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Affiliation(s)
- Mary M McDermott
- Northwestern University Feinberg School of Medicine, Chicago, IL
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McDermott MM, Tian L, Zhang D, Zhao L, Greenland P, Kibbe MR, Criqui MH, Thangada ND, Ferrucci L, Ho KJ, Guralnik JM, Polonsky TS. Discordance of patient-reported outcome measures with objectively assessed walking decline in peripheral artery disease. J Vasc Surg 2024; 79:893-903. [PMID: 38122859 DOI: 10.1016/j.jvs.2023.12.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/05/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE Among people with peripheral artery disease (PAD), perceived change in walking difficulty over time, compared with people without PAD, is unclear. Among people reporting no change in walking difficulty over time, differences in objectively measured change in walking performance between people with and without PAD are unknown. METHODS A total of 1289 participants were included. Eight hundred seventy-four participants with PAD (aged 71.1 ± 9.1 years) were identified from noninvasive vascular laboratories and 415 without PAD (aged 69.9 ± 7.6 years) were identified from people with normal vascular laboratory testing or general medical practices in Chicago. The Walking Impairment Questionnaire and 6-minute walk were completed at baseline and 1-year follow-up. The Walking Impairment Questionnaire assessed perceived difficulty walking due to symptoms in the calves or buttocks on a Likert scale (range, 0-4). Symptom change was determined by comparing difficulty reported at 1-year follow-up to difficulty reported at baseline. RESULTS At 1-year follow-up, 31.9% of participants with and 20.6% of participants without PAD reported walking difficulty that was improved (P < .01), whereas 41.2% vs 55%, respectively, reported walking difficulty that was unchanged (P < .01). Among all reporting no change in walking difficulty, participants with PAD declined in 6-minute walk, whereas participants without PAD improved (-10 vs +15 meters; mean difference, -25; 95% confidence interval, -38 to -13; P < .01). CONCLUSIONS Most people with PAD reported improvement or no change in walking difficulty from calf or buttock symptoms at one-year follow-up. Among all participants who perceived stable walking ability, those with PAD had significant greater declines in objectively measured walking performance, compared with people without PAD.
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Affiliation(s)
- Mary M McDermott
- Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Lu Tian
- Department of Health Research and Policy, Stanford University, Stanford, CA
| | - Dongxue Zhang
- Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lihui Zhao
- Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Philip Greenland
- Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Melina R Kibbe
- Departments of Medical Science, Surgery, and Biomedical Engineering, University of Virginia School of Medicine, Charlottesville, VA
| | - Michael H Criqui
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA
| | - Neela D Thangada
- Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Karen J Ho
- Departments of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jack M Guralnik
- Department of Epidemiology, University of Maryland, College Park, MD
| | - Tamar S Polonsky
- Department of Medicine, University of Chicago Medicine, Chicago, IL
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McDermott MM, Bibbins-Domingo K. Climate Change and Health-A New JAMA Series. JAMA 2024; 331:395. [PMID: 38175629 DOI: 10.1001/jama.2023.27809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Affiliation(s)
- Mary M McDermott
- Deputy Editor, JAMA
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Ismaeel A, McDermott MM, Joshi JK, Sturgis JC, Zhang D, Ho KJ, Sufit R, Ferrucci L, Peterson CA, Kosmac K. Cocoa flavanols, Nrf2 activation, and oxidative stress in peripheral artery disease: mechanistic findings in muscle based on outcomes from a randomized trial. Am J Physiol Cell Physiol 2024; 326:C589-C605. [PMID: 38189132 DOI: 10.1152/ajpcell.00573.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/23/2023] [Accepted: 12/23/2023] [Indexed: 01/09/2024]
Abstract
The pathophysiology of muscle damage in peripheral artery disease (PAD) includes increased oxidant production and impaired antioxidant defenses. Epicatechin (EPI), a naturally occurring flavanol, has antioxidant properties that may mediate the beneficial effects of natural products such as cocoa. In a phase II randomized trial, a cocoa-flavanol-rich beverage significantly improved walking performance compared with a placebo in people with PAD. In the present work, the molecular mechanisms underlying the therapeutic effect of cocoa flavanols were investigated by analyzing baseline and follow-up muscle biopsies from participants. Increases in nuclear factor erythroid 2-related factor 2 (Nrf2) target antioxidants heme oxygenase-1 (HO-1) and NAD(P)H dehydrogenase [quinone] 1 (NQO1) in the cocoa group were significantly associated with reduced accumulation of central nuclei, a myopathy indicator, in type II muscle fibers (P = 0.017 and P = 0.023, respectively). Protein levels of the mitochondrial respiratory complex III subunit, cytochrome b-c1 complex subunit 2 (UQCRC2), were significantly higher in the cocoa group than in the placebo group (P = 0.032), and increases in UQCRC2 were significantly associated with increased levels of Nrf2 target antioxidants HO-1 and NQO1 (P = 0.001 and P = 0.035, respectively). Exposure of non-PAD human myotubes to ex vivo serum from patients with PAD reduced Nrf2 phosphorylation, an indicator of activation, increased hydrogen peroxide production and oxidative stress, and reduced mitochondrial respiration. Treatment of myotubes with EPI in the presence of serum from patients with PAD increased Nrf2 phosphorylation and protected against PAD serum-induced oxidative stress and mitochondrial dysfunction. Overall, these findings suggest that cocoa flavanols may enhance antioxidant capacity in PAD via Nrf2 activation.NEW & NOTEWORTHY The current study supports the hypothesis that in people with PAD, cocoa flavanols activate Nrf2, thereby increasing antioxidant protein levels, protecting against skeletal muscle damage, and increasing mitochondrial protein abundance. These results suggest that Nrf2 activation may be an important therapeutic target for improving walking performance in people with PAD.
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Affiliation(s)
- Ahmed Ismaeel
- Deparment of Physiology, University of Kentucky, Lexington, Kentucky, United States
- Center for Muscle Biology, University of Kentucky, Lexington, Kentucky, United States
| | - Mary M McDermott
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Jai K Joshi
- Department of Physical Therapy, University of Kentucky, Lexington, Kentucky, United States
| | - Jada C Sturgis
- Center for Muscle Biology, University of Kentucky, Lexington, Kentucky, United States
- Department of Physical Therapy, University of Kentucky, Lexington, Kentucky, United States
| | - Dongxue Zhang
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Karen J Ho
- Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Robert Sufit
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Luigi Ferrucci
- National Institute on Aging, Intramural Research Program, Baltimore, Maryland, United States
| | - Charlotte A Peterson
- Center for Muscle Biology, University of Kentucky, Lexington, Kentucky, United States
- Department of Physical Therapy, University of Kentucky, Lexington, Kentucky, United States
| | - Kate Kosmac
- Department of Physical Therapy, Augusta University, Augusta, Georgia, United States
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Paluch AE, Boyer WR, Franklin BA, Laddu D, Lobelo F, Lee DC, McDermott MM, Swift DL, Webel AR, Lane A. Resistance Exercise Training in Individuals With and Without Cardiovascular Disease: 2023 Update: A Scientific Statement From the American Heart Association. Circulation 2024; 149:e217-e231. [PMID: 38059362 DOI: 10.1161/cir.0000000000001189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Resistance training not only can improve or maintain muscle mass and strength, but also has favorable physiological and clinical effects on cardiovascular disease and risk factors. This scientific statement is an update of the previous (2007) American Heart Association scientific statement regarding resistance training and cardiovascular disease. Since 2007, accumulating evidence suggests resistance training is a safe and effective approach for improving cardiovascular health in adults with and without cardiovascular disease. This scientific statement summarizes the benefits of resistance training alone or in combination with aerobic training for improving traditional and nontraditional cardiovascular disease risk factors. We also address the utility of resistance training for promoting cardiovascular health in varied healthy and clinical populations. Because less than one-third of US adults report participating in the recommended 2 days per week of resistance training activities, this scientific statement provides practical strategies for the promotion and prescription of resistance training.
