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Ji H, Zhao X, Chen X, Fang H, Gao H, Wei G, Zhang M, Kuang H, Yang B, Cai X, Su Y, Piao C, Zhao S, Li L, Sun W, Xu T, Xu Q, Fan Y, Ye J, Yao C, Shang M, Song G, Chen L, Zheng Q, Xiao X, Yan L, Lian F, Tong X, Jia Z. Jinlida for Diabetes Prevention in Impaired Glucose Tolerance and Multiple Metabolic Abnormalities: The FOCUS Randomized Clinical Trial. JAMA Intern Med 2024; 184:727-735. [PMID: 38829648 PMCID: PMC11148787 DOI: 10.1001/jamainternmed.2024.1190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 03/07/2024] [Indexed: 06/05/2024]
Abstract
Importance Previous studies have shown that Jinlida (JLD) granules, an approved treatment for type 2 diabetes in China, can reduce blood glucose level, reduce glycated hemoglobin (HbA1c), and improve insulin resistance in people with type 2 diabetes. Objective To evaluate the effect of long-term administration of JLD vs placebo on the incidence of diabetes in participants with impaired glucose tolerance (IGT) and multiple metabolic abnormalities. Design, Setting, and Participants This multicenter, double-blind, placebo-controlled randomized clinical trial (FOCUS) was conducted across 35 centers in 21 cities in China from June 2019 to February 2023. Individuals aged 18 to 70 years with IGT and multiple metabolic abnormalities were enrolled. Intervention Participants were randomly allocated 1:1 to receive JLD or placebo (9 g, 3 times per day, orally). They continued this regimen until they developed diabetes, withdrew from the study, were lost to follow-up, or died. Main Outcomes and Measures The primary outcome was the occurrence of diabetes, which was determined by 2 consecutive oral glucose tolerance tests. Secondary outcomes included waist circumference; fasting and 2-hour postprandial plasma glucose levels; HbA1c; fasting insulin level; homeostatic model assessment for insulin resistance (HOMA-IR); total cholesterol, low-density lipoprotein cholesterol, and triglyceride levels; ankle-brachial index; and carotid intima-media thickness. Results A total of 889 participants were randomized, of whom 885 were in the full analysis set (442 in the JLD group; 443 in the placebo group; mean [SD] age, 52.57 [10.33] years; 463 [52.32%] female). Following a median observation period of 2.20 years (IQR, 1.27-2.64 years), participants in the JLD group had a lower risk of developing diabetes compared with those in the placebo group (hazard ratio, 0.59; 95% CI, 0.46-0.74; P < .001). During the follow-up period, the JLD group had a between-group difference of 0.95 cm (95% CI, 0.36-1.55 cm) in waist circumference, 9.2 mg/dL (95% CI, 5.4-13.0 mg/dL) in 2-hour postprandial blood glucose level, 3.8 mg/dL (95% CI, 2.2-5.6 mg/dL) in fasting blood glucose level, 0.20% (95% CI, 0.13%-0.27%) in HbA1c, 6.6 mg/dL (95% CI, 1.9-11.2) in total cholesterol level, 4.3 mg/dL (95% CI, 0.8-7.7 mg/dL) in low-density lipoprotein cholesterol level, 25.7 mg/dL (95% CI, 15.9-35.4 mg/dL) in triglyceride levels, and 0.47 (95% CI, 0.12-0.83) in HOMA-IR compared with the placebo group. After 24 months of follow-up, the JLD group had a significant improvement in ankle-brachial index and waist circumference compared with the placebo group. Conclusions and Relevance The findings suggest that JLD can reduce the risk of diabetes in participants with IGT and multiple metabolic abnormalities. Trial Registration Chinese Clinical Trial Register: ChiCTR1900023241.
