1
|
Adou C, Magne J, Gazere N, Aouida M, Chastaingt L, Aboyans V. Global epidemiology of lower extremity artery disease in the 21st century (2000-21): a systematic review and meta-analysis. Eur J Prev Cardiol 2024; 31:803-811. [PMID: 38079162 DOI: 10.1093/eurjpc/zwad381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 02/06/2024]
Abstract
AIMS The epidemiology of lower extremity artery disease (LEAD) is evolving. This meta-analysis of aggregate data aimed to (i) determine the global prevalence of LEAD and by regions in the 21st century and (ii) update the associated risk factors in this period. METHODS AND RESULTS A systematic literature review was performed through PubMed, Cochrane, Scopus, Science Direct, and Google Scholar databases, restricted to general population studies between January 2000 and September 2021, with LEAD defined by a low (≤0.90) ankle-brachial index. The Newcastle-Ottawa Scale was used to evaluate the quality of the articles before data extraction. Due to high heterogeneity, the random effect model was applied to this meta-analysis. Among 1418 references, 38 studies (127 961 participants) were retained. The global prevalence in adults, mostly ≥40 years, was estimated at 9.7% [95% confidence interval (CI): 7.1-12.4], higher in women (10.2%) than in men (8.8%), increasing sharply with age. The highest prevalence was found in South-Central Asia (14.5%) and the lowest in North America (5.6%). Significant associations were found between LEAD and current [odds ratio (OR) = 1.9, 95% CI: 1.4-2.5] and past smoking (OR = 1.6, 95% CI: 1.3-1.9) and between LEAD and diabetes (OR = 2.3, 95% CI: 2.0-2.8). Hypertension was significantly associated with LEAD (OR = 2.3, 95% CI: 1.9-2.8) and in particular in South America (OR = 4.0). Obesity (OR = 1.5, 95% CI: 1.2-1.8) and hypercholesterolaemia ≥200 mg/dL (OR = 1.9, 95% CI: 1.3-2.8) were also significantly associated with LEAD. CONCLUSION This meta-analysis highlights a currently high prevalence of LEAD worldwide, with substantial differences in global regions and between sexes. The strongest associations were found with metabolic risk factors.
Collapse
Affiliation(s)
- Caroline Adou
- EpiMaCT Research Unit U1094 Inserm U270 IRD EpiMaCT, School of Medicine, Limoges University, 2ave Marcland, 87025 Limoges, France
| | - Julien Magne
- EpiMaCT Research Unit U1094 Inserm U270 IRD EpiMaCT, School of Medicine, Limoges University, 2ave Marcland, 87025 Limoges, France
| | - Nana Gazere
- EpiMaCT Research Unit U1094 Inserm U270 IRD EpiMaCT, School of Medicine, Limoges University, 2ave Marcland, 87025 Limoges, France
| | - Maissa Aouida
- EpiMaCT Research Unit U1094 Inserm U270 IRD EpiMaCT, School of Medicine, Limoges University, 2ave Marcland, 87025 Limoges, France
| | - Lucie Chastaingt
- EpiMaCT Research Unit U1094 Inserm U270 IRD EpiMaCT, School of Medicine, Limoges University, 2ave Marcland, 87025 Limoges, France
- Department of Vascular Surgery and Vascular Medicine, Dupuytren University Hospital, Limoges, France
| | - Victor Aboyans
- EpiMaCT Research Unit U1094 Inserm U270 IRD EpiMaCT, School of Medicine, Limoges University, 2ave Marcland, 87025 Limoges, France
- Department of Cardiology, Dupuytren University Hospital, 16 rue Bernard Descottes, 87042 Limoges, France
| |
Collapse
|
2
|
Levin MG, Klarin D, Walker VM, Gill D, Lynch J, Hellwege JN, Keaton JM, Lee KM, Assimes TL, Natarajan P, Hung AM, Edwards T, Rader DJ, Gaziano JM, Davies NM, Tsao PS, Chang KM, Voight BF, Damrauer SM. Association Between Genetic Variation in Blood Pressure and Increased Lifetime Risk of Peripheral Artery Disease. Arterioscler Thromb Vasc Biol 2021; 41:2027-2034. [PMID: 33853351 PMCID: PMC8159880 DOI: 10.1161/atvbaha.120.315482] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
[Figure: see text].