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Nordanstig J, Behrendt CA, Baumgartner I, Belch J, Bäck M, Fitridge R, Hinchliffe R, Lejay A, Mills JL, Rother U, Sigvant B, Spanos K, Szeberin Z, van de Water W, Antoniou GA, Björck M, Gonçalves FB, Coscas R, Dias NV, Van Herzeele I, Lepidi S, Mees BME, Resch TA, Ricco JB, Trimarchi S, Twine CP, Tulamo R, Wanhainen A, Boyle JR, Brodmann M, Dardik A, Dick F, Goëffic Y, Holden A, Kakkos SK, Kolh P, McDermott MM. Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Asymptomatic Lower Limb Peripheral Arterial Disease and Intermittent Claudication. Eur J Vasc Endovasc Surg 2024; 67:9-96. [PMID: 37949800 DOI: 10.1016/j.ejvs.2023.08.067] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 08/14/2023] [Indexed: 11/12/2023]
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McDermott MM, Ho KJ, Alabi O, Criqui MH, Goodney P, Hamburg N, McNeal DM, Pollak A, Smolderen KG, Bonaca M. Disparities in Diagnosis, Treatment, and Outcomes of Peripheral Artery Disease: JACC Scientific Statement. J Am Coll Cardiol 2023; 82:2312-2328. [PMID: 38057074 DOI: 10.1016/j.jacc.2023.09.830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 09/13/2023] [Accepted: 09/20/2023] [Indexed: 12/08/2023]
Abstract
Disparities by sex, race, socioeconomic status, and geography exist in diagnosis, treatment, and outcomes for people with lower extremity peripheral artery disease (PAD). PAD prevalence is similar in men and women, but women have more atypical symptoms and undergo lower extremity revascularization at older ages compared to men. People who are Black have an approximately 2-fold higher prevalence of PAD, compared to people who are White and have more atypical symptoms, greater mobility loss, less optimal medical care, and higher amputation rates. Although fewer data are available for other races, people with PAD who are Hispanic have higher amputation rates than White people. Rates of amputation also vary by geography in the United States, with the highest rates of amputation in the southeastern United States. To improve PAD outcomes, intentional actions to eliminate disparities are necessary, including clinician education, patient education with culturally appropriate messaging, improved access to high-quality health care, science focused on disparity elimination, and health policy changes.
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Affiliation(s)
- Mary M McDermott
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
| | - Karen J Ho
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Olamide Alabi
- Emory University School of Medicine, Atlanta, Georgia, USA
| | - Michael H Criqui
- University of California-San Diego, School of Medicine, La Jolla, California, USA
| | - Philip Goodney
- Dartmouth School of Medicine, Hanover, New Hampshire, USA
| | | | - Demetria M McNeal
- University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
| | - Amy Pollak
- Mayo Clinic Jacksonville, Jacksonville, Florida, USA
| | - Kim G Smolderen
- Yale University School of Medicine, New Haven, Connecticut, USA
| | - Marc Bonaca
- University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado, USA
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McDermott MM, Bibbins-Domingo K. Black Race and Hepatitis C-a New Focus for JAMA Narrative Reviews. JAMA 2023; 330:2170. [PMID: 37943565 DOI: 10.1001/jama.2023.22464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Affiliation(s)
- Mary M McDermott
- Deputy Editor, JAMA
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Thangada ND, Xu S, Tian L, Zhao L, Criqui MH, Ferrucci L, Rejeski WJ, Leeuwenburgh C, Manini T, Spring B, Treat-Jacobson D, Forman DE, Bazzano L, Guralnik J, Sufit R, Polonsky T, Kibbe MR, McDermott MM. Hospitalizations during home-based walking exercise interventions in peripheral artery disease: Results from two randomized clinical trials. Vasc Med 2023; 28:583-585. [PMID: 37622748 DOI: 10.1177/1358863x231191909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Affiliation(s)
- Neela D Thangada
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Shujun Xu
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Lu Tian
- Department of Health Research and Policy, Stanford University, Stanford, CA, USA
| | - Lihui Zhao
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael H Criqui
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - Luigi Ferrucci
- Division of Intramural Research, National Institute on Aging, Bethesda, MD, USA
| | - W Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA
| | - Christiaan Leeuwenburgh
- Department of Aging and Geriatric Research, Institute on Aging, University of Florida, Gainesville, FL, USA
| | - Todd Manini
- Department of Aging and Geriatric Research, Institute on Aging, University of Florida, Gainesville, FL, USA
| | - Bonnie Spring
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Daniel E Forman
- Department of Medicine (Geriatrics and Cardiology), University of Pittsburgh, Pittsburgh, PA, USA
- Geriatrics, Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Lydia Bazzano
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Jack Guralnik
- Department of Epidemiology and Public Health, University of Maryland, Baltimore, MD, USA
| | - Robert Sufit
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Tamar Polonsky
- Department of Medicine, Medical School, University of Chicago, Chicago, IL, USA
| | - Melina R Kibbe
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Mary M McDermott
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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Kusumoto FM, Bittl JA, Creager MA, Dauerman HL, Lala A, McDermott MM, Turco JV, Taqueti VR, Fuster V. Challenges and Controversies in Peer Review: JACC Review Topic of the Week. J Am Coll Cardiol 2023; 82:2054-2062. [PMID: 37968021 DOI: 10.1016/j.jacc.2023.08.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/19/2023] [Accepted: 08/18/2023] [Indexed: 11/17/2023]
Abstract
The process of peer review has been the gold standard for evaluating medical science, but significant pressures from the recent COVID-19 pandemic, new methods of communication, larger amounts of research, and an evolving publication landscape have placed significant pressures on this system. A task force convened by the American College of Cardiology identified the 5 most significant controversies associated with the current peer-review process: the effect of preprints, reviewer blinding, reviewer selection, reviewer incentivization, and publication of peer reviewer comments. Although specific solutions to these issues will vary, regardless of how scientific communication evolves, peer review must remain an essential process for ensuring scientific integrity, timely dissemination of information, and better patient care. In medicine, the peer-review process is crucial because harm can occur if poor-quality data or incorrect conclusions are published. With the dramatic increase in scientific publications and new methods of communication, high-quality peer review is more important now than ever.