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Affiliation(s)
- Hangyu Ji
- Good Clinical Practice Office, Guang’anmen
Hospital China Academy of Chinese Medical Sciences, Beijing, China
| | - Xuefei Zhao
- Department of Endocrinology, Guang’anmen
Hospital China Academy of Chinese Medical Sciences, Beijing, China
| | - Xinyan Chen
- Department of Prevention and Treatment of
Disease, Guangdong Provincial Hospital of Traditional Chinese Medicine, Guangzhou,
China
| | - Hui Fang
- Department of Endocrinology, Tangshan Gongren
Hospital, Tangshan, China
| | - Huailin Gao
- Department of Endocrinology, Hebei Yiling
Hospital, Shijiazhuang, China
| | - Geng Wei
- Department of Traditional Chinese Medicine,
Shijiazhuang 2nd Hospital, Shijiazhuang, China
| | - Min Zhang
- Department of General Practice, Baotou Central
Hospital, Baotou, China
| | - Hongyu Kuang
- Department of Endocrinology, The First
Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Baijing Yang
- Department of Traditional Chinese Medicine, The
First Affiliated Hospital of Medical College of Shihezi University, Shihezi,
China
| | - Xiaojun Cai
- Department of Endocrinology, Heilongjiang
Academy of Traditional Chinese Medicine, Harbin, China
| | - Yanjin Su
- Department of Endocrinology, Affiliated
Hospital of Shaanxi University of Traditional Chinese Medicine, Xianyang,
China
| | - Chunli Piao
- Department of Endocrinology, Shenzhen Hospital
(Futian) of Guangzhou University of Chinese Medicine, Shenzhen, China
| | - Shuyu Zhao
- Department of Endocrinology, Tongliao City
Horqin District First People’s Hospital, Tongliao, China
| | - Liyang Li
- Department of Endocrinology, Baoji Second
People’s Hospital, Baoji, China
| | - Wenliang Sun
- Department of Endocrinology, Hebei Cangzhou
Hospital of Integrated Chinese and Western Medicine, Cangzhou, China
| | - Tianshu Xu
- Department of Traditional Chinese Medicine,
Nanjing Drum Tower Hospital, Nanjing, China
| | - Qinghua Xu
- Geriatrics Department, Liaocheng
People’s Hospital, Liaocheng, China
| | - Yuan Fan
- Department of Endocrinology, Second Affiliated
Hospital of Yunnan University of Chinese Medicine, Kunming, China
| | - Jianhua Ye
- Department of Endocrinology, The First
Affiliated Hospital of Guangdong Pharmaceutical University, Guangzhou, China
| | - Chen Yao
- Department of Biostatistics, Peking University
First Hospital, Beijing, China
| | - Meixia Shang
- Department of Biostatistics, Peking University
First Hospital, Beijing, China
| | - Guangyao Song
- Department of Endocrinology, Hebei General
Hospital, Shijiazhuang, China
| | - Liming Chen
- NHC Key Laboratory of Hormones and
Development, Chu Hsien-I Memorial Hospital and Tianjin Institute of Endocrinology,
Tianjin Medical University, Tianjin, China
| | - Qingshan Zheng
- Center for Drug Clinical Research, Shanghai
University of Traditional Chinese Medicine, Shanghai, China
| | - Xinhua Xiao
- Department of Endocrinology, Peking Union
Medical College Hospital, Beijing, China
| | - Li Yan
- Department of Endocrinology, Sun Yat-Sen
Memorial Hospital, Sun Yai-Sen University, Guangzhou, China
| | - Fengmei Lian
- Good Clinical Practice Office, Guang’anmen
Hospital China Academy of Chinese Medical Sciences, Beijing, China
| | - Xiaolin Tong
- Metabolic Disease Institute, Guang’anmen
Hospital China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhenhua Jia
- Department of Endocrinology, Hebei Yiling
Hospital, Shijiazhuang, China
- State Key Laboratory for Innovation and
Transformation of Luobing Theory of Hebei Yiling Hospital,
Shijiazhuang, Hebei Province, China
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Li Z, Tong X, Ma Y, Bao T, Yue J. Relationship Between Low Skeletal Muscle Mass and Arteriosclerosis in Western China: A Cross-Sectional Study. Front Cardiovasc Med 2021; 8:735262. [PMID: 34746254 PMCID: PMC8563701 DOI: 10.3389/fcvm.2021.735262] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 09/23/2021] [Indexed: 02/05/2023] Open
Abstract