Collapse
Affiliation(s)
- Michael G. Levin
- Division of Cardiovascular Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
| | - Derek Klarin
- Malcolm Randall VA Medical Center, Gainesville, FL
- Department of Surgery, University of Florida, Gainesville, FL
| | - Venexia M. Walker
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Dipender Gill
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, United Kingdom
- Centre for Pharmacology & Therapeutics, Department of Medicine, Hammersmith Campus, Imperial College London, London, United Kingdom
- Novo Nordisk Research Centre Oxford, Old Road Campus, Oxford, United Kingdom
- Clinical Pharmacology and Therapeutics Section, Institute of Medical and Biomedical Education and Institute for Infection and Immunity, St George’s, University of London, London, United Kingdom
- Clinical Pharmacology Group, Pharmacy and Medicines Directorate, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Julie Lynch
- Edith Nourse VA Medical Center, Bedford, MA
- VA Informatics and Computing Infrastructure, Department of Veterans Affairs, Salt Lake City Health Care System, Salt Lake City, CT, USA
| | - Jacklyn N. Hellwege
- Division of Genetic Medicine, Department of Medicine, Vanderbilt Genetics Institute, Vanderbilt Epidemiology Center, Vanderbilt University Medical Center, Nashville, TN
- Biomedical Laboratory Research and Development, Tennessee Valley Healthcare System (626)/Vanderbilt University, Nashville, TN
| | - Jacob M. Keaton
- Medical Genomics and Metabolic Genetics Branch, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD
- Division of Epidemiology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Kyung M. Lee
- VA Informatics and Computing Infrastructure, Department of Veterans Affairs, Salt Lake City Health Care System, Salt Lake City, CT, USA
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Hospital, Bedford, MA, USA
- Department of Health Law, Policy & Management, Boston University School of Public Health, Boston, MA
| | - Themistocles L. Assimes
- Palo Alto VA Healthcare System, Palo Alto, CA
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA
| | - Pradeep Natarajan
- Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA
- Broad Institute of Harvard and MIT, Cambridge, MA
- Department of Medicine, Harvard Medical School, Boston, MA
- VA Boston Healthcare System, Boston, MA
| | - Adriana M. Hung
- Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Todd Edwards
- Division of Epidemiology, Department of Medicine, Institute for Medicine and Public Health, Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Vanderbilt University, Nashville, TN
| | - Daniel J. Rader
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Institute for Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - J. Michael Gaziano
- VA Boston Healthcare System, Boston, MA
- Division of Aging, Department of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA
| | - Neil M. Davies
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Norway
| | - Philip S. Tsao
- Palo Alto VA Healthcare System, Palo Alto, CA
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA
| | - Kyong-Mi Chang
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
| | - Benjamin F. Voight
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
- Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Institute for Translational Medicine and Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Scott M. Damrauer
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| |
Collapse
|
3
|
Desormais I, Aboyans V, Guerchet M, Ndamba-Bandzouzi B, Mbelesso P, Magne J, Jesus P, Marin B, Lacroix P, Preux PM. Body mass index and peripheral arterial disease, a "U-shaped" relationship in elderly African population - the EPIDEMCA study. VASA 2019; 49:50-56. [PMID: 31621522 DOI: 10.1024/0301-1526/a000825] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background: There is no study available concerning specifically the role of underweight in PAD prevalence. Patients and methods: Individuals ≥ 65 years living in urban and rural areas of two countries in Central Africa (Central African Republic and the Republic of Congo) were invited. Demographic, clinical and biological data were collected, and ankle-brachial index measured. BMI was calculated as weight/height2 and participants were categorized according to the World Health Organization as with underweight (< 18.5 kg/m2), normal weight (18.5-24.9 kg/m2), overweight (25-29.9 kg/m2), and obese (≥ 30 kg/m2). Results: Among the 1815 participants (age 73.0 years, 61.8 % females), the prevalence of underweight was 34.1 %, higher in subjects with PAD than in PAD free subjects (37.1 % vs. 33.5 %, p = 0.0333). The overall prevalence of PAD was 14.3 %. Underweight and obesity were still significantly associated with PAD after adjustment to all potential confounding factors (OR: 2.09, p = 0.0009 respectively OR: 1.90, p = 0.0336) while overweight was no more significantly associated with PAD after multivariate analysis. Conclusions: While obesity is a well-known PAD associated marker, low BMI provides novel independent and incremental information on African subject's susceptibility to present PAD, suggesting a "U-shaped" relationship between BMI and PAD in this population.
