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Fatemi S, Acosta S, Zarrouk M, Nilsson PM, Gottsäter A. A population-based study on hyperinsulinaemia and arterial stiffness in men with and without abdominal aortic aneurysm. Cardiovasc Endocrinol Metab 2023; 12:e0290. [PMID: 37731907 PMCID: PMC10508446 DOI: 10.1097/xce.0000000000000290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 08/10/2023] [Indexed: 09/22/2023]
Abstract
Objectives Patients with type 2 diabetes mellitus (DM) run lower risk for abdominal aortic aneurysm (AAA, aortic diameter ≥ 30 mm) and its complications. We aimed to evaluate associations between disturbances in glucose metabolism and arterial stiffness, AAA, and abdominal aortic diameter in 65-year-old men. Methods Forty-eight 65-year-old men with screening-detected AAA and 115 men with normal abdominal aortic diameter underwent examination of glucose metabolism and arterial stiffness. Results Men with AAA had higher BMI, waist-hip ratio (WHR), frequency of DM, haemoglobin A1c, smoking exposure, and plasma insulin levels at 0, 60 and 120 min during OGTT compared to those without. The increase in p-insulin (P < 0.001) after OGTT was also higher in men with AAA, adjusted for smoking, WHR, and nadir value of p-insulin. In analyses adjusted for smoking, use of lipid-lowering agents, and WHR, the increase in p-insulin at 2-hours (P = 0.006) after OGTT and p-homocysteine were associated with abdominal aortic diameter. There were no differences between groups in aortic stiffness or skin autofluorescence Advanced Glycation End products. Conclusion In this population-based study hyperinsulinaemia as a marker of insulin resistance, but not hyperglycaemia or aortic stiffness, was associated with AAA and abdominal aortic diameter in 65-year-old men.
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Affiliation(s)
- Shahab Fatemi
- Department of Clinical Sciences, Lund University, Malmö
- Department of Medicine, Trelleborg Hospital
| | - Stefan Acosta
- Department of Clinical Sciences, Lund University, Malmö
- Departments of Cardiothoracic and Vascular Surgery
| | - Moncef Zarrouk
- Department of Clinical Sciences, Lund University, Malmö
- Departments of Cardiothoracic and Vascular Surgery
| | - Peter M. Nilsson
- Department of Clinical Sciences, Lund University, Malmö
- Internal and Emergency Medicine, Skåne University Hospital, Malmö, Sweden
| | - Anders Gottsäter
- Department of Clinical Sciences, Lund University, Malmö
- Internal and Emergency Medicine, Skåne University Hospital, Malmö, Sweden
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Rastogi A, Sudhayakumar A, Schaper NC, Jude EB. A paradigm shift for cardiovascular outcome evaluation in diabetes: Major adverse cardiovascular events (MACE) to major adverse vascular events (MAVE). Diabetes Metab Syndr 2023; 17:102875. [PMID: 37844433 DOI: 10.1016/j.dsx.2023.102875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND AND AIMS Drugs for diabetes are required to demonstrate cardiovascular safety through CV outcome trials (CVOT). The pre-defined end-points for cardiovascular outcome studies may not be sufficient to capture all clinically relevant atherosclerotic cardio vascular disease (ASCVD) events particularly peripheral arterial disease (PAD). METHODS We planned a scoping review and searched database to identify CVOT conducted in population with diabetes measuring lower limb events due to PAD as the primary outcome measure. We also searched CVOT for reported differential cardiovascular outcomes in population with PAD. RESULTS We identified that CV outcomes are measured as 3 point major adverse cardiovascular outcomes (3P-MACE) that includes nonfatal MI and nonfatal stroke or 4P-MACE that included additional unstable angina which is further expanded to 5P-MACE by the inclusion of hospitalization for heart failure (HHF). These CV end points are captured as surrogate for CV mortality based on the biological plausibility of relation between the surrogate and final outcome from pathophysiological studies. We found the prevalence of PAD is no lesser than other CV events in people with diabetes. Moreover, PAD contributes to the significant morbidity associated with diabetes as a surrogate for mortality. However, none of the CVOT with anti-diabetic drugs include PAD events as primary outcome measure despite the inclusion of 6-25 % participants with PAD in major CVOT. PAD outcomes are objectively measurable with tibial arterial waveforms and clinical end-point as lower extremity amputation. PAD outcomes do improve with treatment including intensive glycemic control and novel oral anticoagulants. We suggest the inclusion of PAD to MACE as a pre-specified outcome for a comprehensive capture of major adverse vascular event in future studies for people with diabetes. CONCLUSIONS MACE should be expanded to include PAD event as major adverse vascular event in cardiovascular outcome studies since PAD is clinically relevant and objectively measurable in diabetes.
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Affiliation(s)
- Ashu Rastogi
- Dept of Endocrinology, PGIMER, Chandigarh, 160012, India.
| | | | - Nicolaas C Schaper
- Division of Endocrinology, Department Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Edward B Jude
- Tameside and Glossop Integrated Care NHS Foundation Trust and University of Manchester, Ashton under Lyne, UK
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Stancu B, Ilyés T, Farcas M, Coman HF, Chiș BA, Andercou OA. Diabetic Foot Complications: A Retrospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:187. [PMID: 36612509 PMCID: PMC9819188 DOI: 10.3390/ijerph20010187] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/17/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
Diabetes mellitus is a highly prevalent disease globally and contributes to significant morbidity and mortality. As a consequence of multiple pathophysiologic changes which are associated with diabetes, these patients frequently suffer from foot-related disorders: infections, ulcerations, and gangrene. Approximately half of all amputations occur in diabetic individuals, usually as a complication of diabetic foot ulcers. In this retrospective study, we analyzed and characterized a cohort of 69 patients and their diabetes-related foot complications. The main characteristics of our cohort were as follows: older age at diagnosis (mean age 66); higher incidence of diabetes in males; predominantly urban patient population. The most frequent complications of the lower extremity were ulcerations and gangrene. Moreover, in our study, 35% of patients required surgical reintervention, and 27% suffered from complications, while 13% required ICU admission. However, diabetic foot lesions are preventable via simple interventions which pointedly reduce foot amputations. Early identification and the appropriate medical and surgical treatment of the complications associated with diabetic foot disease are important because they still remain common, complex and costly.