Objectives: This study explored the prevalence and the correlation between low muscle mass and arteriosclerosis in different gender and age groups, to increase the attention paid to the risk factors of arteriosclerosis in the young and middle-aged population. Methods: This was an analytical, cross-sectional study. Data were obtained from healthy individuals recruited from the Health Management Center of W Hospital. The brachial-ankle pulse-wave velocity was used as an indicator of arteriosclerosis, and a bioelectrical impedance analysis was used to assess the body composition. Results: A total of 36,374 subjects (men, 58.4%; women, 41.6%; mean age, 43.74 ± 12.34 years [range, 18-80 years]) participated in this study. The prevalence of low skeletal muscle mass and arteriosclerosis was 17.7 and 53.1%, respectively, in all subjects. Low skeletal muscle mass was significantly associated with arteriosclerosis (OR: 1.435, 95% CI: 1.343-1.533, P < 0.001) in all subjects, and the association remained significant in young age (OR: 1.506, 95% CI: 1.353-1.678, P < 0.001), middle-age (OR: 1.329, 95% CI: 1.195-1.479, P < 0.001), and old age (OR: 1.676, 95% CI: 1.191-2.358, P = 0.003), and also significant in men (OR: 1.559, 95% CI: 1.396-1.740, P < 0.001) and women (OR: 1.266, 95% CI: 1.143-1.401, P < 0.001). Conclusions and Implications: Our results show that the prevalence of low muscle mass and arteriosclerosis is high in the general population, even among middle-aged people and young people, and confirmed that there is a significant independent association between low skeletal muscle mass and arteriosclerosis in all subjects and in different age and gender subgroups.
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Affiliation(s)
- Zhenzhen Li
- Health Management Center, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Xiang Tong
- Department of Respiratory and Critical Care Medicine, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Yao Ma
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Ting Bao
- Health Management Center, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
| | - Jirong Yue
- Department of Geriatrics and National Clinical Research Center for Geriatrics, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, China
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Clark CE, Warren FC, Boddy K, McDonagh STJ, Moore SF, Goddard J, Reed N, Turner M, Alzamora MT, Ramos Blanes R, Chuang SY, Criqui M, Dahl M, Engström G, Erbel R, Espeland M, Ferrucci L, Guerchet M, Hattersley A, Lahoz C, McClelland RL, McDermott MM, Price J, Stoffers HE, Wang JG, Westerink J, White J, Cloutier L, Taylor RS, Shore AC, McManus RJ, Aboyans V, Campbell JL. Associations Between Systolic Interarm Differences in Blood Pressure and Cardiovascular Disease Outcomes and Mortality: Individual Participant Data Meta-Analysis, Development and Validation of a Prognostic Algorithm: The INTERPRESS-IPD Collaboration. Hypertension 2020; 77:650-661. [PMID: 33342236 PMCID: PMC7803446 DOI: 10.1161/hypertensionaha.120.15997] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Systolic interarm differences in blood pressure have been associated with all-cause mortality and cardiovascular disease. We undertook individual participant data meta-analyses to (1) quantify independent associations of systolic interarm difference with mortality and cardiovascular events; (2) develop and validate prognostic models incorporating interarm difference, and (3) determine whether interarm difference remains associated with risk after adjustment for common cardiovascular risk scores. We searched for studies recording bilateral blood pressure and outcomes, established agreements with collaborating authors, and created a single international dataset: the Inter-arm Blood Pressure Difference - Individual Participant Data (INTERPRESS-IPD) Collaboration. Data were merged from 24 studies (53 827 participants). Systolic interarm difference was associated with all-cause and cardiovascular mortality: continuous hazard ratios 1.05 (95% CI, 1.02-1.08) and 1.06 (95% CI, 1.02-1.11), respectively, per 5 mm Hg systolic interarm difference. Hazard ratios for all-cause mortality increased with interarm difference magnitude from a ≥5 mm Hg threshold (hazard ratio, 1.07 [95% CI, 1.01-1.14]). Systolic interarm differences per 5 mm Hg were associated with cardiovascular events in people without preexisting disease, after adjustment for Atherosclerotic Cardiovascular Disease (hazard ratio, 1.04 [95% CI, 1.00-1.08]), Framingham (hazard ratio, 1.04 [95% CI, 1.01-1.08]), or QRISK cardiovascular disease risk algorithm version 2 (QRISK2) (hazard ratio, 1.12 [95% CI, 1.06-1.18]) cardiovascular risk scores. Our findings confirm that systolic interarm difference is associated with increased all-cause mortality, cardiovascular mortality, and cardiovascular events. Blood pressure should be measured in both arms during cardiovascular assessment. A systolic interarm difference of 10 mm Hg is proposed as the upper limit of normal. Registration: URL: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42015031227.
