Random-effects models were computed with the Moses-Littenberg constant. Hierarchical summary receiver operating characteristic curves (HSROC) were used to summarise the overall test performance. RESULTS Twenty studies (1263 subjects and 3695 legs) were included in the meta-analysis. The pooled diagnostic odds ratio (dOR) for the oscillometric ABI was 32.49 (95% CI: 19.6-53.8), with 65% sensitivity (95% CI: 57-74) and 96% specificity (95%CI: 93-99). In the subgroup analysis, the "per subjects" group showed a better performance than the "per legs" group (dOR 36.44 vs 29.03). Similarly, an analysis considering oscillometric errors as PAD equivalents improved diagnostic performance (dOR 31.48 vs 28.29). The time needed for the oscillometric ABI was significantly shorter than that required for the Doppler ABI (5.90 vs 10.06 minutes, respectively). CONCLUSIONS AND RELEVANCE The oscillometric ABI showed an acceptable diagnostic accuracy and feasibility, potentially making it a useful tool for PAD diagnosis. We recommend considering oscillometric errors as PAD equivalents, and a "per subject" instead of a "per leg" approach, in order to improve sensitivity. Borderline oscillometric ABI values in diabetic population should raise concern of PAD.
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Affiliation(s)
- Ángel Herráiz-Adillo
- Department of Primary Care, Health Service of Castilla-La Mancha (SESCAM), Tragacete, Spain
| | - Iván Cavero-Redondo
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
| | - Celia Álvarez-Bueno
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
| | - Vicente Martínez-Vizcaíno
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca, Spain
- Universidad Autónoma de Chile, Facultad de Ciencias de la Salud, Talca, Chile
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