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Affiliation(s)
- Fred M Kusumoto
- Department of Cardiovascular Disease, Mayo Clinic Alix School of Medicine, Jacksonville, Florida, USA.
| | - John A Bittl
- Scientific Publications Committee, American College of Cardiology, Washington, DC, USA
| | - Mark A Creager
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
| | - Harold L Dauerman
- Department of Medicine, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Anuradha Lala
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mary M McDermott
- Northwestern University's Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Viviany R Taqueti
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Valentin Fuster
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain
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Thangada ND, Zhang D, Tian L, Zhao L, Rejeski WJ, Ho KJ, Ferrucci L, Spring B, Kibbe MR, Polonsky TS, Criqui MH, McDermott MM. Home-Based Walking Exercise and Supervised Treadmill Exercise in Patients With Peripheral Artery Disease: An Individual Participant Data Meta-Analysis. JAMA Netw Open 2023; 6:e2334590. [PMID: 37733346 PMCID: PMC10514734 DOI: 10.1001/jamanetworkopen.2023.34590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Accepted: 08/14/2023] [Indexed: 09/22/2023] Open
Abstract
Importance Few people with lower extremity peripheral artery disease (PAD) participate in supervised treadmill exercise covered by the Center for Medicare and Medicaid Services. In people with PAD, the benefits of home-based walking exercise, relative to supervised exercise, remain unclear. Objective To study whether home-based walking exercise improves 6-minute walk (6MW) more than supervised treadmill exercise in people with PAD (defined as Ankle Brachial Index ≤0.90). Data Sources Data were combined from 5 randomized clinical trials of exercise therapy for PAD using individual participant data meta-analyses, published from 2009 to 2022. Study Selection Of the 5 clinical trials, 3 clinical trials compared supervised treadmill exercise to nonexercise control (N = 370) and 2 clinical trials compared an effective home-based walking exercise intervention to nonexercise control (N = 349). Data Extraction and Synthesis Individual participant-level data from 5 randomized clinical trials led by 1 investigative team were combined. The 5 randomized clinical trials included 3 clinical trials of supervised treadmill exercise and 2 effective home-based walking exercise interventions. Main Outcomes and Measures Change in 6MW distance, maximum treadmill walking distance, and Walking Impairment Questionnaire at 6-month follow-up. The supervised treadmill exercise intervention consisted of treadmill exercise in the presence of an exercise physiologist, conducted 3 days weekly for up to 50 minutes per session. Home-based walking exercise consisted of a behavioral intervention in which a coach helped participants walk for exercise in or around home for up to 5 days per week for 50 minutes per session. Results A total of 719 participants with PAD (mean [SD] age, 68.8 [9.5] years; 46.5% female) were included (349 in a home-based exercise clinical trial and 370 in a supervised exercise trial). Compared with nonexercise control, supervised treadmill exercise was associated with significantly improved 6MW by 32.9 m (95% CI, 20.6-45.6; P < .001) and home-based walking exercise was associated with significantly improved 6MW by 50.7 m (95% CI, 34.8-66.7; P < .001). Compared with supervised treadmill exercise, home-based walking exercise was associated with significantly greater improvement in 6MW distance (between-group difference: 23.8 m [95% CI, 3.6, 44.0; P = .02]) but significantly less improvement in maximum treadmill walking distance (between-group difference:-132.5 m [95% CI, -192.9 to -72.1; P < .001]). Conclusions and Relevance In this individual participant data meta-analyses, compared with supervised exercise, home-based walking exercise was associated with greater improvement in 6MW in people with PAD. These findings support home-based walking exercise as a first-line therapy for walking limitations in PAD.
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Affiliation(s)
- Neela D. Thangada
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Dongxue Zhang
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lu Tian
- Department of Health Research and Policy, Stanford University, Stanford, California
| | - Lihui Zhao
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - W. Jack Rejeski
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, North Carolina
| | - Karen J. Ho
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Luigi Ferrucci
- Division of Intramural Research, National Institute on Aging, Bethesda, Maryland
| | - Bonnie Spring
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Melina R. Kibbe
- Department of Surgery, University of Virginia School of Medicine, Charlottesville
- Editor, JAMA Surgery
| | - Tamar S. Polonsky
- Department of Medicine, Medical School, University of Chicago, Chicago, Illinois
| | - Michael H. Criqui
- Department of Family Medicine and Public Health University of California San Diego, La Jolla
| | - Mary M. McDermott
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Deputy Editor, JAMA
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Whipple MO, Pfammatter AF, Spring B, Rejeski WJ, Treat‐Jacobson D, Domanchuk KJ, Dressler EV, Ferrucci L, Gildea L, Guralnik JM, Harvin L, Leeuwenburgh C, Polonsky TS, Reynolds E, Stowe CL, Sufit R, Van Horn L, Walkup MP, Ambrosius WT, McDermott MM. Study Design, Rationale, and Methodology for Promote Weight Loss in Patients With Peripheral Artery Disease Who Also Have Obesity: The PROVE Trial. J Am Heart Assoc 2023; 12:e031182. [PMID: 37642035 PMCID: PMC10547361 DOI: 10.1161/jaha.123.031182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 07/28/2023] [Indexed: 08/31/2023]
Abstract
Background Overweight and obesity are associated with adverse functional outcomes in people with peripheral artery disease (PAD). The effects of weight loss in people with overweight/obesity and PAD are unknown. Methods The PROVE (Promote Weight Loss in Obese PAD Patients to Prevent Mobility Loss) Trial is a multicentered randomized clinical trial with the primary aim of testing whether a behavioral intervention designed to help participants with PAD lose weight and walk for exercise improves 6-minute walk distance at 12-month follow-up, compared with walking exercise alone. A total of 212 participants with PAD and body mass index ≥25 kg/m2 will be randomized. Interventions are delivered using a Group Mediated Cognitive Behavioral intervention model, a smartphone application, and individual telephone coaching. The primary outcome is 12-month change in 6-minute walk distance. Secondary outcomes include total minutes of walking exercise/wk at 12-month follow-up and 12-month change in accelerometer-measured physical activity, the Walking Impairment Questionnaire distance score, and the Patient-Reported Outcomes Measurement Information System mobility questionnaire. Tertiary outcomes include 12-month changes in perceived exertional effort at the end of the 6-minute walk, diet quality, and the Short Physical Performance Battery. Exploratory outcomes include changes in gastrocnemius muscle biopsy measures of mitochondrial cytochrome C oxidase activity, mitochondrial biogenesis, capillary density, and inflammatory markers. Conclusions The PROVE randomized clinical trial will evaluate the effects of exercise with an intervention of coaching and a smartphone application designed to achieve weight loss, compared with exercise alone, on walking performance in people with PAD and overweight/obesity. Results will inform optimal treatment for the growing number of patients with PAD who have overweight/obesity. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04228978.