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Affiliation(s)
- Christopher E Clark
- From the Primary Care Research Group, Institute of Health Services Research (C.E.C., F.C.W., S.T.J.M., S.F.M., R.S.T., J.L.C.), University of Exeter Medical School, College of Medicine & Health, Devon, England
| | - Fiona C Warren
- From the Primary Care Research Group, Institute of Health Services Research (C.E.C., F.C.W., S.T.J.M., S.F.M., R.S.T., J.L.C.), University of Exeter Medical School, College of Medicine & Health, Devon, England
| | - Kate Boddy
- Patient and Public Involvement Team, PenCLAHRC (K.B., J.G., N.R., M.T.), University of Exeter Medical School, College of Medicine & Health, Devon, England
| | - Sinead T J McDonagh
- From the Primary Care Research Group, Institute of Health Services Research (C.E.C., F.C.W., S.T.J.M., S.F.M., R.S.T., J.L.C.), University of Exeter Medical School, College of Medicine & Health, Devon, England
| | - Sarah F Moore
- From the Primary Care Research Group, Institute of Health Services Research (C.E.C., F.C.W., S.T.J.M., S.F.M., R.S.T., J.L.C.), University of Exeter Medical School, College of Medicine & Health, Devon, England
| | - John Goddard
- Patient and Public Involvement Team, PenCLAHRC (K.B., J.G., N.R., M.T.), University of Exeter Medical School, College of Medicine & Health, Devon, England
| | - Nigel Reed
- Patient and Public Involvement Team, PenCLAHRC (K.B., J.G., N.R., M.T.), University of Exeter Medical School, College of Medicine & Health, Devon, England
| | - Malcolm Turner
- Patient and Public Involvement Team, PenCLAHRC (K.B., J.G., N.R., M.T.), University of Exeter Medical School, College of Medicine & Health, Devon, England
| | - Maria Teresa Alzamora
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Mataró, Spain (M.T.A.)
| | - Rafel Ramos Blanes
- Unitat de Suport a la Recerca Girona, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Institut d'Investigació Biomèdica de Girona (IdIBGi), Department of Medical Sciences, School of Medicine, University of Girona, Spain (R.R.B.)
| | - Shao-Yuan Chuang
- Institute of Population Health Sciences, National Health Research Institutes (NHRI), Taiwan, R.O.C (S.-Y.C.)
| | - Michael Criqui
- Department of Family Medicine and Public Health, University of California, San Diego, School of Medicine, La Jolla (M.C.)
| | - Marie Dahl
- Vascular Research Unit, Department of Vascular Surgery, Viborg Regional Hospital, Heibergs Allé 4, 8800 Viborg, Denmark (M.D.).,Department of Clinical Medicine, Aarhus University, Denmark (M.D.)
| | - Gunnar Engström
- Department of Clinical Science in Malmö, Lund University, Sweden (G.E.)
| | - Raimund Erbel
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Germany (R.E.)
| | | | | | - Maëlenn Guerchet
- INSERM U1094 & IRD, Tropical Neuroepidemiology, Institut d'Epidémiologie et de Neurologie Tropicale (IENT), Faculté de Médecine de l'Université de Limoges, Limoges Cedex, France (M.G., V.A.)
