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Garcia EL, Pereira AH, Menezes MG, Pereira AA, Stein R, Franzoni LT, Danzmann LC, dos Santos AC. Effects of aerobic and combined training on pain-free walking distance and health-related quality of life in patients with peripheral artery disease: a randomized clinical trial. J Vasc Bras 2023; 22:e20230024. [PMID: 37790896 PMCID: PMC10545230 DOI: 10.1590/1677-5449.202300242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 05/22/2023] [Indexed: 10/05/2023] Open
Abstract
Background Decreased walking ability in patients with peripheral arterial disease is often a clinical problem and limits the quality of life and daily activities of these subjects. physical exercise is important in this scenario, as it improves both the daily walking distance and the ability to withstand intermittent claudication related to the limitations of the peripheral disease. Objectives Our aim was to compare the effects of two types of exercise training (aerobic training and aerobic training combined with resistance exercises) on pain-free walking distance (PFWD) and health-related quality of life (HRQoL) in a sample composed of patients with peripheral artery disease (PAD). Methods Twenty patients with claudication symptoms were randomized to either aerobic control (AC) N= 9, or combined training (CT) N= 8, (24 sixty-minute sessions, twice a week). The total walking distance until onset of pain due to claudication was assessed using the 6-minute walk test and HRQoL was measured using the WHOQOL-bref questionnaire (general and specific domains) at baseline and after training. We used generalized estimating equations (GEE) to assess the differences between groups for the PFWD and HRQoL domains, testing the main group and time effects and their respective interaction effects. P values < 0.05 were considered statistically significant. Results Seventeen patients (mean age 63±9 years; 53% male) completed the study. Both groups experienced improvement in claudication, as reflected by a significant increase in PFWD: AC, 149 m to 299 m (P<0.001); CT, 156 m to 253 m (P<0.001). HRQoL domains also improved similarly in both groups (physical capacity, psychological aspects, and self-reported quality of life; P=0.001, P=0.003, and P=0.011 respectively). Conclusions Both aerobic and combined training similarly improved PFWD and HRQoL in PAD patients. There are no advantages in adding strength training to conventional aerobic training. This study does not support the conclusion that combined training is a good strategy for these patients when compared with classic training.
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Affiliation(s)
- Eduardo Lima Garcia
- Universidade Federal do Rio Grande do Sul - UFRGS, Porto Alegre, RS, Brasil.
| | | | | | - Alexandre Araújo Pereira
- Hospital de Clínicas de Porto Alegre - HCPA, Porto Alegre, RS, Brasil.
- Hospital Moinhos de Vento, Porto Alegre, RS, Brasil.
| | - Ricardo Stein
- Universidade Federal do Rio Grande do Sul - UFRGS, Porto Alegre, RS, Brasil.
| | | | - Luiz Claudio Danzmann
- Universidade Federal do Rio Grande do Sul - UFRGS, Porto Alegre, RS, Brasil.
- Universidade Luterana do Brasil, Canoas, RS, Brasil.
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Marcucci R, Berteotti M, Gragnano F, Galli M, Cavallari I, Renda G, Capranzano P, Santilli F, Capodanno D, Angiolillo DJ, Cirillo P, Calabrò P, Patti G, De Caterina R. Monitoring antiplatelet therapy: where are we now? J Cardiovasc Med (Hagerstown) 2022; 24:e24-e35. [PMID: 36729588 DOI: 10.2459/jcm.0000000000001406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Single antiplatelet therapy represents the cornerstone of thrombosis prevention in atherosclerotic cardiovascular disease. Dual antiplatelet therapy (DAPT), consisting of aspirin plus a P2Y12 inhibitor, is the standard of care for patients with acute coronary syndrome or undergoing both coronary and peripheral percutaneous interventions. Recent data suggest the efficacy of DAPT also after minor stroke. In this setting, a large body of evidence has documented that genetic and acquired patients' characteristics may affect the magnitude of platelet inhibition induced by antiplatelet agents. The implementation of tools allowing the identification and prediction of platelet inhibition has recently been shown to improve outcomes, leading to an optimal balance between antithrombotic efficacy and bleeding risk. We are therefore clearly moving towards tailored antiplatelet therapy. The aim of this paper is to summarize the available evidence on the evaluation of platelet inhibition in patients with coronary, peripheral, or cerebrovascular atherosclerosis. We will here focus on antiplatelet therapy based on both aspirin and P2Y12 inhibitors. In addition, we provide practical insights into the clinical settings in which it appears reasonable to implement antiplatelet therapy monitoring.