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Affiliation(s)
| | | | - Bonnie Spring
- Feinberg School of MedicineNorthwestern UniversityChicagoIL
| | - W. Jack Rejeski
- Department of Health and Exercise ScienceWake Forest UniversityWinston‐SalemNC
| | | | | | - Emily V. Dressler
- Department of Biostatistics and Data ScienceWake Forest University School of MedicineWinston‐SalemNC
| | - Luigi Ferrucci
- National Institute on Aging, National Institutes of HealthBaltimoreMD
| | - Lois Gildea
- School of NursingUniversity of MinnesotaMinneapolisMN
| | | | - Lea Harvin
- Department of Biostatistics and Data ScienceWake Forest University School of MedicineWinston‐SalemNC
| | | | | | - Eric Reynolds
- Department of Biostatistics and Data ScienceWake Forest University School of MedicineWinston‐SalemNC
| | - Cynthia L. Stowe
- Department of Biostatistics and Data ScienceWake Forest University School of MedicineWinston‐SalemNC
| | - Robert Sufit
- Feinberg School of MedicineNorthwestern UniversityChicagoIL
| | - Linda Van Horn
- Feinberg School of MedicineNorthwestern UniversityChicagoIL
| | - Michael P. Walkup
- Department of Health and Exercise ScienceWake Forest UniversityWinston‐SalemNC
| | - Walter T. Ambrosius
- Department of Biostatistics and Data ScienceWake Forest University School of MedicineWinston‐SalemNC
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Sonderman M, Aday AW, Farber-Eger E, Mai Q, Freiberg MS, Liebovitz DM, Greenland P, McDermott MM, Beckman JA, Wells Q. Identifying Patients With Peripheral Artery Disease Using the Electronic Health Record: A Pragmatic Approach. JACC Adv 2023; 2:100566. [PMID: 37829143 PMCID: PMC10569163 DOI: 10.1016/j.jacadv.2023.100566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/14/2023]
Abstract
BACKGROUND Peripheral artery disease (PAD) is underdiagnosed due to poor patient and clinician awareness. Despite this, no widely accepted PAD screening is recommended. OBJECTIVES The authors used machine learning to develop an automated risk stratification tool for identifying patients with a high likelihood of PAD. METHODS Using data from the electronic health record (EHR), ankle-brachial indices (ABIs) were extracted for 3,298 patients. In addition to ABI, we extracted 60 other patient characteristics and used a random forest model to rank the features by association with ABI. The model identified several features independently correlated with PAD. We then built a logistic regression model to predict PAD status on a validation set of patients (n = 1,089), an external cohort of patients (n = 2,922), and a national database (n = 2,488). The model was compared to an age-based and random forest model. RESULTS The model had an area under the curve (AUC) of 0.68 in the validation set. When evaluated on an external population using EHR data, it performed similarly with an AUC of 0.68. When evaluated on a national database, it had an AUC of 0.72. The model outperformed an age-based model (AUC: 0.62; P < 0.001). A random forest model with inclusion of all 60 features did not perform significantly better (AUC: 0.71; P = 0.31). CONCLUSIONS Statistical techniques can be used to build models which identify individuals at high risk for PAD using information accessible from the EHR. Models such as this may allow large health care systems to efficiently identify patients that would benefit from aggressive preventive strategies or targeted-ABI screening.
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Affiliation(s)
- Mark Sonderman
- Division of Cardiology, Department of Medicine, University of Washington Medical Center, Seattle, Washington, USA
| | - Aaron W. Aday
- Division of Cardiovascular Medicine, Vanderbilt Translational and Clinical Cardiovascular Research Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Eric Farber-Eger
- Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Quan Mai
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Matthew S. Freiberg
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - David M. Liebovitz
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Philip Greenland
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Mary M. McDermott
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joshua A. Beckman
- Division of Cardiology, Department of Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Quinn Wells
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Rrapo-Kaso E, Loffler AI, Petroni GR, Meyer CH, Walker M, Kay JR, DiMaria JM, Domanchuk K, Carr JC, McDermott MM, Kramer CM. Alirocumab and plaque volume, calf muscle blood flow, and walking performance in peripheral artery disease: A randomized clinical trial. Vasc Med 2023; 28:282-289. [PMID: 37093712 PMCID: PMC10552651 DOI: 10.1177/1358863x231169324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
BACKGROUND The distal superficial femoral artery (SFA) is most commonly affected in peripheral artery disease (PAD). The effects of the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor alirocumab added to statin therapy on SFA atherosclerosis, downstream flow, and walking performance are unknown. METHODS Thirty-five patients with PAD on maximally tolerated statin therapy were recruited. Patients were randomized to alirocumab 150 mg subcutaneously (n = 18) or matching placebo (n = 17) therapy every 2 weeks for 1 year. The primary outcome was change in SFA plaque volume by black blood magnetic resonance imaging (MRI). Secondary outcomes were changes in calf muscle perfusion by cuff/occlusion hyperemia arterial spin labeling MRI, 6-minute walk distance (6MWD), low-density lipoprotein (LDL) cholesterol, and other biomarkers. RESULTS Age (mean ± SD) was 64 ± 8 years, 20 (57%) patients were women, 17 (49%) were Black individuals, LDL was 107 ± 36 mg/dL, and the ankle-brachial index 0.71 ± 0.20. The LDL fell more with alirocumab than placebo (mean [95% CI]) (-49.8 [-66.1 to -33.6] vs -7.7 [-19.7 to 4.3] mg/dL; p < 0.0001). Changes in SFA plaque volume and calf perfusion showed no difference between groups when adjusted for baseline (+0.25 [-0.29 to 0.79] vs -0.04 [-0.47 to 0.38] cm3; p = 0.37 and 0.22 [-8.67 to 9.11] vs 3.81 [-1.45 to 9.08] mL/min/100 g; p = 0.46, respectively), nor did 6MWD. CONCLUSION In this exploratory study, the addition of alirocumab therapy to statins did not alter SFA plaque volume, calf perfusion or 6MWD despite significant LDL lowering. Larger studies with longer follow up that include plaque characterization may improve understanding of the effects of intensive LDL-lowering therapy in PAD (ClinicalTrials.gov Identifier: NCT02959047).
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Affiliation(s)
- Elona Rrapo-Kaso
- Department of Medicine, Cardiovascular Division, University of Virginia Health, Charlottesville, VA, USA
| | - Adrian I Loffler
- Department of Medicine, Cardiovascular Division, University of Virginia Health, Charlottesville, VA, USA
| | - Gina R Petroni
- Departments of Public Health Sciences, University of Virginia Health, Charlottesville, VA, USA
| | - Craig H Meyer
- Department of Biomedical Engineering, University of Virginia Health, Charlottesville, VA, USA
- Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, VA, USA
| | - McCall Walker
- Department of Medicine, Cardiovascular Division, University of Virginia Health, Charlottesville, VA, USA
| | - Jennifer R. Kay
- Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, VA, USA
| | - Joseph M DiMaria
- Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, VA, USA
| | | | - James C Carr
- Department of Medicine, Northwestern University, Chicago, IL, USA
- Department of Radiology, Northwestern University, Chicago, IL, USA
| | - Mary M McDermott
- Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Christopher M Kramer
- Department of Medicine, Cardiovascular Division, University of Virginia Health, Charlottesville, VA, USA
- Department of Radiology and Medical Imaging, University of Virginia Health, Charlottesville, VA, USA
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15
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Ferrucci L, Candia J, Ubaida-Mohien C, Lyaskov A, Banskota N, Leeuwenburgh C, Wohlgemuth S, Guralnik JM, Kaileh M, Zhang D, Sufit R, De S, Gorospe M, Munk R, Peterson CA, McDermott MM. Transcriptomic and Proteomic of Gastrocnemius Muscle in Peripheral Artery Disease. Circ Res 2023; 132:1428-1443. [PMID: 37154037 DOI: 10.1161/circresaha.122.322325] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
BACKGROUND Few effective therapies exist to improve lower extremity muscle pathology and mobility loss due to peripheral artery disease (PAD), in part because mechanisms associated with functional impairment remain unclear. METHODS To better understand mechanisms of muscle impairment in PAD, we performed in-depth transcriptomic and proteomic analyses on gastrocnemius muscle biopsies from 31 PAD participants (mean age, 69.9 years) and 29 age- and sex-matched non-PAD controls (mean age, 70.0 years) free of diabetes or limb-threatening ischemia. RESULTS Transcriptomic and proteomic analyses suggested activation of hypoxia-compensatory mechanisms in PAD muscle, including inflammation, fibrosis, apoptosis, angiogenesis, unfolded protein response, and nerve and muscle repair. Stoichiometric proportions of mitochondrial respiratory proteins were aberrant in PAD compared to non-PAD, suggesting that respiratory proteins not in complete functional units are not removed by mitophagy, likely contributing to abnormal mitochondrial activity. Supporting this hypothesis, greater mitochondrial respiratory protein abundance was significantly associated with greater complex II and complex IV respiratory activity in non-PAD but not in PAD. Rate-limiting glycolytic enzymes, such as hexokinase and pyruvate kinase, were less abundant in muscle of people with PAD compared with non-PAD participants, suggesting diminished glucose metabolism. CONCLUSIONS In PAD muscle, hypoxia induces accumulation of mitochondria respiratory proteins, reduced activity of rate-limiting glycolytic enzymes, and an enhanced integrated stress response that modulates protein translation. These mechanisms may serve as targets for disease modification.