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Affiliation(s)
- Bogdan Stancu
- 2nd Department of General Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Tamás Ilyés
- Department of Molecular Sciences, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Marius Farcas
- Hematology Department, Institute of Oncology “Prof. Dr. Ion Chiricuță”, 400015 Cluj-Napoca, Romania
| | - Horațiu Flaviu Coman
- Department of Vascular Surgery, County Clinical Emergency Hospital, 400347 Cluj-Napoca, Romania
| | - Bogdan Augustin Chiș
- 2nd Department of Internal Medicine, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
| | - Octavian Aurel Andercou
- 2nd Department of General Surgery, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania
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Zheng H, Qiu Z, Chai T, He J, Zhang Y, Wang C, Ye J, Wu X, Li Y, Zhang L, Chen L. Insulin Resistance Promotes the Formation of Aortic Dissection by Inducing the Phenotypic Switch of Vascular Smooth Muscle Cells. Front Cardiovasc Med 2022; 8:732122. [PMID: 35187097 PMCID: PMC8850393 DOI: 10.3389/fcvm.2021.732122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 12/21/2021] [Indexed: 11/13/2022] Open
Abstract
Background Insulin resistance (IR) plays a key role in the development of type 2 diabetes mellitus (T2DM) and is one of its most important characteristics. Previous studies have shown that IR and T2DM were independent risk factors for a variety of cardiovascular and cerebrovascular diseases. However, there are few studies on the relationship between IR and aortic dissection (AD). The goal of this research was to find evidence that IR promotes the occurrence of AD. Methods Through the statistical analysis, we determined the proportion of glycosylated hemoglobin (HbA1c) abnormalities (HbA1c > 5.7) in people with acute thoracic aortic dissection (ATAD) and compared the difference of messenger RNA (mRNA) and protein expression of GluT1 in the thoracic aorta of normal people and those with ATAD to find evidence that IR is a causative factor in AD. The mouse model of IR and AD and the IR model of human aortic vascular smooth muscle cells (HA-VSMC) were established. Real time-PCR (RT-PCR) and Western blotting were used to study the mRNA and protein expression. Hematoxylin and eosin (H&E), Masson, and elastic fiber staining, and immunofluorescence were used to study the morphological structure. Results The proportion of HbA1c abnormalities in patients with ATAD was 59.37%, and the mRNA and protein expression of GluT1 were significantly lower than that in normal people. Fasting glucose concentration (FGC), serum insulin concentration (SIC), and the homeostasis model assessment of insulin resistance (HOMA-IR) of mice was obviously increased in the high-fat diet group and the protein expressions of Glut1 and GluT4 were reduced, indicating that the mouse IR model was successfully established. The incidence of AD was different between the two groups (IR: 13/14, Ctrl: 6/14), and the protein expression of MMP2, MMP9, and OPN were upregulated and SM22 and α-SMA were downregulated in mice. The expressions of mRNA and protein of GluT1 and SM22 in HA-VSMCs with IR were reduced and OPN was increased. Conclusion Combined results of clinical findings, mouse models, and cell experiments show that IR induced the phenotypic switching of vascular smooth muscle cells (VSMCs) from contractile to synthetic, which contributes to the occurrence of AD. It provides a basis for further research on the specific mechanism of how IR results in AD and a new approach for the prevention and treatment of AD.
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Affiliation(s)
- Hui Zheng
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fuzhou, China
- Fujian Provincial Special Reserve Talents Laboratory, Fujian University, Fuzhou, China
- Engineering Research Center of Tissue and Organ Regeneration, Fujian University, Fuzhou, China
| | - Zhihuang Qiu
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fuzhou, China
- Fujian Provincial Special Reserve Talents Laboratory, Fujian University, Fuzhou, China
- Engineering Research Center of Tissue and Organ Regeneration, Fujian University, Fuzhou, China
| | - Tianci Chai
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fuzhou, China
- Fujian Provincial Special Reserve Talents Laboratory, Fujian University, Fuzhou, China
- Engineering Research Center of Tissue and Organ Regeneration, Fujian University, Fuzhou, China
| | - Jian He
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fuzhou, China
- Fujian Provincial Special Reserve Talents Laboratory, Fujian University, Fuzhou, China
- Engineering Research Center of Tissue and Organ Regeneration, Fujian University, Fuzhou, China
| | - Yuling Zhang
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fuzhou, China
- Fujian Provincial Special Reserve Talents Laboratory, Fujian University, Fuzhou, China
- Engineering Research Center of Tissue and Organ Regeneration, Fujian University, Fuzhou, China
| | - Chaoyun Wang
- Fujian Center for Evaluation of New Drug, Fujian Medical University, Fuzhou, China
| | - Jianqiang Ye
- Fujian Center for Evaluation of New Drug, Fujian Medical University, Fuzhou, China
| | - Xiaohui Wu
- Fujian Center for Evaluation of New Drug, Fujian Medical University, Fuzhou, China
| | - Yumei Li
- Fujian Center for Evaluation of New Drug, Fujian Medical University, Fuzhou, China
| | - Li Zhang
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Fujian Medical University, Fuzhou, China
| | - Liangwan Chen
- Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, China
- Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fuzhou, China
- Fujian Provincial Special Reserve Talents Laboratory, Fujian University, Fuzhou, China
- Engineering Research Center of Tissue and Organ Regeneration, Fujian University, Fuzhou, China
- *Correspondence: Liangwan Chen
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Sprenger L, Mader A, Larcher B, Mächler M, Vonbank A, Zanolin-Purin D, Leiherer A, Muendlein A, Drexel H, Saely CH. Type 2 diabetes and the risk of cardiovascular events in peripheral artery disease versus coronary artery disease. BMJ Open Diabetes Res Care 2021; 9:9/2/e002407. [PMID: 34782334 PMCID: PMC8593703 DOI: 10.1136/bmjdrc-2021-002407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 09/18/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION The prevalence of type 2 diabetes mellitus (T2DM) is higher in peripheral artery disease (PAD) than in coronary artery disease (CAD) patients, and PAD overall confers higher cardiovascular risk than CAD. How cardiovascular risk compares between PAD and CAD patients when analyses are stratified by the presence of type 2 diabetes is unclear and is addressed in the present study. RESEARCH DESIGN AND METHODS We prospectively recorded major cardiovascular events (MACE; ie, cardiovascular death, myocardial infarction or stroke) over 10.0±4.7 years in 923 patients with stable CAD, of whom 26.7% had T2DM and in 292 patients with PAD, of whom 42.1% had T2DM. Four groups were analyzed: CAD patients without diabetes (CAD/T2DM-; n=677), CAD patients with T2DM (CAD/T2DM+; n=246), PAD patients without diabetes (PAD/T2DM-; n=169) and PAD patients with T2DM (PAD/T2DM+; n=123). RESULTS The event rate for MACE increased over our four investigated groups: it was lowest in CAD/T2DM- patients (2.52 events per 100 person-years). It was significantly higher in CAD/T2DM+ patients (3.96 events per 100 person-years; p<0.001), in PAD/T2DM- patients (3.68 events per 100 person-years; p=0.022), and in PAD/T2DM+ patients (7.10 events per 100 person-years; p<0.001), who in turn were at a higher risk than CAD/T2DM+ or PAD/T2DM- patients (p=0.001 and p<0.001, respectively). Cox regression analysis after multivariate adjustment showed that the presence of T2DM (HR=1.44 (95% CI 1.09 to 1.92); p=0.012) and the presence of PAD versus CAD (HR=1.48 (95% CI 1.15 to 1.91); p=0.002) were mutually independent predictors of cardiovascular events. CONCLUSIONS In conclusion, our data show that T2DM as well as the presence of PAD versus CAD are mutually independent predictors of MACE. Patients with both PAD and T2DM are at an exceedingly high risk of cardiovascular events.