| | - Andrew Hattersley
- Institute of Biomedical and Clinical Science (A.H.), University of Exeter Medical School, College of Medicine & Health, Devon, England
| | - Carlos Lahoz
- Lípid and Vascular Risk Unit, Internal Medicine Service, Carlos III, La Paz Hospital, Madrid, Spain (C.L.)
| | | | - Mary M McDermott
- Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.)
| | - Jackie Price
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Scotland (J.P.)
| | - Henri E Stoffers
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, the Netherlands (H.E.S.)
| | - Ji-Guang Wang
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (J.-G.W.)
| | - Jan Westerink
- Department of Vascular Medicine, University Medical Center Utrecht, the Netherlands (J. Westerink)
| | - James White
- DECIPHer, Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Wales (J. White)
| | - Lyne Cloutier
- Département des Sciences Infirmières, Université du Québec à Trois-Rivières, Canada (L.C.)
| | - Rod S Taylor
- From the Primary Care Research Group, Institute of Health Services Research (C.E.C., F.C.W., S.T.J.M., S.F.M., R.S.T., J.L.C.), University of Exeter Medical School, College of Medicine & Health, Devon, England.,MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Scotland (R.S.T.)
| | - Angela C Shore
- NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter College of Medicine & Health, England (A.C.S.)
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, England (R.J.M.)
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, and Inserm 1094, Tropical Neuroepidemiology, Limoges, France (V.A.)
| | - John L Campbell
- From the Primary Care Research Group, Institute of Health Services Research (C.E.C., F.C.W., S.T.J.M., S.F.M., R.S.T., J.L.C.), University of Exeter Medical School, College of Medicine & Health, Devon, England
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Sri-Amad R, Huipao N, Prasertsri P, Roengrit T. Aortic Pulse Wave Velocity, Ankle-Brachial Index, and Malondialdehyde in Older Adults with or without Metabolic Syndrome. Pulse (Basel) 2020; 8:31-39. [PMID: 32999876 DOI: 10.1159/000505838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 01/08/2020] [Indexed: 12/14/2022] Open
Abstract
Metabolic syndrome is an important health problem associated with both subclinical atherosclerosis and an increased risk of cardiovascular disease and it leads to an elevated total mortality. Aortic pulse wave velocity (aPWV) is widely used for noninvasive assessment of arterial stiffness. Ankle-brachial index (ABI) predicts peripheral arterial disease (PAD) of the lower extremities. In addition, malondialdehyde (MDA) is thought to be involved in the development of arterial stiffness. The present study aimed to: (1) compare aPWV, ABI, and MDA between participants with MetS and those without MetS and (2) investigate the correlation of aPWV and ABI with the components of MetS and MDA. A total of 48 Thai elderly subjects were divided into 2 groups (MetS and non-MetS) according to the parameters set by the International Diabetes Federation (IDF). aPWV and ABI were measured using the VaSera VS-1500 system (Fukuda Denshi Co., Tokyo, Japan). MDA was determined by spectrophotometry. aPWV and MDA were significantly higher in the MetS group compared to the participants in the non-MetS group (9.33 ± 2.72 vs. 7.95 ± 1.37 m/s, p = 0.03, and 0.74 ± 0.71 vs. 0.45 ± 0.20 μmol, p = 0.02, respectively). However, ABI did not differ between the groups. Analysis of the risk factors of aPWV in each group revealed that there were no statistical associations between the components of MetS and MDA and aPWV in both the MetS and the non-MetS groups. A high aPWV is more prevalent among patients with MetS than among those without MetS. Monitoring of aPWV might help to explore potential detection of vascular damage in the elderly.