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Affiliation(s)
- Luigi Ferrucci
- National Institute on Aging, Intramural Research Program, Baltimore, MD (L.F., J.C., C.U.-M., A.L., N.B., M.K., S.D., M.G., R.M.)
| | - Julián Candia
- National Institute on Aging, Intramural Research Program, Baltimore, MD (L.F., J.C., C.U.-M., A.L., N.B., M.K., S.D., M.G., R.M.)
| | - Ceereena Ubaida-Mohien
- National Institute on Aging, Intramural Research Program, Baltimore, MD (L.F., J.C., C.U.-M., A.L., N.B., M.K., S.D., M.G., R.M.)
| | - Alexey Lyaskov
- National Institute on Aging, Intramural Research Program, Baltimore, MD (L.F., J.C., C.U.-M., A.L., N.B., M.K., S.D., M.G., R.M.)
| | - Nirad Banskota
- National Institute on Aging, Intramural Research Program, Baltimore, MD (L.F., J.C., C.U.-M., A.L., N.B., M.K., S.D., M.G., R.M.)
| | - Christiaan Leeuwenburgh
- Department of Physiology and Aging, University of Florida, Institute on Aging, Gainesville (C.L., S.W.)
| | - Stephanie Wohlgemuth
- Department of Physiology and Aging, University of Florida, Institute on Aging, Gainesville (C.L., S.W.)
| | - Jack M Guralnik
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD (J.M.G.)
| | - Mary Kaileh
- National Institute on Aging, Intramural Research Program, Baltimore, MD (L.F., J.C., C.U.-M., A.L., N.B., M.K., S.D., M.G., R.M.)
| | - Dongxue Zhang
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL. (D.Z., R.S.)
| | - Robert Sufit
- Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL. (D.Z., R.S.)
| | - Supriyo De
- National Institute on Aging, Intramural Research Program, Baltimore, MD (L.F., J.C., C.U.-M., A.L., N.B., M.K., S.D., M.G., R.M.)
| | - Myriam Gorospe
- National Institute on Aging, Intramural Research Program, Baltimore, MD (L.F., J.C., C.U.-M., A.L., N.B., M.K., S.D., M.G., R.M.)
| | - Rachel Munk
- National Institute on Aging, Intramural Research Program, Baltimore, MD (L.F., J.C., C.U.-M., A.L., N.B., M.K., S.D., M.G., R.M.)
| | - Charlotte A Peterson
- Center for Muscle Biology. College of Health Sciences, University of Kentucky, Lexington (C.A.P.)
| | - Mary M McDermott
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL. (M.M.D.)
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16
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Nayak P, Polonsky T, Tian L, Greenland P, Xu S, Zhang D, Zhao L, Criqui MH, Kibbe MR, Gladders B, Goodney P, Ho K, Guralnik JM, McDermott MM. Medical therapies, comorbid conditions, and functional performance in people with peripheral artery disease enrolled in clinical trials between 2004 and 2021. Vasc Med 2023; 28:144-146. [PMID: 36588397 DOI: 10.1177/1358863x221145533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Pooja Nayak
- Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Tamar Polonsky
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Lu Tian
- Department of Health Research and Policy, Stanford University, Stanford, CA, USA
| | - Philip Greenland
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Shujun Xu
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Dongxue Zhang
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lihui Zhao
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael H Criqui
- Department of Family Medicine and Public Health, University of California San Diego, San Diego, CA, USA
| | - Melina R Kibbe
- University of Virginia School of Medicine, Charlottesville, VA, USA
| | | | | | - Karen Ho
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jack M Guralnik
- Department of Epidemiology, University of Maryland, College Park, MD, USA
| | - Mary M McDermott
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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17
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Picca A, Wohlgemuth SE, McDermott MM, Saini SK, Dayanidhi S, Zhang D, Xu S, Kosmac K, Tian L, Ferrucci L, Sufit RL, Marzetti E, Leeuwenburgh C. Mitochondrial Complex Abundance, Mitophagy Proteins, and Physical Performance in People With and Without Peripheral Artery Disease. J Am Heart Assoc 2023; 12:e027088. [PMID: 36892048 PMCID: PMC10111535 DOI: 10.1161/jaha.122.027088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/10/2023]
Abstract
Background Mitochondrial abnormalities exist in gastrocnemius muscle of people with peripheral artery disease (PAD). Whether abnormalities in mitochondrial biogenesis and autophagy are associated with greater ischemia or walking impairment in PAD is unknown. Methods and Results Protein markers of mitochondrial biogenesis and autophagy and the abundance of mitochondrial electron transport chain complexes were quantified in gastrocnemius muscle biopsies from people with and without PAD. Their 6-minute walk distance and 4-m gait speed were measured. Sixty-seven participants (mean age 65.0 years [±6.8], 16 [23.9%] women, 48 [71.6%] Black) were enrolled, including 15 with moderate to severe PAD (ankle brachial index [ABI] <0.60), 29 with mild PAD (ABI 0.60-0.90), and 23 without PAD (ABI 1.00-1.40). Abundance of all electron transport chain complexes was significantly higher in participants with lower ABI (eg, complex I: 0.66, 0.45, 0.48 arbitrary units [AU], respectively, P trend=0.043). Lower ABI values were associated with a higher LC3A/B II-to-LC3A/B I (microtubule-associated protein 1A/1B-light chain 3) ratio (2.54, 2.31, 2.15 AU, respectively, P trend=0.017) and reduced abundance of the autophagy receptor p62 (0.71, 0.69, 0.80 AU, respectively, P trend=0.033). The abundance of each electron transport chain complex was positively and significantly associated with 6-minute walk distance and 4-m gait speed at usual and fast pace only among participants without PAD (eg, complex I: r=0.541, P=0.008; r=0.477, P=0.021; r=0.628, P=0.001, respectively). Conclusions These results suggest that accumulation of electron transport chain complexes in gastrocnemius muscle of people with PAD may be because of impaired mitophagy in the setting of ischemia. Findings are descriptive, and further study in larger sample sizes is needed.