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Affiliation(s)
- Lukas Sprenger
- VIVIT, Vorarlberg Institute of Vascular Investigation and Treatment, Feldkirch, Vorarlberg, Austria
- Department of Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Vorarlberg, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Arthur Mader
- VIVIT, Vorarlberg Institute of Vascular Investigation and Treatment, Feldkirch, Vorarlberg, Austria
- Department of Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Vorarlberg, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Barbara Larcher
- VIVIT, Vorarlberg Institute of Vascular Investigation and Treatment, Feldkirch, Vorarlberg, Austria
- Department of Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Vorarlberg, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Maximilian Mächler
- VIVIT, Vorarlberg Institute of Vascular Investigation and Treatment, Feldkirch, Vorarlberg, Austria
- Department of Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Vorarlberg, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Alexander Vonbank
- VIVIT, Vorarlberg Institute of Vascular Investigation and Treatment, Feldkirch, Vorarlberg, Austria
- Department of Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Vorarlberg, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Daniela Zanolin-Purin
- VIVIT, Vorarlberg Institute of Vascular Investigation and Treatment, Feldkirch, Vorarlberg, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Andreas Leiherer
- VIVIT, Vorarlberg Institute of Vascular Investigation and Treatment, Feldkirch, Vorarlberg, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Axel Muendlein
- VIVIT, Vorarlberg Institute of Vascular Investigation and Treatment, Feldkirch, Vorarlberg, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Heinz Drexel
- VIVIT, Vorarlberg Institute of Vascular Investigation and Treatment, Feldkirch, Vorarlberg, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
- Department of Medicine, County Hospital Bregenz, Bregenz, Vorarlberg, Austria
| | - Christoph H Saely
- VIVIT, Vorarlberg Institute of Vascular Investigation and Treatment, Feldkirch, Vorarlberg, Austria
- Department of Medicine I, Academic Teaching Hospital Feldkirch, Feldkirch, Vorarlberg, Austria
- Private University in the Principality of Liechtenstein, Triesen, Liechtenstein
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Zhang X, Xu Z, Ran X, Ji L. Development and validation of a risk score model for prediction of lower extremity arterial disease in Chinese with type 2 diabetes aged over 50 years. Endocr Connect 2021; 10:1212-1220. [PMID: 34424851 PMCID: PMC8494415 DOI: 10.1530/ec-21-0152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 08/20/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND Lower extremity arterial disease (LEAD) is highly prevalent in people with diabetes in China, but half of cases are underdiagnosed due to diversities of clinical presentations and complexities of diagnosis approaches. The purpose of this study was to develop a risk score model for LEAD to facilitate early screening among type 2 diabetes (T2DM) patients. METHODS A total of 8313 participants with T2DM from the China DIA-LEAD study, a multicenter, cross-sectional epidemiological study, were selected as the training dataset to develop a risk score model for LEAD by logistic regression. The area under receiver operating characteristic curve (AUC) and bootstrapping were utilized for internal validation. A dataset of 287 participants consecutively enrolled from a teaching hospital between July 2017 and November 2017 was used as external validation for the risk score model. RESULTS A total of 931 (11.2%) participants were diagnosed as LEAD in the training dataset. Factors including age, current smoking, duration of diabetes, blood pressure control, low density lipoprotein cholesterol, estimated glomerular filtration rate, and coexistence of cardio and/or cerebrovascular disease correlated with LEAD in logistic regression analysis and resulted in a weighed risk score model of 0-13. A score of ≥5 was found to be the optimal cut-off for discriminating moderate-high risk participants with AUC of 0.786 (95% CI: 0.778-0.795). The bootstrapping validation showed that the AUC was 0.784. Similar performance of the risk score model was observed in the validation dataset with AUC of 0.731 (95% CI: 0.651-0.811). The prevalence of LEAD was 3.4, 12.1, and 27.6% in the low risk (total score 0-4), moderate risk (total score 5-8), and high risk (total score 9-13) groups of LEAD in the training dataset, respectively, which were 4.3, 19.6, and 30.2% in the validation dataset. CONCLUSION The weighed risk score model for LEAD could reliably discriminate the presence of LEAD in Chinese with T2DM aged over 50 years, which may be helpful for a precise risk assessment and early diagnosis of LEAD.
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Affiliation(s)
- Xiaomei Zhang
- Department of Endocrinology, Peking University International Hospital, Beijing, China
| | - Zhangrong Xu
- Diabetes Center, Characteristic Medical Center of Strategic Support Force, Beijing, China
| | - Xingwu Ran
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu, China
- Correspondence should be addressed to X Ran or L Ji: or
| | - Linong Ji
- Department of Endocrinology, Peking University International Hospital, Beijing, China
- Department of Endocrinology and Metabolism, Peking University People’s Hospital, Beijing, China
- Correspondence should be addressed to X Ran or L Ji: or
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Lin DSH, Lee JK, Chen WJ. Major adverse cardiovascular and limb events in patients with diabetes treated with GLP-1 receptor agonists vs DPP-4 inhibitors. Diabetologia 2021; 64:1949-1962. [PMID: 34195865 DOI: 10.1007/s00125-021-05497-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/09/2021] [Indexed: 01/14/2023]
Abstract
AIMS/HYPOTHESIS The safety and efficacy of glucagon-like peptide-1 receptor agonists (GLP1RAs) and dipeptidyl peptidase-4 inhibitors (DPP4is) in major cardiovascular adverse events were previously examined in cardiovascular outcome trials. However, the effects of these drugs on adverse limb outcomes were poorly examined. This study aimed to determine the real-world outcomes of patients with diabetes mellitus receiving GLP1RAs as compared with those receiving DPP4is in terms of major adverse cardiovascular and limb events. METHODS A retrospective cohort study was conducted with data collected by the Taiwan National Health Insurance database between 1 May 2011 and 31 December 2017. Patients who were treated for type 2 diabetes with a GLP1RA or DDP4i during this period (n = 1,080,993), were identified. The primary outcome was a composite of major adverse limb events, defined as peripheral artery disease (PAD), critical limb ischaemia, percutaneous transluminal angioplasty or peripheral bypass for PAD, and amputation. The secondary cardiovascular outcome was the composite of cardiovascular death, non-fatal myocardial infarction and non-fatal ischaemic stroke. Propensity-score matching (PSM) at a 1:3 ratio between GLP1RA and DPP4i groups was done to minimise possible selection bias. RESULTS A total of 948,342 individuals treated between 1 May 2011 and 31 December 2017, were identified, with 4460 in the GLP1RA group and 13,380 in the DPP4i group after PSM. The incidence of primary composite outcome events was significantly lower in those treated with GLP1RAs compared with those treated with DPP4is (2.59 vs 4.22 events per 1000 person-years; subdistribution HR [SHR] 0.63 [95% CI 0.41, 0.96]), primarily due to lower rates of amputation (1.29 events per 1000 person-years for GLP1RAs vs 2.4 events per 1000 person-years for DPP4is; SHR 0.55 [95% CI 0.30, 0.99]). Treatment with GLP1RAs was also associated with significantly lower risks of secondary composite outcome events (11.02 vs 17.95 events per 1000 person-years; HR 0.62 [95% CI 0.51, 0.76]). Moreover, the observed beneficial effects of GLP1RAs on reducing composite adverse limb outcomes were particularly noticeable in the non-cardiovascular patients and statin users (p for interaction <0.05). CONCLUSIONS/INTERPRETATION In individuals with diabetes, the use of GLP1RAs was associated with significantly lower risks of major adverse limb events when compared with the use of DPP4is. The reduction in risk was driven largely by reduced rate of amputations. Moreover, treatment with GLP1RAs was also associated with lower risks of cardiovascular death, non-fatal stroke, non-fatal myocardial infarction and death from any cause. However, some unexplored confounding factors may exist in this observation study and future large-scale randomised controlled trials are needed.
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Affiliation(s)
- Donna Shu-Han Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Jen-Kuang Lee
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
- Department of Laboratory Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.
- Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan.
- Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan.
| | - Wen-Jone Chen
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
- Cardiovascular Center, National Taiwan University Hospital, Taipei, Taiwan
- Department of Emergency Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
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Iacopi E, Coppelli A, Goretti C, Bargellini I, Cicorelli A, Cioni R, Piaggesi A. Effect of Direct Endovascular Revascularization Based on the Angiosome Model on Risk of Major Amputations and Life Expectancy in Type 2 Diabetic Patients with Critical Limb Ischemia and Foot Ulceration. J Am Podiatr Med Assoc 2021; 111:454031. [PMID: 33533936 DOI: 10.7547/18-130] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND We evaluated whether direct or indirect endovascular revascularization based on the angiosome model affects outcomes in type 2 diabetes and critical limb ischemia. METHODS From 2010 to 2015, 603 patients with type 2 diabetes were admitted for critical limb ischemia and submitted to endovascular revascularization. Among these patients, 314 (52%) underwent direct and 123 (20%) indirect revascularization, depending on whether the flow to the artery directly feeding the site of ulceration, according to the angiosome model, was successfully acquired; 166 patients (28%) were judged unable to be revascularized. Outcomes were healing, major amputation, and mortality rates. RESULTS An overall healing rate of 62.5% was observed: patients who did not receive percutaneous transluminal angioplasty presented a healing rate of 58.4% (P < .02 versus revascularized patients). A higher healing rate was observed in the direct versus the indirect group (82.4% versus 50.4%; P < .001). The major amputation rate was significantly higher in the indirect versus the direct group (9.2% versus 3.2%; P < .05). The overall mortality rate was 21.6%, and it was higher in the indirect versus the direct group (24% versus 14%; P < .05). CONCLUSIONS These data show that direct revascularization of arteries supplying the diabetic foot ulcer site by means of the angiosome model is associated with a higher healing rate and lower risk of amputation and death compared with the indirect procedure. These results support use of the angiosome model in type 2 diabetes with critical limb ischemia.