Collapse
Affiliation(s)
- Ileana Desormais
- INSERM UMR 1094, Tropical Neuroepidemiology, Limoges, France.,Department of Thoracic and Cardiovascular Surgery and Angiology, Dupuytren University Hospital, Limoges, France
| | - Victor Aboyans
- INSERM UMR 1094, Tropical Neuroepidemiology, Limoges, France.,Department of Cardiology, Dupuytren University Hospital, Limoges, France
| | - Maëlenn Guerchet
- INSERM UMR 1094, Tropical Neuroepidemiology, Limoges, France.,King's College London, Centre for Global Mental Health, Health Services and Population Research Department, Institute of Psychiatry, Psychology and Neurosciences, London, UK
| | | | - Pascal Mbelesso
- Department of Neurology, Amitié Hospital, Bangui, Central African Republic
| | - Julien Magne
- INSERM UMR 1094, Tropical Neuroepidemiology, Limoges, France.,Department of Cardiology, Dupuytren University Hospital, Limoges, France
| | - Pierre Jesus
- INSERM UMR 1094, Tropical Neuroepidemiology, Limoges, France.,Nutrition Unit, Dupuytren University Hospital, Limoges, France
| | - Benoît Marin
- INSERM UMR 1094, Tropical Neuroepidemiology, Limoges, France.,Department of Medical Information & Evaluation, Clinical Research and Biostatistic Unit, Dupuytren University Hospital, Limoges, France
| | - Philippe Lacroix
- INSERM UMR 1094, Tropical Neuroepidemiology, Limoges, France.,Department of Thoracic and Cardiovascular Surgery and Angiology, Dupuytren University Hospital, Limoges, France
| | - Pierre Marie Preux
- INSERM UMR 1094, Tropical Neuroepidemiology, Limoges, France.,Nutrition Unit, Dupuytren University Hospital, Limoges, France
| | | |
Collapse
|
4
|
Chen Z, Guo W, Jiang W, Wang F, Fu W, Zou Y, Deckers S, Li P, Popma JJ, Jaff MR. IN.PACT SFA Clinical Study Using the IN.PACT Admiral Drug-Coated Balloon in a Chinese Patient Population. J Endovasc Ther 2019; 26:471-478. [PMID: 31204595 PMCID: PMC6630064 DOI: 10.1177/1526602819852084] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Purpose: To confirm the safety and effectiveness of the IN.PACT Admiral drug-coated balloon (DCB) as a treatment for de novo and native artery restenotic lesions in the superficial femoral artery (SFA) and/or proximal popliteal artery in Chinese subjects. Materials and Methods: IN.PACT SFA China (ClinicalTrials.gov identifier NCT02118532) was a single-arm, independently adjudicated, prospective, premarket study that enrolled 143 subjects (mean age 66.8±7.7 years; 107 men) at 15 centers. The predominant risk factors were hypertension (104, 72.7%) and diabetes mellitus (66, 46.2%). The majority of subjects were classified as Rutherford category 2 or 3 [69 (48.3%) and 55 (38.5%), respectively]; 19 (13.3%) subjects had critical limb ischemia (Rutherford category 4). The mean lesion length was 10.4±6.51 cm; more than half of the lesions (75, 52.4%) were chronic total occlusions. Calcification was found in 66 (46.2%) lesions. Outcomes at 12 months were compared with DCB safety and effectiveness performance goals derived from the literature. The 30-day primary safety outcome was a composite of freedom from device- and procedure-related mortality, major target limb amputation, and clinically-driven target lesion revascularization (CD-TLR). Results: The primary safety outcome was 99.3% at 30 days. Follow-up compliance at 12 months was 92.6%. Estimated 1-year primary patency using Kaplan-Meier analysis was 90.9% and freedom from CD-TLR was 97.1%. The rate of CD-TLR at 12 months was 2.9%. The Rutherford category status improved significantly (p<0.001) between baseline and 12 months. Conclusion: Results from IN.PACT SFA China demonstrated high rates of patency and low rates of CD-TLR in Chinese subjects through 12 months despite patient and lesion complexity. These data are consistent with the results of other IN.PACT DCB trials.