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Affiliation(s)
- Anna Picca
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS Rome Italy
- Department of Medicine and Surgery LUM University Casamassima Italy
| | - Stephanie E Wohlgemuth
- Department of Physiology and Aging University of Florida, Institute on Aging Gainesville FL USA
| | - Mary M McDermott
- Department of Preventive Medicine Northwestern University, Feinberg School of Medicine Chicago IL USA
- Department of Medicine Northwestern University, Feinberg School of Medicine Chicago IL USA
| | - Sunil K Saini
- Department of Biophysics All India Institute of Medical Sciences New Delhi India
| | - Sudarshan Dayanidhi
- Departments of Physical Medicine and Rehabilitation, Physical Therapy and Human Movement Science Northwestern University, Feinberg School of Medicine Chicago IL USA
- Shirley Ryan AbilityLab Chicago IL USA
| | - Dongxue Zhang
- Department of Preventive Medicine Northwestern University, Feinberg School of Medicine Chicago IL USA
| | - Shujun Xu
- Department of Preventive Medicine Northwestern University, Feinberg School of Medicine Chicago IL USA
| | - Kate Kosmac
- Department of Epidemiology College of Health Sciences, University of Kentucky Lexington KY USA
| | - Lu Tian
- Department of Health and Policy Stanford University Stanford CA USA
| | - Luigi Ferrucci
- Division of Intramural Research National Institute on Aging Baltimore MD USA
| | - Robert L Sufit
- Department of Medicine Northwestern University, Feinberg School of Medicine Chicago IL USA
| | - Emanuele Marzetti
- Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS Rome Italy
- Department of Geriatrics and Orthopedics Università Cattolica del Sacro Cuore Rome Italy
| | - Christiaan Leeuwenburgh
- Department of Physiology and Aging University of Florida, Institute on Aging Gainesville FL USA
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18
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Kaso ER, Loffler AI, Petroni GR, Meyer C, Walker MR, Carr JC, McDermott MM, Kramer CM. LDL CHOLESTEROL LOWERING WITH PCSK9 INHIBITION AND PLAQUE VOLUME, CALF MUSCLE PERFUSION, AND WALKING PERFORMANCE IN PERIPHERAL ARTERIAL DISEASE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02455-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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19
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Affiliation(s)
- Howard Bauchner
- Boston University School of Medicine, Boston, Massachusetts (H.B.)
| | | | - Atul J Butte
- University of California, San Francisco, San Francisco, California (A.J.B.)
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20
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Thangada N, Xu S, Tian L, Zhao L, McDermott MM. Abstract P626: Associations of Supervised and Home-Based Exercise With Serious Adverse Event Rates During Exercise Interventions for Peripheral Artery Disease: A Meta-Analysis of Five Randomized Clinical Trials. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.p626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
Background:
Supervised or home-based walking exercise therapy (ET) are guideline recommended to improve walking performance in people with peripheral artery disease (PAD). This study compared serious adverse event (SAE) rates associated with home-based compared to supervised exercise in people randomized into clinical trials of ET for PAD.
Methods:
Data from five randomized clinical trials of ET for PAD were combined. In three trials (GOALS, HONOR, and LITE), participants were randomized to home-based ET or control. In two trials (PROPEL and TELEX), participants were randomized to supervised ET or control. The primary outcome in all trials was change in six-minute walk. SAEs consisted of hospitalization or death and were identified from participants, family members, and medical records. In post-hoc analyses, a meta-analysis compared associations of supervised ET and home-based ET on odds of a SAE or death. Control groups from the trials of supervised and home-based ET were not combined.
Results:
867 unique participants were included (mean age + SD: 69 ±10 years, 47% female, 57 % Black, mean + SD ABI 0.66 ±0.15). Results are shown in the Table.
Conclusion:
In clinical trials of home-based ET, rates of coronary revascularizations and cardiovascular events were significantly higher in participants randomized to exercise, compared to control. However, there were no significant differences in rates of coronary revascularizations or cardiovascular events between participants randomized to home-based, compared to supervised ET. Improved walking performance from home-based exercise may precipitate symptoms from underlying coronary artery disease in people with PAD.
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Affiliation(s)
| | - Shujun Xu
- NORTHWESTERN UNIVERSITY, Chicago, IL
| | - Lu Tian
- Stanford Univ, Palo Alto, CA
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21
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McDermott MM. Walking Exercise for Peripheral Artery Disease. JAMA Cardiol 2023; 8:310-311. [PMID: 36753120 DOI: 10.1001/jamacardio.2022.5443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- Mary M McDermott
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
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22
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Guo M, McDermott MM, Dayanidhi S, Leeuwenburgh C, Wohlgemuth S, Ferrucci L, Peterson CA, Kosmac K, Tian L, Zhao L, Sufit R, Ho K, Criqui M, Xu S, Zhang D, Greenland P. Cigarette smoking and mitochondrial dysfunction in peripheral artery disease. Vasc Med 2023; 28:28-35. [PMID: 36567551 DOI: 10.1177/1358863x221143152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND This study evaluated the association of smoking with mitochondrial function in gastrocnemius muscle of people with peripheral artery disease (PAD). METHODS Participants were enrolled from Chicago, Illinois and consented to gastrocnemius biopsy. Mitochondrial oxidative capacity was measured in muscle with respirometry. Abundance of voltage-dependent anion channel (VDAC) (mitochondrial membrane abundance), peroxisome proliferator-activated receptor-γ coactivator (PGC-1α) (mitochondrial biogenesis), and electron transport chain complexes I-V were measured with Western blot. RESULTS Fourteen of 31 people with PAD (age 72.1 years, ABI 0.64) smoked cigarettes currently. Overall, there were no significant differences in mitochondrial oxidative capacity between PAD participants who currently smoked and those not currently smoking (complex I+II-mediated oxidative phosphorylation: 86.6 vs 78.3 pmolO2/s/mg, respectively [p = 0.39]). Among participants with PAD, those who currently smoked had a higher abundance of PGC-1α (p < 0.01), VDAC (p = 0.022), complex I (p = 0.021), and complex III (p = 0.021) proteins compared to those not currently smoking. People with PAD who currently smoked had lower oxidative capacity per VDAC unit (complex I+II-mediated oxidative phosphorylation [137.4 vs 231.8 arbitrary units, p = 0.030]) compared to people with PAD not currently smoking. Among people without PAD, there were no significant differences in any mitochondrial measures between currently smoking (n = 5) and those not currently smoking (n = 63). CONCLUSIONS Among people with PAD, cigarette smoking may stimulate mitochondrial biogenesis to compensate for reduced oxidative capacity per unit of mitochondrial membrane, resulting in no difference in overall mitochondrial oxidative capacity according to current smoking status among people with PAD. However, these results were cross-sectional and a longitudinal study is needed.