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Affiliation(s)
- Rossella Marcucci
- Department of Clinical and Experimental Medicine, University of Florence, Florence
| | - Martina Berteotti
- Department of Clinical and Experimental Medicine, University of Florence, Florence
| | - Felice Gragnano
- Division of Clinical Cardiology, Azienda Ospedaliera di Rilievo Nazionale 'Sant'Anna e San Sebastiano', Caserta.,Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Naples
| | - Mattia Galli
- Catholic University of the Sacred Heart, Rome.,Maria Cecilia Hospital, GVM Care & Research, Cotignola
| | | | - Giulia Renda
- Department of Neuroscience, Imaging and Clinical Sciences, and Center for Advanced Studies and Technology (CAST), G. d'Annunzio University Chieti-Pescara
| | - Piera Capranzano
- Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco", University of Catania, Catania
| | - Francesca Santilli
- Department of Medicine and Aging, and Center for Advanced Studies and Technology (CAST), G. d'Annunzio University Chieti-Pescara, Italy
| | - Davide Capodanno
- Division of Cardiology, Azienda Ospedaliero Universitaria Policlinico "G. Rodolico-San Marco", University of Catania, Catania
| | - Dominick J Angiolillo
- Division of Cardiology, University of Florida College of Medicine, Jacksonville, FL, USA
| | - Plinio Cirillo
- Division of Cardiology, Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples
| | - Paolo Calabrò
- Division of Clinical Cardiology, Azienda Ospedaliera di Rilievo Nazionale 'Sant'Anna e San Sebastiano', Caserta.,Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Naples
| | - Giuseppe Patti
- Maggiore della Carità Hospital, University of Eastern Piedmont, Novara
| | - Raffaele De Caterina
- Department of Surgical, Medical and Molecular Pathology and of Critical Sciences, University of Pisa, Pisa.,Division of Cardiology, Azienda Ospedaliero-Universitaria Pisana, Pisa.,Fondazione VillaSerena per la Ricerca, Città Sant'Angelo-Pescara, Pescara, Italy
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Kim M, Kim Y, Ryu GW, Choi M. Functional Status and Health-Related Quality of Life in Patients with Peripheral Artery Disease: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182010941. [PMID: 34682683 PMCID: PMC8535998 DOI: 10.3390/ijerph182010941] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 10/13/2021] [Accepted: 10/13/2021] [Indexed: 12/24/2022]
Abstract
Peripheral artery disease (PAD) is a progressive atherosclerotic disease that negatively affects individuals’ functional status and health-related quality of life (HRQOL). This study aimed to investigate the HRQOL and associated factors in patients with PAD in Korea. We conducted a cross-sectional study using self-administered questionnaires in a tertiary hospital in Seoul. We measured HRQOL using the EuroQol-5 dimensions-5 levels (EQ-5D-5L) questionnaire and the functional status using a PAD-specific walking impairment questionnaire. We also measured health behavior, social support, walking impairment, general health perceptions, and clinical characteristics; lastly, we performed a descriptive analysis and multiple linear regression analysis. Participants of this study comprised 138 patients (mean age 69.04 ± 10.94 years; men 91.3%). The mean EQ-5D-5L utility score was 0.81 ± 0.17. The patients’ HRQOL was significantly associated with claudication pain (β = −0.188, p = 0.012), walking distance (β = 0.371, p < 0.001), and stair climbing (β = 0.315, p = 0.001). The regression model predicted 60.4% of patients’ HRQOL (F = 15.92, p < 0.001). Our study showed that less severe claudication pain and a low degree of difficulty in walking distance and stair climbing were significantly related to better HRQOL. To enhance patients’ HRQOL, health professionals should focus on managing symptoms and improving functional status.
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Affiliation(s)
- Mihui Kim
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul 03772, Korea; (M.K.); (Y.K.); (G.W.R.)
| | - Yesol Kim
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul 03772, Korea; (M.K.); (Y.K.); (G.W.R.)
| | - Gi Wook Ryu
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul 03772, Korea; (M.K.); (Y.K.); (G.W.R.)