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Xu X, Zhang M, Fei Z, Sheng H, Qu S, Cui R. Calcification of lower extremity arteries is related to the presence of osteoporosis in postmenopausal women with type 2 diabetes mellitus: a cross-sectional observational study. Osteoporos Int 2021; 32:1185-1193. [PMID: 33411011 PMCID: PMC8128735 DOI: 10.1007/s00198-020-05775-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 12/03/2020] [Indexed: 12/21/2022]
Abstract
UNLABELLED It is unknown whether there is any relationship between extremity arterial macroangiopathy and osteoporosis in type 2 diabetic mellitus (T2DM) patients. We provide evidence to show the association between lower extremity arterial calcification and the presence of osteoporosis in postmenopausal T2DM women, but not in T2DM men of similar age. PURPOSE To investigate the relationship between lower extremity arterial calcification and the presence of osteoporosis in type 2 diabetic mellitus (T2DM) patients. METHODS We performed a retrospective cross-sectional study in patients with T2DM. They were assigned into two groups (patients with or without vascular calcification) in both sexes. Clinical characteristics, presence of osteoporosis, and bone metabolic markers were compared. Arterial calcification was determined by ultrasonography examination. Osteoporosis was defined based on the measurements from dual-energy X-ray absorptiometry. The relationship between the lower extremity arterial calcification and the presence of osteoporosis was analyzed. Statistical analysis was performed in SPSS 26.0. RESULTS A total of 933 T2DM patients (535 men ≥ 50 years old, and 398 postmenopausal women) were identified and analyzed. A significant association between arterial calcification and osteoporosis was only observed in women, with a higher prevalence of osteoporosis observed in women with calcification (40.8%) than in women without calcification (26.9%) (P = 0.004). Compared to women without calcification, women with calcification had lower bone mineral densities in the hip (P < 0.001) and femoral neck (P < 0.001). Ordinal logistic regression analysis showed that women with calcification had a nearly 2-fold increased risk for osteoporosis, even after adjusting for age, duration of T2DM, body mass index, pulse pressure, clearance of creatinine, glycosylated hemoglobin, and fasting C-peptide. Similar differences were not identified between men with and without calcification. CONCLUSION Calcification of lower extremity arteries is related with the presence of osteoporosis in postmenopausal T2DM women.
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Affiliation(s)
- Xiaojuan Xu
- grid.24516.340000000123704535Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Manna Zhang
- grid.24516.340000000123704535Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Zhaoliang Fei
- grid.24516.340000000123704535Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Hui Sheng
- grid.24516.340000000123704535Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shen Qu
- grid.24516.340000000123704535Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
| | - Ran Cui
- grid.24516.340000000123704535Department of Endocrinology and Metabolism, Shanghai Tenth People’s Hospital, Tongji University School of Medicine, Shanghai, China
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10
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Kim JH, Jeon J, Kim J. Lower risk of subarachnoid haemorrhage in diabetes: a nationwide population-based cohort study. Stroke Vasc Neurol 2021; 6:402-409. [PMID: 33526636 PMCID: PMC8485249 DOI: 10.1136/svn-2020-000601] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 10/26/2020] [Accepted: 11/14/2020] [Indexed: 11/17/2022] Open
Abstract
Background and purpose Diabetes mellitus (DM) is a common metabolic disorder with increased risk of cardiovascular and cerebrovascular complications. However, its relationship with risk of subarachnoid haemorrhage (SAH), the most devastating form of stroke, remains controversial. Methods To evaluate the relationship between DM and risk of SAH, we performed a retrospective cohort study using a nationwide, population‐based, health screening database in Korea. We included participants without history of stroke who underwent a nationwide health screening programme between 2003 and 2004. Primary outcome was occurrence of SAH. Participants were followed up until development of SAH or December 2015. Multivariate Cox proportional hazards regression analysis was performed with adjustments for age, sex, systolic blood pressure, total cholesterol, body mass index, physical activity, smoking status, alcohol habit, household income and treatment with antihypertensive agents and statins. Results Among 421 768 study participants, prevalence of DM was 9.6%. During a mean follow-up period of 11.6±1.9 years, 1039 patients developed SAH. Presence of DM was significantly associated with decreased risk of SAH (adjusted HR 0.68; 95% CI 0.53 to 0.86; p<0.001). Elevated level of fasting blood glucose was also negatively associated with risk of SAH (adjusted HR per 1 mmol/L increase 0.90; 95% CI 0.86 to 0.95; p<0.001). Conclusion DM and elevated level of fasting blood glucose were inversely associated with risk of SAH. Further studies may elucidate the possibly protective, pathophysiological role played by hyperglycaemia in patients at risk of SAH.
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Affiliation(s)
- Jang Hoon Kim
- Department of Neurosurgery, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jimin Jeon
- Department of Neurology, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Jinkwon Kim
- Department of Neurology, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
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11
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Poorthuis MHF, Halliday A, Massa MS, Sherliker P, Clack R, Morris DR, Clarke R, de Borst GJ, Bulbulia R, Lewington S. Validation of Risk Prediction Models to Detect Asymptomatic Carotid Stenosis. J Am Heart Assoc 2020; 9:e014766. [PMID: 32310014 PMCID: PMC7428515 DOI: 10.1161/jaha.119.014766] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Accepted: 02/07/2020] [Indexed: 12/27/2022]
Abstract
Background Significant asymptomatic carotid stenosis (ACS) is associated with higher risk of strokes. While the prevalence of moderate and severe ACS is low in the general population, prediction models may allow identification of individuals at increased risk, thereby enabling targeted screening. We identified established prediction models for ACS and externally validated them in a large screening population. Methods and Results Prediction models for prevalent cases with ≥50% ACS were identified in a systematic review (975 studies reviewed and 6 prediction models identified [3 for moderate and 3 for severe ACS]) and then validated using data from 596 469 individuals who attended commercial vascular screening clinics in the United States and United Kingdom. We assessed discrimination and calibration. In the validation cohort, 11 178 (1.87%) participants had ≥50% ACS and 2033 (0.34%) had ≥70% ACS. The best model included age, sex, smoking, hypertension, hypercholesterolemia, diabetes mellitus, vascular and cerebrovascular disease, measured blood pressure, and blood lipids. The area under the receiver operating characteristic curve for this model was 0.75 (95% CI, 0.74-0.75) for ≥50% ACS and 0.78 (95% CI, 0.77-0.79) for ≥70% ACS. The prevalence of ≥50% ACS in the highest decile of risk was 6.51%, and 1.42% for ≥70% ACS. Targeted screening of the 10% highest risk identified 35% of cases with ≥50% ACS and 42% of cases with ≥70% ACS. Conclusions Individuals at high risk of significant ACS can be selected reliably using a prediction model. The best-performing prediction models identified over one third of all cases by targeted screening of individuals in the highest decile of risk only.