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Affiliation(s)
- Michelle Guo
- Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Mary M McDermott
- Department of Medicine, Northwestern University, Chicago, IL, USA.,Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | | | | | - Stephanie Wohlgemuth
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
| | - Luigi Ferrucci
- Division of Intramural Research, National Institute on Aging, Baltimore, MD, USA
| | | | - Kate Kosmac
- Center for Muscle Biology, University of Kentucky, Lexington, KY, USA
| | - Lu Tian
- Department of Health Research and Policy, Stanford University, Stanford, CA, USA
| | - Lihui Zhao
- Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
| | - Robert Sufit
- Department of Neurology, Northwestern University, Chicago, IL, USA
| | - Karen Ho
- Department of Surgery, Northwestern University, Chicago, IL, USA
| | - Michael Criqui
- Departments of Preventive Medicine, Family Medicine, and Public Health, University of California San Diego, San Diego, CA, USA
| | - Shujun Xu
- Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Dongxue Zhang
- Department of Medicine, Northwestern University, Chicago, IL, USA
| | - Philip Greenland
- Department of Medicine, Northwestern University, Chicago, IL, USA.,Department of Preventive Medicine, Northwestern University, Chicago, IL, USA
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23
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Cetlin MD, Polonsky T, Ho K, Zhang D, Tian L, Zhao L, Greenland P, Treat-Jacobson D, Kibbe MR, Criqui MH, Guralnik JM, McDermott MM. Barriers to participation in supervised exercise therapy reported by people with peripheral artery disease. J Vasc Surg 2023; 77:506-514. [PMID: 36150636 DOI: 10.1016/j.jvs.2022.09.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE This study identified barriers to participation in supervised exercise therapy covered by the Centers for Medicare and Medicaid Services (CMS), reported by people with lower extremity peripheral artery disease (PAD). METHODS People with PAD participating in research studies of walking impairment due to PAD in the Chicagoland area were asked to complete a questionnaire between March 15, 2019, and July 12, 2022, assessing their experience and attitudes about supervised exercise therapy. Participants were identified using mailed postcards to people aged 50 and older in Chicagoland, from medical centers in Chicago, and using bus and train advertisements. The questionnaire was developed based on focus group feedback from people with PAD. RESULTS Of 516 participants with PAD approached, 489 (94.8%) completed the questionnaire (mean age: 71.0 years [standard deviation: 8.7], mean ankle-brachial index: 0.71 [standard deviation: 0.25]; 204 [41.7%] women and 261 [53.4%] Black). Of the 489 participants, 416 (85.1%) reported that their physician had never prescribed or recommended supervised exercise therapy. Overall, 357 (73.2%) reported willingness to travel three times weekly to the medical center for supervised exercise participation. However, of these, 214 (59.9%) reported that they were unwilling or unable to pay the $11 per exercise session copay required for supervised exercise covered by CMS. Of 51 people with PAD who reported prior participation in supervised exercise, only 5 (9.8%) completed the 12 weeks of supervised exercise therapy covered by CMS and 29 (56.9%) completed 6 or fewer weeks. Of 131 (26.8%) unwilling to travel three times weekly to a center for supervised exercise, the most common reasons for unwillingness to participate were "too time-consuming" (55.0%), "too inconvenient" (45.8%), and "lack of interest in treadmill exercise" (28.2%). CONCLUSIONS Approximately 2 to 4 years after CMS began covering supervised exercise for PAD, most people with PAD in this study from a large urban area had not participated in supervised exercise therapy. Of those who participated, most completed fewer than half of the sessions covered by CMS. The required CMS copayment was a common barrier to supervised exercise participation by people with PAD.
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Affiliation(s)
| | - Tamar Polonsky
- Department of Medicine, University of Chicago Medical School, Chicago, IL
| | - Karen Ho
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Dongxue Zhang
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lu Tian
- Department of Health Research and Policy, Stanford University, Stanford, CA
| | - Lihui Zhao
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Philip Greenland
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | | | - Melina R Kibbe
- University of Virginia School of Medicine, Charlottesville, VA
| | - Michael H Criqui
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA
| | - Jack M Guralnik
- Department of Epidemiology, University of Maryland, College Park, MD
| | - Mary M McDermott
- Northwestern University Feinberg School of Medicine, Chicago, IL.
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Kosmac K, Ismaeel A, Kim-Shapiro DB, McDermott MM. Praliciguat and Soluble Guanylate Cyclase Stimulators for Peripheral Artery Disease. Circ Res 2023; 132:49-51. [PMID: 36603062 DOI: 10.1161/circresaha.122.322298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Kate Kosmac
- University of Kentucky Center for Muscle Biology, Lexington (K.K., A.I.)
| | - Ahmed Ismaeel
- University of Kentucky Center for Muscle Biology, Lexington (K.K., A.I.)
| | | | - Mary M McDermott
- Department of Medicine and Preventive Medicine, Northwestern University Feinberg School of Medicine (M.M.M.)
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Hammond MM, Tian L, Zhao L, Zhang D, McDermott MM. Attendance at Supervised Exercise Sessions and Walking Outcomes in Peripheral Artery Disease: Results From 2 Randomized Clinical Trials. J Am Heart Assoc 2022; 11:e026136. [PMID: 36533626 PMCID: PMC9798808 DOI: 10.1161/jaha.122.026136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Supervised exercise therapy (SET) is the first-line therapy for walking impairment in peripheral artery disease (PAD). This study evaluated the association between attendance at SET and improved walking performance, compared with a control group, in PAD. Methods and Results Data from 2 randomized clinical trials of SET for PAD were combined. In each trial, participants were randomized to 3 times weekly supervised treadmill exercise or an attention control group for 6 months (maximum, 77 exercise sessions). Participants randomized to SET were categorized into tertiles, according to the proportion of exercise sessions they attended. Results adjusted for age, sex, race, baseline walking performance, comorbidities, and other potential confounders. A total of 272 participants with PAD (mean age, 67.9±9.3 years; 44% women; 61% Black race) were included. For participants randomized to SET, tertiles of attendance rates at exercise sessions were as follows: 11% to 68% (N=45), 69% to <85% (N=46), and ≥85% (N=46). Compared with control, mean improvement in 6-minute walk was significantly greater in each SET tertile: mean (95% CI) for tertile 1, 27.9 m (1.3-54.4 m; P=0.04), tertile 2, 38.2 m (12.2-64.2 m; P=0.001), and tertile 3, 56.9 m (29.9-83.8 m; P<0.0001). Among participants randomized to SET, greater SET attendance was associated with greater improvement in 6-minute walk distance (overall P for trend=0.025). Compared with control, improvement in maximal treadmill walking time was greater in each SET attendance tertile: tertile 1 (3.3 minutes [95% CI, 1.7-4.8 minutes]; P<0.0001), tertile 2 (3.8 minutes [95% CI, 2.3-5.3 minutes]; P<0.0001), and tertile 3 (5.4 minutes [95% CI, 3.9-7.0 minutes]; P:<0.0001). Among participants randomized to SET, greater attendance at SET was not significantly associated with greater improvement in maximal treadmill walking time (overall P for trend=0.064). Conclusions Among people with PAD randomized to SET, better attendance at exercise sessions was associated with significantly greater 6-minute walk improvement. Among all participants with PAD, even relatively low SET attendance was associated with significantly greater improvement in walking performance, compared with a control group who did not exercise. Registration URL: https://clinicaltrials.gov/ct2/show/NCT01408901. URL: https://clinicaltrials.gov/ct2/show/NCT00106327.