- Department of Nursing, Namseoul University, Cheonan-si 31020, Korea
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul 03772, Korea
| | - Mona Choi
- College of Nursing and Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul 03772, Korea
- Correspondence:
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Natale F, Capasso R, Casalino A, Crescenzi C, Sangiuolo P, Golino P, Loffredo FS, Cimmino G. Peripheral Artery Disease and Abdominal Aortic Aneurysm: The Forgotten Diseases in COVID-19 Pandemic. Results from an Observational Study on Real-World Management. ACTA ACUST UNITED AC 2021; 57:medicina57070672. [PMID: 34209552 PMCID: PMC8307785 DOI: 10.3390/medicina57070672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/11/2021] [Accepted: 06/25/2021] [Indexed: 12/24/2022]
Abstract
Background and Objectives: It is well established that patients with peripheral artery disease (PAD) as well abdominal aortic aneurysm (AAA) have an increased cardiovascular (CV) mortality. Despite this higher risk, PAD and AAA patients are often suboptimality treated. This study assessed the CV profile of PAD and AAA patients, quantifying the survival benefits of target-based risk-factors modification even in light of the COVID-19 pandemic. Materials and Methods: PAD and AAA patients admitted for any reason to the Vascular Unit from January 2019 to February 2020 were retrospectively analyzed. Biochemical and CV profiles as well as ongoing medical therapies were recorded. Benefits of CV risk-factors control were estimated using the SMART-REACH model. A follow-up visit during the year 2020 was scheduled. Results: A total of 669 patients were included. Of these, 190 showed AAA and 479 PAD at any stage. Only 54% of PAD and 41% of AAA patients were on lipid-lowering drugs with non-optimal low-density lipoprotein (LDL) levels for most of them. A better control of all modifiable CV risk-factors based on the current guidelines would offer an absolute risk reduction of the mean 10-year CV risk by 9% in PAD and 14% in AAA. Unfortunately, the follow-up visit was lost because of COVID-19 limitations. Conclusions: Lipid profiles of PAD and AAA patients were far from guideline-based targets, and medical management was suboptimal. In our center, the COVID-19 pandemic impacted on the strict surveillance required in these very high-risk patients. The achievement of guideline-based therapeutic targets would definitively confer additional significant benefits in reducing the CV risk in these patients.
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Affiliation(s)
- Francesco Natale
- Vanvitelli Cardiology and Intensive Care Unit, Monaldi Hospital, 80131 Naples, Italy; (P.G.); (F.S.L.)
- Correspondence: ; Tel.:+39-0817064239
| | - Raffaele Capasso
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (R.C.); (G.C.)
| | - Alfonso Casalino
- Vascular Surgery Unit, Monaldi Hospital, 80131 Naples, Italy; (A.C.); (C.C.); (P.S.)
| | - Clotilde Crescenzi
- Vascular Surgery Unit, Monaldi Hospital, 80131 Naples, Italy; (A.C.); (C.C.); (P.S.)
| | - Paolo Sangiuolo
- Vascular Surgery Unit, Monaldi Hospital, 80131 Naples, Italy; (A.C.); (C.C.); (P.S.)
| | - Paolo Golino
- Vanvitelli Cardiology and Intensive Care Unit, Monaldi Hospital, 80131 Naples, Italy; (P.G.); (F.S.L.)
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (R.C.); (G.C.)
| | - Francesco S. Loffredo
- Vanvitelli Cardiology and Intensive Care Unit, Monaldi Hospital, 80131 Naples, Italy; (P.G.); (F.S.L.)
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (R.C.); (G.C.)
- Molecular Cardiology, International Centre for Genetic Engineering and Biotechnology, 34149 Trieste, Italy
| | - Giovanni Cimmino
- Department of Translational Medical Sciences, Section of Cardiology, University of Campania “Luigi Vanvitelli”, 80131 Naples, Italy; (R.C.); (G.C.)
- Cardiology Unit, Policlinico Vanvitelli, 80138 Naples, Italy
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Lourenço ALG, da Silva JL, Leite JC. The impact of peripheral arterial disease on exercise tolerance and quality of life in the elderly and the role of cardiovascular physiotherapy: review article. J Vasc Bras 2021; 20:e20200117. [PMID: 34093682 PMCID: PMC8147882 DOI: 10.1590/1677-5449.200117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The primary symptom of peripheral arterial its intermittent claudication; a condition that causes functional disabilities, compromising quality of life. This review aimed to survey the impacts of this disease on the elderly, investigating possible contributions that cardiovascular physiotherapy has to offer. Searches were run on the MEDLINE, LILACS, SciELO, Scopus, Science Direct, and PEDro databases, identifying 7,587 studies. Seven of these met the eligibility criteria and were grouped and analyzed according evidence level, recommendation grade, and methodological quality. It was observed that this disease is responsible for considerable impact on exercise tolerance and quality of life. Regarding the therapeutic approach to these outcomes, the studies reported that there were improvements in walking and quality of life, increased functional capacity, and reduced pain. With regard to the treatment modality, most research included aerobic exercises.
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Affiliation(s)
| | | | - Jéssica Costa Leite
- Centro Universitário UNIFACISA, Departamento de Fisioterapia, Campina Grande, PB, Brasil
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Affiliation(s)
- Hélio Amante Miot
- Universidade Estadual Paulista - UNESP, Faculdade de Medicina de Botucatu, Departamento de Dermatologia e Radioterapia, Botucatu, SP, Brasil
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