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Affiliation(s)
- Ruchada Sri-Amad
- Department of Physiology, Faculty of Science, Prince of Songkla University, Songkhla, Thailand
| | - Nawiya Huipao
- Department of Physiology, Faculty of Science, Prince of Songkla University, Songkhla, Thailand
| | - Piyapong Prasertsri
- Faculty of Allied Health Sciences, Burapha University, Chonburi, Thailand.,Exercise and Nutrition Sciences and Innovation Research Unit, Burapha University, Chonburi, Thailand
| | - Thapanee Roengrit
- Department of Physiology, Faculty of Science, Prince of Songkla University, Songkhla, Thailand
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Gupta N, Giri S, Rathi V, Ranga GS. Flow Mediated Dilatation, Carotid Intima Media Thickness, Ankle Brachial Pressure Index and Pulse Pressure in Young Male Post Myocardial Infarction Patients in India. J Clin Diagn Res 2016; 10:OC35-OC39. [PMID: 27891375 DOI: 10.7860/jcdr/2016/20872.8751] [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] [Received: 04/21/2016] [Accepted: 07/12/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Due to increase in Coronary Artery Disease (CAD) at a younger age, we should try to diagnose atherosclerotic process and population at risk, at the earliest. Flow Mediated Dilatation (FMD), Carotid Intima-Media Thickness (CIMT) and Ankle-Brachial Pressure Index (ABI) are probable markers for early atherosclerosis and may be useful in coronary risk stratification. AIM To compare and correlate the FMD, CIMT, ABI and Pulse Pressure (PP) in young male patients of Myocardial Infarction (MI) with age and sex matched healthy controls. MATERIALS AND METHODS Eighty male patients of MI aged ≤45 years, who presented to the Cardiac Care Unit and Department of Medicine of Guru Teg Bahadur Hospital, Delhi, India, from November 2010 to April 2012 were recruited consecutively for this case control study and same number of age and sex matched healthy controls were also analyzed. Six weeks after MI, FMD of the brachial artery, intima media thickness of carotid artery, ABPI and PP were measured in the cases and compared with healthy controls. RESULTS The FMD was lower among young patients of MI than controls (p<0.001). CIMT was higher among cases than controls (p=0.001). ABI was lower among cases than controls (p<0.001). Compared to controls, PP was higher among cases (p=0.001). In all subjects, a negative correlation between FMD and CIMT (r=-0.220, p=0.005) and a positive correlation between FMD and ABPI (r=0.304, p<0.001) was found. A statistically significant negative correlation was found between endothelial dependent FMD and PP among cases and control groups (r=-0.209, p=0.007). CONCLUSION Biophysical parameters were deranged in young post MI patients. Majority of our young male patients fell in low risk Framingham risk score but still they manifested with CAD. Despite six weeks of treatment among young male patients of MI, various biophysical parameters were still deranged.
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Affiliation(s)
- Nikhil Gupta
- Senior Resident, Department of Rheumatology, CMC , Vellore, Tamilnadu, India
| | - Subhash Giri
- Professor, Department of Medicine, University College of Medical Sciences , Dilshad Garden, Delhi, India
| | - Vinita Rathi
- Professor, Department of Radio-Diagnosis, University College of Medical Sciences , Dilshad Garden, Delhi, India
| | - Gajender Singh Ranga
- Professor, Department of Medicine, University College of Medical Sciences , Dilshad Garden, Delhi, India
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Hajibandeh S, Hajibandeh S, Shah S, Child E, Antoniou GA, Torella F. Prognostic significance of ankle brachial pressure index: A systematic review and meta-analysis. Vascular 2016; 25:208-224. [PMID: 27411571 DOI: 10.1177/1708538116658392] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose To synthesize and quantify the excess risk of morbidity and mortality in individuals with low ankle-brachial pressure index. Methods Electronic databases were searched to identify studies investigating morbidity and mortality outcomes in individuals undergoing ankle-brachial pressure index measurement. Meta-analysis of the outcomes was performed using fixed- or random-effects models. Uncertainties related to varying follow-up periods among the studies were resolved by meta-analysis of time-to-event outcomes. Results Forty-three observational cohort studies, enrolling 94,254 participants, were selected. A low ankle-brachial pressure index (<0.9) was associated with a significant risk of all-cause mortality (risk ratio: 2.52, 95% CI 2.26-2.82, P < 0.00001); cardiovascular mortality (risk ratio: 2.94, 95% CI 2.72-3.18, P < 0.00001); cerebrovascular event (risk ratio: 2.17, 95% CI 1.90-2.47, P < 0.00001); myocardial infarction (risk ratio: 2.28, 95% CI 2.07-2.51, P < 0.00001); fatal myocardial infarction (risk ratio: 2.81, 95% CI 2.33-3.40, P < 0.00001); fatal stroke (risk ratio: 2.28, 95% CI 1.80-2.89, P < 0.00001); and the composite of myocardial infarction, stroke, and death (risk ratio: 2.29, 95% CI 1.87-2.81, P < 0.00001). Similar findings resulted from analyses of individuals with asymptomatic PAD, individuals with cardiovascular or cerebrovascular co-morbidity, and patients with diabetes. Conclusions A low ankle-brachial pressure index is associated with an increased risk of subsequent cardiovascular and cerebrovascular morbidity and mortality. Randomised controlled trials are required to investigate the effectiveness of screening for PAD in asymptomatic and undiagnosed individuals and to evaluate benefits of early treatment of screen-detected PAD.