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Affiliation(s)
- Michiel H. F. Poorthuis
- Clinical Trial Service Unit and Epidemiological Studies UnitNuffield Department of Population HealthUniversity of Oxford,United Kingdom
- MRC Population Health Research UnitNuffield Department of Population HealthUniversity of Oxford,United Kingdom
- Department of Vascular SurgeryUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Alison Halliday
- Nuffield Department of Surgical SciencesJohn Radcliffe HospitalUniversity of OxfordUnited Kingdom
| | - M. Sofia Massa
- Clinical Trial Service Unit and Epidemiological Studies UnitNuffield Department of Population HealthUniversity of Oxford,United Kingdom
| | - Paul Sherliker
- Clinical Trial Service Unit and Epidemiological Studies UnitNuffield Department of Population HealthUniversity of Oxford,United Kingdom
- MRC Population Health Research UnitNuffield Department of Population HealthUniversity of Oxford,United Kingdom
| | - Rachel Clack
- Clinical Trial Service Unit and Epidemiological Studies UnitNuffield Department of Population HealthUniversity of Oxford,United Kingdom
| | - Dylan R. Morris
- Clinical Trial Service Unit and Epidemiological Studies UnitNuffield Department of Population HealthUniversity of Oxford,United Kingdom
- MRC Population Health Research UnitNuffield Department of Population HealthUniversity of Oxford,United Kingdom
| | - Robert Clarke
- Clinical Trial Service Unit and Epidemiological Studies UnitNuffield Department of Population HealthUniversity of Oxford,United Kingdom
| | - Gert J. de Borst
- Department of Vascular SurgeryUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Richard Bulbulia
- Clinical Trial Service Unit and Epidemiological Studies UnitNuffield Department of Population HealthUniversity of Oxford,United Kingdom
- MRC Population Health Research UnitNuffield Department of Population HealthUniversity of Oxford,United Kingdom
| | - Sarah Lewington
- Clinical Trial Service Unit and Epidemiological Studies UnitNuffield Department of Population HealthUniversity of Oxford,United Kingdom
- MRC Population Health Research UnitNuffield Department of Population HealthUniversity of Oxford,United Kingdom
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12
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Heffron SP, Dwivedi A, Rockman CB, Xia Y, Guo Y, Zhong J, Berger JS. Body mass index and peripheral artery disease. Atherosclerosis 2020; 292:31-36. [PMID: 31739257 PMCID: PMC6981229 DOI: 10.1016/j.atherosclerosis.2019.10.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/08/2019] [Accepted: 10/25/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND AIMS An independent association of body mass index (BMI) with atherosclerotic cardiovascular disease is somewhat controversial and may differ by vascular bed. Sex-specific risk factors for atherosclerosis may further modify these associations. Obesity and peripheral artery disease (PAD) are both more prevalent in women. We sought to determine the association between PAD and BMI using a very large population-based study. METHODS Self-referred individuals at >20,000 US sites completed medical questionnaires including height and weight, and were evaluated by screening ankle brachial indices (ABI) for PAD (ABI<0.9). RESULTS Among 3,250,350 individuals, the mean age was 63.1 ± 10.5 years and 65.5% were women. The mean BMI was 27.7 ± 5.8 kg/m2. 27.8% of participants were obese (BMI ≥30 kg/m2) - 27.6% females, 28.1% males. Overweight individuals (BMI 25-29.9 kg/m2) exhibited the lowest prevalence of PAD. There was a J-shaped association of BMI with prevalent PAD. After adjustment for age and cardiovascular risk factors, underweight was associated with similarly increased odds of PAD (1.72 vs. 1.39, women and men, respectively). The association of obesity with PAD was predominant in women, with only a slight association of increasing BMI with PAD in men (OR = 2.98 vs. 1.37 for BMI ≥40 kg/m2). CONCLUSIONS Our study suggests that increasing BMI is a robust independent risk factor for PAD only in women. This observation requires validation, but highlights the need for further research on sex-specific risk and mechanisms of atherosclerosis.
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Affiliation(s)
- Sean P Heffron
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University Langone Medical Center, New York, NY, USA; Center for the Prevention of Cardiovascular Disease, New York University Langone Medical Center, New York, NY, USA
| | - Aeshita Dwivedi
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University Langone Medical Center, New York, NY, USA
| | - Caron B Rockman
- Division of Vascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY, USA
| | - Yuhe Xia
- Division of Biostatistics, Department of Population Health, New York University Langone Medical Center, New York, NY, USA
| | - Yu Guo
- Division of Biostatistics, Department of Population Health, New York University Langone Medical Center, New York, NY, USA
| | - Judy Zhong
- Division of Biostatistics, Department of Population Health, New York University Langone Medical Center, New York, NY, USA
| | - Jeffrey S Berger
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University Langone Medical Center, New York, NY, USA; Center for the Prevention of Cardiovascular Disease, New York University Langone Medical Center, New York, NY, USA; Division of Vascular Surgery, Department of Surgery, New York University Langone Medical Center, New York, NY, USA.
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13
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Iacopi E, Coppelli A, Riitano N, Abbruzzese L, Pieruzzi L, Goretti C, Piaggesi A. Adherence to guideline recommended medical therapies in type 2 diabetic patients with chronic critical limb ischemia. Diabetes Res Clin Pract 2019; 158:107898. [PMID: 31672503 DOI: 10.1016/j.diabres.2019.107898] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Revised: 09/30/2019] [Accepted: 10/23/2019] [Indexed: 12/30/2022]
Abstract
AIM The aim of this study was to evaluate the adherence to guideline recommended medical therapies in type 2 diabetic patients with chronic critical limb ischemia (CCLI). METHODS We retrospectively analyzed the data of 1315 admissions performed in our Department, focusing on diabetic foot patients (842-64%) of which 603 consecutive type 2 diabetic patients with CCLI (M/F(%): 73/27; age: 70.3 ± 10.4 yrs; diabetes duration: 17.3 ± 13.7 yrs; BMI: 27.7 ± 5.3 Kg/m2; HbA1c 7.8 ± 1.8%) referred to a third-level Center from 2011 to 2015. We focused on medical therapy of diabetes, dyslipidemia, hypertension, peripheral vascular disease and smoke habits. RESULTS In total, at admission, 66.6% of patients had HbA1c levels higher than recommended; 65.9% of patients were on statins; 81.4% on anti-hypertensive treatment and 72.4% on antiplatelet drugs. Concerning smoke habits, 27% of patients were no-smokers; 41% former smokers and 32% active smokers. Among all patients, only 24% were prescribed all five guideline recommended therapies while 32% reached four out of five of these. As for patients treated with anti-hypertensive drugs, we observed higher levels of systolic pressure (138.0 ± 29.5 vs 107.7 ± 36.6 p < 0.02) while no differences were observed in diastolic pressure levels. CONCLUSIONS In conclusion, when it comes to diabetic patients with a severe limb and life threatening clinical condition, we noticed a lower-than-expected application of international guideline-recommended medical therapies. In fact, only one out of four patients was following all the recommended therapies. Nevertheless, these patients did not reach the standard targets requested to prevent cardiovascular disease.
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Affiliation(s)
| | | | - Nicola Riitano
- Diabetic Foot Section, Pisa University Hospital, Pisa, Italy
| | | | | | - Chiara Goretti
- Diabetic Foot Section, Pisa University Hospital, Pisa, Italy
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14
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Flynn S, Montoya M, Bikkina R, Hammond BJ, Dardik H, Bernik T. Iatrogenic Interval Gangrene of the Thigh. Ann Vasc Surg 2019; 66:665.e1-665.e3. [PMID: 31743783 DOI: 10.1016/j.avsg.2019.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 11/11/2019] [Accepted: 11/11/2019] [Indexed: 10/25/2022]
Abstract
Interval gangrene of the thigh is an extremely rare complication in vascular surgery. Most cases have reported interval gangrene of the calf as a consequence of a distal bypass procedure, with little documentation of interval thigh gangrene occurring after endovascular intervention. The present case suggests that in the process of placing multiple-level covered and bare metal stents in the iliac, superficial femoral, and popliteal arteries, interval gangrene of the thigh must be considered as a potential, albeit rare, complication. Preservation of pelvic and profunda femoris flow to the thigh is imperative to prevent the development of interval tissue loss. This case demonstrates the importance of maintaining profunda femoris circulation, especially in patients with significant vascular comorbidities. Patient consent was obtained for details of the case to be used for publication.