Collapse
Affiliation(s)
- Zhong Chen
- 1 Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Wei Guo
- 2 Chinese PLA General Hospital, Beijing, China
| | - Weiliang Jiang
- 3 The 2nd Affiliated Hospital of Harbin Medical University Hospital, Harbin, China
| | - Feng Wang
- 4 The First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Weiguo Fu
- 5 Zhongshan Hospital, Fudan University, Shanghai, China
| | - Yinghua Zou
- 6 Peking University First Hospital, Beijing, China
| | - Stefanie Deckers
- 7 Medtronic, Bakken Research Center BV, Maastricht, the Netherlands
| | - Pei Li
- 8 Medtronic, Plymouth, MN, USA
| | | | | |
Collapse
|
5
|
Cornejo del Río V, Mostaza J, Lahoz C, Sánchez-Arroyo V, Sabín C, López S, Patrón P, Fernández-García P, Fernández-Puntero B, Vicent D, Montesano-Sánchez L, García-Iglesias F, González-Alegre T, Estirado E, Laguna F, de Burgos-Lunar C, Gómez-Campelo P, Abanades-Herranz JC, de Miguel-Yanes JM, Salinero-Fort MA. Prevalence of peripheral artery disease (PAD) and factors associated: An epidemiological analysis from the population-based Screening PRE-diabetes and type 2 DIAbetes (SPREDIA-2) study. PLoS One 2017; 12:e0186220. [PMID: 29073236 PMCID: PMC5657631 DOI: 10.1371/journal.pone.0186220] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 09/27/2017] [Indexed: 11/20/2022] Open
Abstract
AIM To describe the prevalence of Peripheral Artery Disease (PAD) in a random population sample and to evaluate its relationship with Mediterranean diet and with other potential cardiovascular risk factors such as serum uric acid and pulse pressure in individuals ranged 45 to 74 years. METHODS Cross-sectional analysis of 1568 subjects (mean age 6.5 years, 43% males), randomly selected from the population. A fasting blood sample was obtained to determine glucose, lipids, and HbA1C levels. An oral glucose tolerance test was performed in non-diabetic subjects. PAD was evaluated by ankle-brachial index and/or having a prior diagnosis. RESULTS PAD prevalence was 3.81% (95% CI, 2.97-4.87) for all participants. In men, PAD prevalence was significantly higher than in women [5.17% (95% CI, 3.74-7.11) vs. 2.78% (95% CI, 1.89-4.07); p = 0.014]. Serum uric acid in the upper quartile was associated with the highest odds ratio (OR) of PAD (for uric acid > 6.1 mg/dl, OR = 4.31; 95% CI, 1.49-12.44). The remaining variables more strongly associated with PAD were: Heart rate >90 bpm (OR = 4.16; 95%CI, 1.62-10.65), pulse pressure in the upper quartile (≥ 54 mmHg) (OR = 3.82; 95%CI, 1.50-9.71), adherence to Mediterranean diet (OR = 2.73; 95% CI, 1.48-5.04), and former smoker status (OR = 2.04; 95%CI, 1.00-4.16). CONCLUSIONS Our results show the existence of a low prevalence of peripheral artery disease in a population aged 45-74 years. Serum uric acid, pulse pressure and heart rate >90 bpm were strongly associated with peripheral artery disease. The direct association between Mediterranean diet and peripheral artery disease that we have found should be evaluated through a follow-up study under clinical practice conditions.