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Affiliation(s)
- Shahab Hajibandeh
- 1 Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital & University Hospital Aintree, Liverpool, UK
| | - Shahin Hajibandeh
- 1 Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital & University Hospital Aintree, Liverpool, UK
| | - Sohan Shah
- 1 Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital & University Hospital Aintree, Liverpool, UK
| | - Emma Child
- 2 Library Resource & Information Centre, University Hospital Aintree, Liverpool, UK
| | - George A Antoniou
- 3 Department of Vascular and Endovascular Surgery, The Royal Oldham Hospital, The Pennine Acute Hospitals NHS Trust, Manchester, UK
| | - Francesco Torella
- 1 Liverpool Vascular and Endovascular Service, Royal Liverpool University Hospital & University Hospital Aintree, Liverpool, UK
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Yoshitomi R, Nakayama M, Ura Y, Kuma K, Nishimoto H, Fukui A, Ikeda H, Tsuchihashi T, Tsuruya K, Kitazono T. Ankle-brachial blood pressure index predicts cardiovascular events and mortality in Japanese patients with chronic kidney disease not on dialysis. Hypertens Res 2014; 37:1050-5. [PMID: 25056682 DOI: 10.1038/hr.2014.120] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 05/24/2014] [Accepted: 06/20/2014] [Indexed: 12/24/2022]
Abstract
The ankle-brachial blood pressure index (ABPI) has been recognized to have a predictive value for cardiovascular (CV) events and mortality in general or dialysis populations. However, the associations between ABPI and those outcomes have not been fully investigated in predialysis patients. The present study aimed to clarify the relationships between ABPI and both CV events and mortality in Japanese chronic kidney disease (CKD) patients not on dialysis. In this prospective observational study, we enrolled 320 patients with CKD stages 3-5 who were not on dialysis. At baseline, ABPI was examined and a low ABPI was defined as <0.9. CV events and all-cause deaths were examined in each patient. A Cox proportional hazards model was applied to determine the risk factors for CV events, as well as for mortality from CV and all causes. The median follow-up period was 30 months. CV events occurred in 56 patients and all-cause deaths occurred in 48, including 20 CV deaths. Multivariate analysis showed that age and low ABPI were risk factors for CV events. It was demonstrated that age, a history of cerebrovascular disease and low ABPI were determined as independent risk factors for CV mortality. In addition, age, body mass index and low ABPI were independently associated with all-cause mortality. In patients with CKD, low ABPI during the predialysis period is independently associated with poor survival and CV events, suggesting the usefulness of measuring ABPI for predicting CV events and patient survival in CKD.