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Affiliation(s)
- Scott Flynn
- Department of Vascular Surgery, Englewood Hospital and Medical Center, Englewood, NJ
| | - Melissa Montoya
- Department of Vascular Surgery, Englewood Hospital and Medical Center, Englewood, NJ
| | - Rama Bikkina
- Department of Vascular Surgery, Englewood Hospital and Medical Center, Englewood, NJ
| | - Brendan J Hammond
- Department of Vascular Surgery, Englewood Hospital and Medical Center, Englewood, NJ
| | - Herbert Dardik
- Department of Vascular Surgery, Englewood Hospital and Medical Center, Englewood, NJ
| | - Thomas Bernik
- Department of Vascular Surgery, Englewood Hospital and Medical Center, Englewood, NJ.
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15
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Low Wang CC, Blomster JI, Heizer G, Berger JS, Baumgartner I, Fowkes FGR, Held P, Katona BG, Norgren L, Jones WS, Lopes RD, Olin JW, Rockhold FW, Mahaffey KW, Patel MR, Hiatt WR. Cardiovascular and Limb Outcomes in Patients With Diabetes and Peripheral Artery Disease: The EUCLID Trial. J Am Coll Cardiol 2019; 72:3274-3284. [PMID: 30573030 DOI: 10.1016/j.jacc.2018.09.078] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/11/2018] [Accepted: 09/20/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Diabetes confers an increased risk for atherosclerotic cardiovascular disease, but less is known about the independent risk diabetes confers on major cardiovascular and limb events in patients with symptomatic peripheral artery disease (PAD) on contemporary management. OBJECTIVES The authors sought to assess the risk of cardiovascular and limb events in patients with PAD and diabetes as compared with those with PAD alone. METHODS In the EUCLID (Examining Use of Ticagrelor in Peripheral Artery Disease) trial, 13,885 patients with symptomatic PAD were evaluated with a primary endpoint of an adjudicated composite of major adverse cardiovascular events (MACE) (cardiovascular death, myocardial infarction, ischemic stroke) followed over a median of ∼30 months. The diabetes subgroup was analyzed compared with the subgroup without diabetes, and further examined for diabetes-specific factors such as glycosylated hemoglobin (HbA1c) that might affect risk for major cardiovascular and limb outcomes. RESULTS A total of 5,345 patients (38.5%) had diabetes; the majority (n = 5,134 [96.1%]) had type 2 diabetes. The primary endpoint occurred in 15.9% of patients with PAD and diabetes as compared with 10.4% of those without diabetes (absolute risk difference 5.5%; adjusted hazard ratio: 1.56; 95% confidence interval [CI]: 1.41 to 1.72; p < 0.001). Every 1% increase in HbA1c was associated with a 14.2% increased relative risk for MACE (95% CI: 1.09 to 1.20; p < 0.0001). CONCLUSIONS Patients with PAD and diabetes are at high risk for cardiovascular and limb ischemic events, even on contemporary therapies. Every 1% increase in HbA1c was associated with a 14.2% increased relative risk for MACE (95% CI: 1.09 to 1.20; p < 0.0001). (A Study Comparing Cardiovascular Effects of Ticagrelor and Clopidogrel in Patients With Peripheral Artery Disease [EUCLID]; NCT01732822).
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Affiliation(s)
- Cecilia C Low Wang
- CPC Clinical Research, Aurora, Colorado; University of Colorado School of Medicine, Department of Medicine, Division of Endocrinology, Metabolism and Diabetes, Aurora, Colorado.
| | - Juuso I Blomster
- AstraZeneca Gothenburg, Mölndal, Sweden; Heart Centre, Turku University Hospital, Turku, Finland
| | - Gretchen Heizer
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Jeffrey S Berger
- Departments of Medicine and Surgery, New York University School of Medicine, New York, New York
| | - Iris Baumgartner
- Swiss Cardiovascular Centre, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - F Gerry R Fowkes
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | | | | | - Lars Norgren
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - W Schuyler Jones
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Renato D Lopes
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Jeffrey W Olin
- Zena and Michael A. Wiener Cardiovascular Institute and Marie-Josée and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mt. Sinai, New York, New York
| | - Frank W Rockhold
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - Kenneth W Mahaffey
- Stanford Center for Clinical Research, Stanford University School of Medicine, Stanford, California
| | - Manesh R Patel
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina
| | - William R Hiatt
- CPC Clinical Research, Aurora, Colorado; University of Colorado School of Medicine, Department of Medicine, Division of Cardiology, Aurora, Colorado
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16
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Saely CH, Schindewolf M, Zanolin D, Heinzle CF, Vonbank A, Silbernagel G, Leiherer A, Drexel H, Baumgartner I. Single and combined effects of peripheral artery disease and of type 2 diabetes mellitus on the risk of cardiovascular events: A prospective cohort study. Atherosclerosis 2018; 279:32-37. [DOI: 10.1016/j.atherosclerosis.2018.09.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2018] [Revised: 07/13/2018] [Accepted: 09/21/2018] [Indexed: 01/22/2023]
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17
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Wilcox T, Newman JD, Maldonado TS, Rockman C, Berger JS. Peripheral vascular disease risk in diabetic individuals without coronary heart disease. Atherosclerosis 2018; 275:419-425. [PMID: 29801688 DOI: 10.1016/j.atherosclerosis.2018.04.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 04/05/2018] [Accepted: 04/24/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIMS Diabetes mellitus is a coronary heart disease (CHD) risk-equivalent for the outcome of peripheral vascular disease. The impact of diabetes with comorbid risk factors on the outcome of peripheral vascular disease remains unexplored. METHODS We performed a cross-sectional analysis of participants in Lifeline Vascular Screening Inc. age 40-90 who were screened for peripheral vascular disease, defined as lower extremity peripheral artery disease (PAD, ABI <0.9) and/or carotid artery stenosis (CAS, internal CAS ≥50%). CHD was defined as prior myocardial infarction or revascularization. Risk factors included hypertension, hyperlipidemia, smoking, obesity, sedentary lifestyle and family history of cardiovascular disease. RESULTS Among 3,517,804 participants, PAD and CAS was identified in 4.4% and 3.7%, respectively. Diabetes was identified in 376,528 participants, 324,680 (86%) of whom did not have CHD. Among diabetic participants without CHD, prevalence of PAD increased with 1-2 (4.3%), 3-4 (7.3%), and ≥5 (12.0%) comorbid risk factors (p trend < 0.0001). The pattern was similar for CAS (3.7%, 6.2%, 8.8%, p trend < 0.0001). Compared to participants without diabetes, those with diabetes and 1-2, 3-4 and ≥5 risk factors had increasing odds of PAD and CAS after adjustment for age, sex and race/ethnicity (1.0, 95% CI 0.98-1.06; 1.8, 95% CI 1.8-1.89; 3.5, 95% CI 3.43-3.64, respectively, p trend < 0.0001). By comparison, in nondiabetic participants, CHD increased odds of PAD and CAS by 2-fold (2.06, 95% CI 2.02-2.1; 2.19, 95% CI 2.15-2.23 respectively). CONCLUSIONS Diabetes, particularly with comorbid risk factors, confers increased odds of PAD and CAS, even in the absence of CHD. Counseling regarding screening and prevention for peripheral vascular disease among individuals with diabetes and multiple risk factors may be useful.