Collapse
Affiliation(s)
- V. Cornejo del Río
- Hospital Carlos III, Madrid, Spain
- Grupo de Investigación en cuidados IdIPAZ, Hospital La Paz, Madrid, Spain
| | | | - C. Lahoz
- Hospital Carlos III, Madrid, Spain
| | | | - C. Sabín
- Hospital Carlos III, Madrid, Spain
| | - S. López
- Hospital Carlos III, Madrid, Spain
| | | | | | | | - D. Vicent
- Hospital Carlos III, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | | | | | | | | | | | - C. de Burgos-Lunar
- Dirección General de Salud Pública, Subdirección de Promoción, Prevención y Educación de la Salud, Consejería de Sanidad, Madrid, Spain
- Red de Investigación en servicios de salud en enfermedades crónicas (REDISSEC), Madrid, Spain
| | - P. Gómez-Campelo
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Plataforma de Apoyo al Investigador Novel, IdiPAZ, Madrid, Spain
| | | | | | - M. A. Salinero-Fort
- Red de Investigación en servicios de salud en enfermedades crónicas (REDISSEC), Madrid, Spain
- Subdirección General de Investigación Sanitaria, Consejería de Sanidad, Madrid, Spain
| | | |
Collapse
|
6
|
Vitalis A, Lip GYH, Kay M, Vohra RK, Shantsila A. Ethnic differences in the prevalence of peripheral arterial disease: a systematic review and meta-analysis. Expert Rev Cardiovasc Ther 2017; 15:327-338. [DOI: 10.1080/14779072.2017.1305890] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Antonios Vitalis
- Institute of Cardiovascular Sciences, University of Birmingham, City Hospital, Birmingham, UK
- Department of Vascular Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Gregory Y. H. Lip
- Institute of Cardiovascular Sciences, University of Birmingham, City Hospital, Birmingham, UK
| | - Mark Kay
- Department of Vascular Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Rajiv K. Vohra
- Department of Vascular Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Alena Shantsila
- Institute of Cardiovascular Sciences, University of Birmingham, City Hospital, Birmingham, UK
| |
Collapse
|
7
|
Mao Y, Huang Y, Yu H, Xu P, Yu G, Yu J, Zhan Y. Incidence of Peripheral Arterial Disease and Its Association with Pulse Pressure: A Prospective Cohort Study. Front Endocrinol (Lausanne) 2017; 8:333. [PMID: 29225591 PMCID: PMC5705627 DOI: 10.3389/fendo.2017.00333] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 11/10/2017] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The association of pulse pressure and peripheral arterial disease (PAD) has seldom been examined using a prospective design. This study aimed to investigate the association of pulse pressure with PAD incidence in an elderly general population. METHODS We utilized data from a cohort conducted in Beijing with additionally 2-year follow-up time. PAD was defined as an ankle brachial index value <0.9 in either leg. Cox proportional hazard regression model was used to quantify the magnitude of pulse pressure on PAD incidence. RESULTS During a 2-year follow-up time, 357 of 4,201 (8.5%) participants developed PAD with 105 (6.9%) men and 252 (9.4%) women, respectively. After adjusting for baseline age, sex, body mass index, hypertension, diabetes, total cholesterol, and high-density lipoprotein cholesterol, and smoking, the hazard ratio and 95% confidence interval for people with pulse pressure greater than 60 mmHg was 2.20 (1.53, 3.15) compared with those whose pulse pressure was less than 40 mmHg. A linear trend was observed for the association of pulse pressure with PAD. CONCLUSION Higher pulse pressure was associated with higher PAD incidence.
Collapse
Affiliation(s)
- Yong Mao
- Department of Epidemiology and Health Statistics, School of Public Health, Kunming Medical University, Kunming, China
| | - Yixiang Huang
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Haining Yu
- Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, China
- *Correspondence: Haining Yu,
| | - Peng Xu
- Shandong Cancer Hospital Affiliated to Shandong University, Shandong Academy of Medical Sciences, Jinan, China
| | - Guangping Yu
- Wuqing Center for Disease Control and Prevention, Tianjin, China
| | - Jinming Yu
- Department of Health Education and Health Behavior, School of Public Health, Fudan University, Shanghai, China
| | | |
Collapse
|
8
|
Abstract
We aim to build models for peripheral arterial disease (PAD) risk prediction and seek to validate these models in 2 different surveys in the US general population. Model building survey was based on the National Health and Nutrition Examination Surveys (NHANES, 1999-2002). Potential predicting variables included race, gender, age, smoking status, total cholesterol (TC), body mass index, high-density lipoprotein (HDL), ratio of TC to HDL, diabetes status, HbA1c, hypertension status, and pulse pressure. The PAD was diagnosed as ankle brachial index <0.9. We used multiple logistic regression method for the prediction model construction. The final predictive variables were chosen based on the likelihood ratio test. Model internal validation was done by the bootstrap method. The NHANES 2003-2004 survey was used for model external validation. Age, race, sex, pulse pressure, the ratio of TC to HDL, and smoking status were selected in the final prediction model. The odds ratio (OR) and 95% confidence interval (CI) for age with 10 years increase was 2.00 (1.72, 2.33), whereas that of pulse pressure for 10 mm Hg increase was 1.19 (1.10, 1.28). The OR of PAD was 1.11 (95% CI: 1.02, 1.21) for 1 unit increase in the TC to HDL ratio and was 1.61 (95% CI: 1.40, 1.85) for people who were currently smoking compared with those who were not. The respective area under receiver operating characteristics (AUC) of the final model from the training survey and validation survey were 0.82 (0.82, 0.83) and 0.76 (0.72, 0.79) indicating good model calibrations. Our model, to some extent, has a moderate usefulness for PAD risk prediction in the general US population.