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Affiliation(s)
- Ryota Yoshitomi
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masaru Nakayama
- Division of Nephrology and Clinical Research Institute, Department of Internal Medicine, National Kyushu Medical Center Hospital, Fukuoka, Japan
| | - Yoriko Ura
- Division of Nephrology and Clinical Research Institute, Department of Internal Medicine, National Kyushu Medical Center Hospital, Fukuoka, Japan
| | - Kazuyoshi Kuma
- Division of Nephrology and Clinical Research Institute, Department of Internal Medicine, National Kyushu Medical Center Hospital, Fukuoka, Japan
| | - Hitomi Nishimoto
- Division of Nephrology and Clinical Research Institute, Department of Internal Medicine, National Kyushu Medical Center Hospital, Fukuoka, Japan
| | - Akiko Fukui
- Division of Nephrology and Clinical Research Institute, Department of Internal Medicine, National Kyushu Medical Center Hospital, Fukuoka, Japan
| | - Hirofumi Ikeda
- Division of Nephrology and Clinical Research Institute, Department of Internal Medicine, National Kyushu Medical Center Hospital, Fukuoka, Japan
| | - Takuya Tsuchihashi
- Division of Hypertension and Clinical Research Institute, Department of Internal Medicine, National Kyushu Medical Center Hospital, Fukuoka, Japan
| | - Kazuhiko Tsuruya
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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8
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Natsuaki C, Inoguchi T, Maeda Y, Yamada T, Sasaki S, Sonoda N, Shimabukuro M, Nawata H, Takayanagi R. Association of borderline ankle-brachial index with mortality and the incidence of peripheral artery disease in diabetic patients. Atherosclerosis 2014; 234:360-5. [DOI: 10.1016/j.atherosclerosis.2014.03.018] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 03/17/2014] [Accepted: 03/17/2014] [Indexed: 11/17/2022]
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9
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Relationship Between Metabolic Scores, Systemic Inflammation, Renal Function, and High-risk Peripheral Arterial Disease. INT J GERONTOL 2013. [DOI: 10.1016/j.ijge.2012.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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10
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Potier L, Abi Khalil C, Mohammedi K, Roussel R. Use and utility of ankle brachial index in patients with diabetes. Eur J Vasc Endovasc Surg 2010; 41:110-6. [PMID: 21095144 DOI: 10.1016/j.ejvs.2010.09.020] [Citation(s) in RCA: 170] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2010] [Accepted: 09/16/2010] [Indexed: 01/25/2023]
Abstract
Ankle brachial index (ABI) is a simple method to screen peripheral arterial disease (PAD) and to evaluate cardiovascular (CV) prognosis in the general population. Measuring it requires a hand-held Doppler probe but it can be done also with an automatic device. ABI is an effective tool for clinical practice or clinical studies. However, in diabetic patients, it has some specific caveats. Sensitivity of the standard threshold of 0.9 appears to be lower in diabetic patients with complications. Moreover, highly frequent arterial medial calcifications in diabetes increase ABI. It has been demonstrated that measurements >1.3 are well correlated with both an increased prevalence of PAD and CV risk. Therefore, ABI thresholds of less than 0.9 and more than 1.3 are highly suspicious for PAD and high CV risk in diabetic patients. However, when there is concomitant clinical peripheral neuropathy or high risk of arterial calcification, the efficiency of ABI seems to be limited. In this case, other methods should be applied, toe pressure, in particular. Thus, the ABI could be used in patients with diabetes, but values should be interpreted with precision, according to the clinical situation.
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Affiliation(s)
- L Potier
- Hôpital Bichat, AP-HP, Paris, France.
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11
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Luo Y, Li X, Li J, Wang X, Qiao Y, Hu D, Merriam PA, Ma Y. Combined effects of smoking and peripheral arterial disease on all-cause and cardiovascular disease mortality in a Chinese male cohort. J Vasc Surg 2010; 51:673-8. [DOI: 10.1016/j.jvs.2009.09.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2009] [Revised: 09/11/2009] [Accepted: 09/12/2009] [Indexed: 11/29/2022]
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12
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Zheng L, Li J, Hu D, Luo Y, Li X, Xu Y, Sun Z, Sun Y. Association of low ankle-brachial index with mortality in patients with ischemic heart disease. J Atheroscler Thromb 2010; 17:759-67. [DOI: 10.5551/jat.4093] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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