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Affiliation(s)
- Tanya Wilcox
- New York University School of Medicine, Department of Medicine, 227 E. 30th Street, TRB rm. 853, New York, NY 10016, USA.
| | - Jonathan D Newman
- New York University School of Medicine, Department of Medicine, Division of Cardiology, 227E. 30th Street, TRB rm. 853, New York, NY 10016, USA.
| | - Thomas S Maldonado
- New York University School of Medicine, Department of Vascular Surgery, 530 1st Ave, New York, NY, 10016, USA
| | - Caron Rockman
- New York University School of Medicine, Department of Vascular Surgery, 530 1st Ave, New York, NY, 10016, USA
| | - Jeffrey S Berger
- New York University School of Medicine, Department of Medicine, Division of Cardiology, 227E. 30th Street, TRB rm. 853, New York, NY 10016, USA
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18
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Lin YT, Chen HJ, Chen PC, Sung FC. Increased Risk of Peripheral Arterial Disease in Patients With Abdominal Aortic Aneurysm: A Retrospective Cohort Study (Version 5). Angiology 2018; 70:41-46. [PMID: 29444589 DOI: 10.1177/0003319718757615] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Studies evaluating the risk of peripheral arterial disease (PAD) in patients with abdominal aortic aneurysm (AAA) are limited. We used insurance claims data of Taiwan to establish a cohort of 6590 patients with AAA newly diagnosed from 2000 to 2008 and 6590 controls without AAA matched by propensity score. The subsequent incidence density rates of PAD were estimated in both cohorts by the end of 2011, and the AAA cohort to the non-AAA cohort hazard ratios (HRs) of PAD were calculated using Cox proportional hazards models. The incidence density of PAD in the AAA cohort was 3.7-fold greater than that in the non-AAA cohort (14.1 vs 3.66 per 1000 person-years) with an adjusted HR of 3.56 (95% confidence interval [CI] = 2.89-4.39). For those without comorbidities, PAD in the AAA cohort was 7.4-fold greater than that in the non-AAA cohort (12.0 vs 1.61 per 1000 person-years) with an adjusted HR of 6.70 (95% CI = 4.43-10.1). The incidence of PAD in patients with ruptured AAA was lower than that in patients without rupture (6.95 vs 15.0 per 1000 person-years). This study demonstrates that patients with AAA are at increased risk of developing PAD.
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Affiliation(s)
- Yi-Ting Lin
- 1 Department of Emergency Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan
| | - Hsuan-Ju Chen
- 2 Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan
| | - Pei-Chun Chen
- 2 Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,3 Department of Public Health, China Medical University, Taichung, Taiwan
| | - Fung-Chang Sung
- 2 Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,4 Graduate Institute of Clinical Medical Science, College of Medicine, China Medical University, Taichung, Taiwan.,5 Department of Health Services Administration, China Medical University, Taichung, Taiwan
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19
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Taimour S, Zarrouk M, Holst J, Rosengren AH, Groop L, Nilsson PM, Gottsäter A. Aortic diameter at age 65 in men with newly diagnosed type 2 diabetes. SCAND CARDIOVASC J 2017; 51:202-206. [DOI: 10.1080/14017431.2017.1319971] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Soumia Taimour
- Department of Vascular Diseases, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Moncef Zarrouk
- Department of Vascular Diseases, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Jan Holst
- Department of Vascular Diseases, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Anders H. Rosengren
- Department of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
- Department of Internal Medicine, Clinical Research Unit, Skåne University Hospital, Malmö, Sweden
| | - Leif Groop
- Department of Internal Medicine, Clinical Research Unit, Skåne University Hospital, Malmö, Sweden
| | - Peter M. Nilsson
- Department of Internal Medicine, Clinical Research Unit, Skåne University Hospital, Malmö, Sweden
| | - Anders Gottsäter
- Department of Vascular Diseases, Lund University, Skåne University Hospital, Malmö, Sweden
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Newman JD, Rockman CB, Kosiborod M, Guo Y, Zhong H, Weintraub HS, Schwartzbard AZ, Adelman MA, Berger JS. Diabetes mellitus is a coronary heart disease risk equivalent for peripheral vascular disease. Am Heart J 2017; 184:114-120. [PMID: 28224925 DOI: 10.1016/j.ahj.2016.09.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 09/08/2016] [Indexed: 10/21/2022]
Abstract
Diabetes mellitus (diabetes) is associated with significantly increased risk of peripheral vascular disease. Diabetes is classified as a coronary heart disease (CHD) risk equivalent, but it is unknown whether diabetes is a CHD risk equivalent for peripheral vascular disease. The objective was to evaluate the odds of peripheral arterial disease (PAD) or carotid artery stenosis (CAS) among participants with diabetes, CHD, or both, compared with participants without diabetes or CHD, in a nationwide vascular screening database. We hypothesized that diabetes and CHD would confer similar odds of PAD and CAS. METHODS A cross-sectional analysis of all eligible Life Line Screening Inc participants age 30 to 90 years with ankle brachial indices for PAD (ankle brachial index <0.9 in either leg) and carotid artery duplex ultrasonographic imaging for CAS (internal CAS ≥50%) was performed (N=3,522,890). RESULTS Diabetes and CHD were present in 372,330 (10.7%) and 182,760 (5.8%) of participants, respectively; PAD and CAS were present in 155,000 (4.4%) and 130,347 (3.7%) of participants. After multivariable adjustment, PAD odds were 1.56 (95% CI 1.54-1.59) and 1.69 (95% CI 1.65-1.73) for participants with diabetes or CHD, respectively. Participants with both diabetes and CHD had 2.75-fold increased odds of PAD (95% CI 2.66-2.85). Findings were similar for CAS; compared with no diabetes or CHD, CAS odds increased for participants with diabetes alone (1.53, 95% CI 1.50-1.56), CHD alone (1.72, 95% CI 1.68-1.76), and both diabetes and CHD (2.57, 95% CI 2.49-2.66). Findings were consistent for women and men. CONCLUSION In a large database of more than 3.5 million self-referred participants, diabetes was a CHD risk equivalent for PAD and CAS, and participants with comorbid diabetes and CHD had an especially robust association with PAD and CAS. Counseling regarding screening and prevention of peripheral vascular disease may be useful for patients with diabetes.
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21
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Tsialtas D, Bolognesi MG, Volpi R, Bolognesi R. A not so adverse impact of diabetes on large abdominal aortic aneurysm. J Cardiovasc Med (Hagerstown) 2016; 18:780-781. [PMID: 27898504 DOI: 10.2459/jcm.0000000000000488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Dimitri Tsialtas
- Department of clinical and experimental medicine, University of Parma, Italy
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22
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Hjellestad ID, Søfteland E, Nilsen RM, Husebye ES, Jonung T. Abdominal aortic aneurysms--glycaemic status and mortality. J Diabetes Complications 2016; 30:438-43. [PMID: 26794646 DOI: 10.1016/j.jdiacomp.2015.12.015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 11/22/2015] [Accepted: 12/14/2015] [Indexed: 12/17/2022]
Abstract
AIMS The prevalence of diabetes mellitus (DM) and mortality with respect to glycaemic status in patients with abdominal aortic aneurysms (AAA) was evaluated. Glycaemic status was assessed by an oral glucose tolerance test (OGTT) and by HbA1c. METHODS Sixty-six patients with AAA admitted to the vascular surgery unit for elective surgery between October 2006 and September 2007 were included. Seven patients had previously known DM. OGTT and HbA1c results were available from 58 patients. The patients were categorized as having DM, prediabetes and normoglycaemia according to the WHO's and American Diabetes Association's criteria. RESULTS The prevalence of newly diagnosed DM according to the OGTT and HbA1c results were 12% and 14% respectively. Mean follow-up time was 68 months and all-cause mortality 43%. HbA1c was an independent predictor for mortality in the DM category. Hazard ratio of all-cause mortality in the DM category defined by the HbA1c values was 6.35, 95% [CI 1.49-27.1]; p = 0.01. CONCLUSIONS DM defined by HbA1c ≥ 6.5% is an important determinant of mortality following surgical treatment for AAA. Half the patients with AAA and DM were unaware of their DM diagnosis. All patients with AAA should be tested for DM using HbA1c. The results should be confirmed in a larger prospective study.