Collapse
Affiliation(s)
- Yang Zhang
- From the Department of Anesthesiology (YZ), Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang; Department of Cardiology (JH), The National Hospital of Enshi Autonomous Prefecture, Enshi, P. R. China; and Department of Cardiology (PW), Wendeng Central Hospital of Weihai, Wendeng, P. R. China
| | | | | |
Collapse
|
9
|
Del Brutto OH, Mera RM, Sedler MJ, Gruen JA, Phelan KJ, Cusick EH, Zambrano M, Brown DL. The Relationship Between High Pulse Pressure and Low Ankle-Brachial Index. Potential Utility in Screening for Peripheral Artery Disease in Population-Based Studies. High Blood Press Cardiovasc Prev 2015; 22:275-80. [PMID: 25986077 DOI: 10.1007/s40292-015-0103-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2015] [Accepted: 05/12/2015] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION The ankle-brachial index (ABI) is a reliable screening procedure for peripheral artery disease detection. However, ABI testing is time-consuming and requires trained personnel, which may preclude its routine use in population-based surveys. Preliminary data suggest a relationship between ABI values and pulse pressure (PP) levels. AIM To assess whether PP calculation might help to detect persons who need ABI screening in population-based studies. METHODS All Atahualpa residents aged ≥60 years were identified during a door-to-door survey and invited to undergo ABI testing. Non-consented persons and those with ABI ≥1.4 were excluded. Using generalized linear and logistic regression models adjusted for demographics and cardiovascular risk factors, as well as receiver operator characteristics curve analysis, we evaluated the association between PP values and ABI, as well as the reliability of PP to identify candidates for ABI testing. RESULTS Out of 239 participants (mean age 70 ± 8 years, 62 % women), 46 (19 %) had an ABI ≤0.9 and 136 (57 %) had PP >65 mmHg, with a negative relationship between them (R = -0.386, p < 0.0001). A PP >65 mmHg was associated with an ABI ≤ 0.9 in the logistic regression model (OR 3.46, 95 % CI 1.07-11.2, p = 0.038). Continuous PP levels also correlated negatively with ABI (β -0.0014, 95 % CI -0.0024 to -0.0004, p = 0.005). The sensitivity of a PP >65 mmHg to predict a low ABI was 85 %, and the specificity was 50 %. In contrast, the sensitivity of blood pressure ≥140/90 mmHg was 27 % and the specificity was 10 %. The area under the curve for the predictive value of a PP >65 mmHg was 0.673 (95 % CI 0.609-0.736), and that of a blood pressure ≥140/90 mmHg was 0.371 (95 % CI 0.30-0.443), with a significant difference between them (p < 0.0001). CONCLUSIONS PP calculation may be a simple tool to detect candidates for ABI testing in population-based studies.
Collapse
Affiliation(s)
- Oscar H Del Brutto
- School of Medicine, Universidad Espíritu Santo, Ecuador, Guayaquil, Ecuador,
| | | | | | | | | | | | | | | |
Collapse
|
10
|
Cyclophilin A is associated with peripheral artery disease and chronic kidney disease in geriatrics: The Tianliao Old People (TOP) study. Sci Rep 2015; 5:9937. [PMID: 25909510 PMCID: PMC4408976 DOI: 10.1038/srep09937] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 03/23/2015] [Indexed: 12/15/2022] Open
Abstract
Cyclophilin A (CyPA), secreted by vascular smooth muscle cells in response to oxidative stress, is important in the pathogenesis of progressive peripheral arterial occlusion disease (PAOD), which is common among chronic kidney disease. We explored the prevalence of PAOD in Taiwan’s elderly (≥ 65 years old) population and its association with CyPA and renal function. Residents of Tianliao District, a rural community in southern Taiwan, were surveyed. An ankle-brachial index (ABI) < 0.91 was defined as PAOD. Chronic kidney disease (CKD) was defined based on eGFR levels < 60 mL/min/1.73 m2. Serum CyPA was measured. Of the 473 participants, 68 (14.4%) had PAOD. Multiple logistic regression analysis showed PAOD was significantly associated with lower eGFR, lower BMI, higher glycated hemoglobin and higher pulse pressure. Serum CyPA levels in participants with PAOD were significantly higher than those with normal ABI values (47.3 ± 0.4 vs. 25.5 ± 0.2 ng/mL, p < 0.001). Moreover, eGFR inversely correlated with serum CyPA level (p < 0.05) in participants with CKD, but not in participants with normal renal function. In conclusion, with a prevalence of PAOD as high as 14.4% in an elderly community, CyPA might be the link between PAOD and advanced impaired renal function.