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Affiliation(s)
- Iren Drange Hjellestad
- Department of Medicine, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway.
| | - Eirik Søfteland
- Department of Medicine, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway
| | - Roy Miodini Nilsen
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Eystein Sverre Husebye
- Department of Medicine, Haukeland University Hospital, Jonas Lies vei 65, 5021, Bergen, Norway; Department of Clinical Sciences, University of Bergen, Bergen, Norway
| | - Torbjørn Jonung
- Department of Clinical Sciences, University of Bergen, Bergen, Norway; Department of Vascular Surgery, Haukeland University Hospital, Bergen, Norway
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23
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Jain RK, Laiteerapong N. Strategies for improving cardiovascular health in women with diabetes mellitus: a review of the evidence. Curr Diab Rep 2015; 15:98. [PMID: 26391392 PMCID: PMC4886737 DOI: 10.1007/s11892-015-0665-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Knowledge about cardiovascular (CV) disease in women with diabetes mellitus (DM) has changed substantially over the past 20 years. Coronary artery disease, strokes, and peripheral vascular disease affect women with DM at higher rates than the general population of women. Lifestyle therapies, such as dietary changes, physical activity, and smoking cessation, offer substantial benefits to women with DM. Of the pharmacotherapies, statins offer the most significant benefits but may not be well tolerated in some women. Aspirin may also benefit high-risk women. Other pharmacotherapies, such as fibrates, ezetimibe, niacin, fish oil, and hormone replacement therapy, remain unproven and, in some cases, potentially dangerous to women with DM. To reduce CV events, risks to women with DM must be better publicized and additional research must be done. Finally, advancements in health care delivery must target high-risk women with DM to lower risk factors and effectively improve cardiovascular health.
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Affiliation(s)
- Rajesh K Jain
- Department of Endocrinology, Diabetes, and Metabolism, University of Chicago Medicine, 5841 S Maryland Ave, AMB M267-MC1027, Chicago, IL, 60637, USA.
| | - Neda Laiteerapong
- Department of General Internal Medicine, University of Chicago Medicine, 5841 S Maryland Ave, MC 2007, Chicago, IL, 60637, USA.
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24
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Affiliation(s)
- Jonathan Golledge
- Vascular Biology Unit, Queensland Research Centre for Peripheral Vascular Disease, School of Medicine and Dentistry, James Cook University, Townsville, Australia Department of Vascular and Endovascular Surgery, The Townsville Hospital, Townsville, Australia
| | - Mark E Cooper
- Diabetes Domain, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
| | - Zhonglin Chai
- Diabetes Domain, Baker IDI Heart and Diabetes Institute, Melbourne, Australia
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25
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Staimez LR, Weber MB, Gregg EW. The role of lifestyle change for prevention of cardiovascular disease in diabetes. Curr Atheroscler Rep 2015; 16:460. [PMID: 25363453 DOI: 10.1007/s11883-014-0460-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The burden of cardiovascular disease (CVD) is disproportionately greater in those with diabetes than in the general population, including higher rates of hospitalization, stroke, myocardial infarction, and mortality. Health-promoting lifestyle factors reduce both diabetes and CVD in healthy individuals; however, the efficacy of these strategies for CVD reduction in people with preexisting diabetes is unclear. In this review, we describe the most recent evidence (2013-2014) surrounding the effects of lifestyle changes on CVD outcomes in those with diabetes, and we contextualize the evidence against a backdrop of earlier key findings. Two major randomized controlled trials were identified, providing opposing conclusions about the role of lifestyle factors on CVD events in those with diabetes. Other recent prospective observational analyses support associations of physical activity and reduced CVD risk in diabetes. Limitations across studies include the use of self-report for measurement of lifestyle or lifestyle change, the length of follow-up needed to measure CVD outcomes, and the role of participants' medications on associations of lifestyle factors and CVD outcomes. Equivocal findings from the two randomized controlled trials support the need for additional research to identify the specific lifestyle factors that reduce CVD mortality and macrovascular complications in populations with diabetes.
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Affiliation(s)
- Lisa R Staimez
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, CNR Room 7043, Atlanta, GA, 30329, USA,
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26
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Heffron SP, Rockman CB, Gianos E, Guo Y, Berger JS. Greater frequency of nut consumption is associated with lower prevalence of peripheral arterial disease. Prev Med 2015; 72:15-8. [PMID: 25532677 PMCID: PMC4518851 DOI: 10.1016/j.ypmed.2014.12.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Revised: 12/12/2014] [Accepted: 12/13/2014] [Indexed: 10/24/2022]
Abstract
UNLABELLED Nut consumption has been associated with lower risk of coronary heart disease and all-cause mortality. The association between nut intake and peripheral arterial disease (PAD) is uncertain. OBJECTIVE We sought to investigate the association between nut consumption and presence of prevalent PAD in a large cross-sectional sample. METHODS Self-referred participants at >20,000 US sites who completed a medical and lifestyle questionnaire were evaluated by screening ankle brachial indices for PAD. Multivariable logistic regression analysis was used to estimate odds of PAD in different nut consumption categories. RESULTS Among 3,312,403 individuals, mean age was 63.6 ± 10.6 years and 62.8% were female. There were 219,527 cases of PAD. After multivariable adjustment there was an inverse association of nut intake with PAD. Compared to subjects with consumption of nuts CONCLUSION These observations suggest the need for more rigorous testing evaluating the role of nuts in PAD prevention.
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Affiliation(s)
- Sean P Heffron
- Department of Medicine, Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York University School of Medicine, 550 First Avenue, New York, NY, USA.
| | - Caron B Rockman
- Department of Surgery, Division of Vascular Surgery, New York University Langone Medical Center, New York University School of Medicine, 550 First Avenue, New York, NY, USA.
| | - Eugenia Gianos
- Department of Medicine, Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York University School of Medicine, 550 First Avenue, New York, NY, USA.
| | - Yu Guo
- Department of Population Health, Division of Biostatistics, New York University Langone Medical Center, New York University School of Medicine, 550 First Avenue, New York, NY, USA.
| | - Jeffrey S Berger
- Department of Medicine, Leon H. Charney Division of Cardiology, New York University Langone Medical Center, New York University School of Medicine, 550 First Avenue, New York, NY, USA; Department of Surgery, Division of Vascular Surgery, New York University Langone Medical Center, New York University School of Medicine, 550 First Avenue, New York, NY, USA.
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27
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Marsico F, Giugliano G, Ruggiero D, Parente A, Paolillo S, Guercio LD, Esposito G, Trimarco B, Filardi PP. Prevalence and severity of asymptomatic coronary and carotid artery disease in patients with abdominal aortic aneurysm. Angiology 2014; 66:360-4. [PMID: 24965380 DOI: 10.1177/0003319714540319] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We evaluated the prevalence and severity of occult coronary artery disease (CAD) and cerebrovascular disease (CeVD) in patients with abdominal aortic aneurysm (AAA). We studied 100 consecutive patients with no history of CAD, normal electrocardiogram, normal systolic function, and no angina or dyspnea. All patients underwent carotid Doppler study and invasive coronary angiography. Significant CAD was observed in 61% of patients. In all, 51% of patients with significant CAD showed either left main (n = 7), 3-vessel (n = 17), or proximal left anterior descending (n = 7) CAD, corresponding to 31% of the total cohort. Cerebrovascular disease was detected in 53% of patients, and in 38% of them was significant (peak systolic flow velocity ≥125 <230 cm/s). In 36% of patients with CeVD either left main (n = 5), 3-vessel (n = 11), or proximal left anterior descending (n = 3) CAD was observed. Severe asymptomatic CAD is prevalent in AAA, and 31% of patients fulfill indications for coronary revascularization.
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Affiliation(s)
- Fabio Marsico
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Giuseppe Giugliano
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Donatella Ruggiero
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Antonio Parente
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Luca Del Guercio
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Bruno Trimarco
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
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