Collapse
|
11
|
Zhan Y, Dong Y, Tang Z, Zhang F, Hu D, Yu J. Serum Uric Acid, Gender, and Low Ankle Brachial Index in Adults With High Cardiovascular Risk. Angiology 2015; 66:687-91. [PMID: 25564679 DOI: 10.1177/0003319714566228] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Uric acid (UA) has been reported to be associated with cardiovascular disease (CVD) in caucasians. However, it is unclear whether this association remains significant in a Chinese population. The present study aimed to investigate the association between UA and low ankle brachial index (ABI), a measurement of peripheral arterial disease, in Chinese patients. A total of 6262 hospital-based patients with high CVD risk were enrolled. Low ABI was defined as ABI ≤0.9 in either side. Low ABI was detected in 1390 (22.2%) patients. Higher UA was significantly associated with higher risk of low ABI and modified by gender (P = .0045). After adjusting for age, body mass index, total cholesterol, triglyceride, low-density lipoprotein, high-density lipoprotein, fasting glucose, hypertension, and smoking, participants in the highest quartile of UA exhibited 37% (odds ratio [OR]:1.37, 95% confidence interval [CI]: 1.03-1.82) higher risk of low ABI compared to those in the lowest quartile in men, while OR (95% CI) was 1.69 (1.29-2.22) for women. However, when kidney function was further adjusted, the associations were attenuated in both men and women and were significant only in women. The results were suggestive of higher UA associating with higher risk of low ABI in women, and the association was largely driven by kidney function, especially in men.
Collapse
Affiliation(s)
- Yiqiang Zhan
- Institute of Clinical Epidemiology, School of Public Health, Fudan University, Shanghai, P. R. China
| | - Ying Dong
- Department of Preventive Medicine, School of Basic Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, P. R. China
| | - Zheng Tang
- Institute of Clinical Epidemiology, School of Public Health, Fudan University, Shanghai, P. R. China
| | - Fen Zhang
- Department of Chronic Disease Prevention, Minhang Center for Disease Control and Prevention, Shanghai, P. R. China
| | - Dayi Hu
- Heart Center, Peking University People's Hospital, Beijing, P. R. China
| | - Jinming Yu
- Institute of Clinical Epidemiology, School of Public Health, Fudan University, Shanghai, P. R. China Key Laboratory of Public Health Safety, Ministry of Education, School of Public Health, Fudan University, Shanghai, P. R. China
| |
Collapse
|
12
|
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.
Collapse
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
| |
Collapse
|
13
|
Liang Y, Yan Z, Sun B, Cai C, Jiang H, Song A, Qiu C. Cardiovascular risk factor profiles for peripheral artery disease and carotid atherosclerosis among Chinese older people: a population-based study. PLoS One 2014; 9:e85927. [PMID: 24465793 PMCID: PMC3895010 DOI: 10.1371/journal.pone.0085927] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2013] [Accepted: 12/04/2013] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Epidemiological data concerning atherosclerotic disease among older people in rural China are sparse. We seek to determine prevalence and cardiovascular risk factor profiles for peripheral artery disease (PAD) and carotid atherosclerosis (CAS) among Chinese older people living in a rural community. METHODS This cross-sectional study included 1499 participants (age ≥60 years, 59.0% women) of the Confucius Hometown Aging Project in Shandong, China. From June 2010-July 2011, data were collected through interviews, clinical examinations, and laboratory tests. PAD was defined as an ankle-brachial index ≤0.9. Carotid intima-media thickness (cIMT) and carotid artery stenosis were assessed by ultrasonography. We defined moderate stenosis as carotid stenosis ≥50%, and severe stenosis as carotid stenosis ≥70%. cIMT≥1.81 mm was considered as an increased cIMT (a measure of CAS). Data were analyzed with multiple logistic models. RESULTS The prevalence was 5.7% for PAD, 8.9% for moderate stenosis, 1.8% for severe stenosis, and 11.2% for increased cIMT. After controlling for multiple potential confounders, diabetes, an increased low-density lipoprotein cholesterol (LDL-C)/high-density lipoprotein cholesterol (HDL-C) ratio, and hypertension were significantly or marginally associated with PAD. Ever smoking, hypertension, and an increased LDL-C/HDL-C ratio were significantly associated with an increased likelihood of increased cIMT. An increasing number of those cardiovascular risk factors were significantly associated with an increasing odds ratio of PAD and increased cIMT, respectively (p for linear trend <0.001). CONCLUSION Among Chinese older people living in a rural community, PAD, carotid artery stenosis, and an increased cIMT are relatively uncommon. Cardiovascular risk factor profiles for PAD and CAS are slightly different, with hypertension and an increased LDL-C/HDL-C ratio being associated with an increased likelihood of both PAD and increased cIMT.
Collapse
Affiliation(s)
- Yajun Liang
- School of Public Health, Jining Medical University, Shandong, P. R. China
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden
- * E-mail: (YL); (CQ)
| | - Zhongrui Yan
- Department of Neurology, Jining First People’s Hospital, Shandong, P. R. China
| | - Binglun Sun
- Xing Long Zhuang Coal Mine Hospital, Yankuang Group, Shandong, P. R. China
| | - Chuanzhu Cai
- Xing Long Zhuang Coal Mine Hospital, Yankuang Group, Shandong, P. R. China
| | - Hui Jiang
- Xing Long Zhuang Coal Mine Hospital, Yankuang Group, Shandong, P. R. China
| | - Aiqin Song
- School of Public Health, Jining Medical University, Shandong, P. R. China
| | - Chengxuan Qiu
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet-Stockholm University, Stockholm, Sweden
- * E-mail: (YL); (CQ)
| |
Collapse
|
14
|
Chen YJ, Lin MS, Hsu KY, Chen CR, Chen CM, Chen W. Prevalence of Asymptomatic Peripheral Arterial Disease and Related Risk Factors in Younger and Elderly Patients in Taiwan. Angiology 2013; 65:396-401. [DOI: 10.1177/0003319713480842] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We determined the prevalence of asymptomatic peripheral arterial disease (PAD) and cardiovascular risk factors in Taiwan. Ambulatory participants (n = 1915) without symptoms of PAD were enrolled (mean age of 61.2 years). The ankle-brachial index (ABI) was used to detect the PAD (ABI < 0.90). The overall prevalence of asymptomatic PAD was 5.4% (2.8% in the younger participants [<65 years of age, n = 1021] and 8.4% in the elderly participants [≥65 years of age, n = 894]). Younger participants with asymptomatic PAD had a significantly higher rate of hypertension (55.2% vs 30%) and obesity (31% vs 13.3%) than those without asymptomatic PAD ( P < .05). Elderly participants with asymptomatic PAD had a significantly higher rate of diabetes mellitus (36% vs 21.2%) and hypertension (69.3% vs 55.4%) than those without asymptomatic PAD ( P < .05). Asymptomatic PAD is prevalent among elderly Taiwanese individuals. Overall, age was the strongest risk factor for the development of asymptomatic PAD.
Collapse
Affiliation(s)
- Yi-Jen Chen
- Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Taiwan
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi Campus, Taiwan
| | - Ming-Shian Lin
- Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Taiwan
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi Campus, Taiwan
| | - Kun-Yen Hsu
- Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Taiwan
| | - Cheng-Ren Chen
- Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Taiwan
| | - Chuan-Mu Chen
- Department of Life Science, National Chung Hsing University, Taichung, Taiwan
| | - Wei Chen
- Department of Internal Medicine, Ditmanson Medical Foundation Chiayi Christian Hospital, Taiwan
- Department of Life Science, National Chung Hsing University, Taichung, Taiwan
- Department of Respiratory Therapy, China Medical University, Taiwan
| |
Collapse
|