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Affiliation(s)
| | - Lu Tian
- Department of Biomedical Data ScienceStanford UniversityPalo AltoCA
| | - Lihui Zhao
- Feinberg School of MedicineNorthwestern UniversityChicagoIL
| | - Dongxue Zhang
- Feinberg School of MedicineNorthwestern UniversityChicagoIL
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Saini SK, Pérez‐Cremades D, Cheng HS, Kosmac K, Peterson CA, Li L, Tian L, Dong G, Wu KK, Bouverat B, Wohlgemuth SE, Ryan T, Sufit RL, Ferrucci L, McDermott MM, Leeuwenburgh C, Feinberg MW. Dysregulated Genes, MicroRNAs, Biological Pathways, and Gastrocnemius Muscle Fiber Types Associated With Progression of Peripheral Artery Disease: A Preliminary Analysis. J Am Heart Assoc 2022; 11:e023085. [PMID: 36300658 PMCID: PMC9673627 DOI: 10.1161/jaha.121.023085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 09/08/2022] [Indexed: 02/01/2023]
Abstract
Background Peripheral artery disease (PAD) is associated with gastrocnemius muscle abnormalities. However, the biological pathways associated with gastrocnemius muscle dysfunction and their associations with progression of PAD are largely unknown. This study characterized differential gene and microRNA (miRNA) expression in gastrocnemius biopsies from people without PAD compared with those with PAD. Participants with PAD included those with and without PAD progression. Methods and Results mRNA and miRNA sequencing were performed to identify differentially expressed genes, differentially expressed miRNAs, mRNA-miRNA interactions, and associated biological pathways for 3 sets of comparisons: (1) PAD progression (n=7) versus non-PAD (n=7); (2) PAD no progression (n=6) versus non-PAD; and (3) PAD progression versus PAD no progression. Immunohistochemistry was performed to determine gastrocnemius muscle fiber types and muscle fiber size. Differentially expressed genes and differentially expressed miRNAs were more abundant in the comparison of PAD progression versus non-PAD compared with PAD with versus without progression. Among the top significant cellular pathways in subjects with PAD progression were muscle contraction or development, transforming growth factor-beta, growth/differentiation factor, and activin signaling, inflammation, cellular senescence, and notch signaling. Subjects with PAD progression had increased frequency of smaller Type 2a gastrocnemius muscle fibers in exploratory analyses. Conclusions Humans with PAD progression exhibited greater differences in the number of gene and miRNA expression, biological pathways, and Type 2a muscle fiber size compared with those without PAD. Fewer differences were observed between people with PAD without progression and control patients without PAD. Further study is needed to confirm whether the identified transcripts may serve as potential biomarkers for diagnosis and progression of PAD.
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Affiliation(s)
- Sunil K. Saini
- All India Institute of Medical Sciences, Department of BiophysicsNew DelhiIndia
| | - Daniel Pérez‐Cremades
- Cardiovascular Division, Department of MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonMA
- Department of PhysiologyUniversity of Valencia and INCLIVA Biomedical Research InstituteValenciaSpain
| | - Henry S. Cheng
- Cardiovascular Division, Department of MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonMA
| | - Kate Kosmac
- Center for Muscle Biology, College of Health SciencesUniversity of KentuckyLexingtonKY
| | - Charlotte A Peterson
- Center for Muscle Biology, College of Health SciencesUniversity of KentuckyLexingtonKY
| | - Lingyu Li
- Department of Preventive Medicine, Northwestern University Feinberg School of MedicineChicagoIL
| | - Lu Tian
- Department of Health Research and Policy, Stanford UniversityStanfordCA
| | - Gengfu Dong
- Department of Applied Physiology & Kinesiology, University of FloridaGainesvilleFL
| | - Kevin K. Wu
- Department of Aging and Geriatric Research, University of Florida, Institute on AgingGainesvilleFL
| | - Brian Bouverat
- Department of Aging and Geriatric Research, University of Florida, Institute on AgingGainesvilleFL
| | - Stephanie E. Wohlgemuth
- Department of Aging and Geriatric Research, University of Florida, Institute on AgingGainesvilleFL
| | - Terence Ryan
- Department of Applied Physiology & Kinesiology, University of FloridaGainesvilleFL
| | - Robert L. Sufit
- Department of Medicine, Northwestern University Feinberg School of MedicineChicagoIL
| | - Luigi Ferrucci
- Division of Intramural Research, National Institute on AgingBaltimoreMD
| | - Mary M. McDermott
- Department of Preventive Medicine, Northwestern University Feinberg School of MedicineChicagoIL
- Department of Medicine, Northwestern University Feinberg School of MedicineChicagoIL
| | - Christiaan Leeuwenburgh
- Department of Aging and Geriatric Research, University of Florida, Institute on AgingGainesvilleFL
| | - Mark W. Feinberg
- Cardiovascular Division, Department of MedicineBrigham and Women’s Hospital and Harvard Medical SchoolBostonMA
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McDermott MM, Bazzano L, Peterson CA, Sufit R, Ferrucci L, Domanchuk K, Zhao L, Polonsky TS, Zhang D, Lloyd-Jones D, Leeuwenburgh C, Guralnik JM, Kibbe MR, Kosmac K, Criqui MH, Tian L. Effect of Telmisartan on Walking Performance in Patients With Lower Extremity Peripheral Artery Disease: The TELEX Randomized Clinical Trial. JAMA 2022; 328:1315-1325. [PMID: 36194220 PMCID: PMC9533188 DOI: 10.1001/jama.2022.16797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 08/31/2022] [Indexed: 02/02/2023]
Abstract
Importance Patients with lower extremity peripheral artery disease (PAD) have reduced lower extremity perfusion, impaired lower extremity skeletal muscle function, and poor walking performance. Telmisartan (an angiotensin receptor blocker) has properties that reverse these abnormalities. Objective To determine whether telmisartan improves 6-minute walk distance, compared with placebo, in patients with lower extremity PAD at 6-month follow-up. Design, Setting, and Participants Double-blind, randomized clinical trial conducted at 2 US sites and involving 114 participants. Enrollment occurred between December 28, 2015, and November 9, 2021. Final follow-up occurred on May 6, 2022. Interventions The trial randomized patients using a 2 × 2 factorial design to compare the effects of telmisartan plus supervised exercise vs telmisartan alone and supervised exercise alone and to compare telmisartan alone vs placebo. Participants with PAD were randomized to 1 of 4 groups: telmisartan plus exercise (n = 30), telmisartan plus attention control (n = 29), placebo plus exercise (n = 28), or placebo plus attention control (n = 27) for 6 months. The originally planned sample size was 240 participants. Due to slower than anticipated enrollment, the primary comparison was changed to the 2 combined telmisartan groups vs the 2 combined placebo groups and the target sample size was changed to 112 participants. Main Outcomes and Measures The primary outcome was the 6-month change in 6-minute walk distance (minimum clinically important difference, 8-20 m). The secondary outcomes were maximal treadmill walking distance; Walking Impairment Questionnaire scores for distance, speed, and stair climbing; and the 36-Item Short-Form Health Survey physical functioning score. The results were adjusted for study site, baseline 6-minute walk distance, randomization to exercise vs attention control, sex, and history of heart failure at baseline. Results Of the 114 randomized patients (mean age, 67.3 [SD, 9.9] years; 46 were women [40.4%]; and 81 were Black individuals [71.1%]), 105 (92%) completed 6-month follow-up. At 6-month follow-up, telmisartan did not significantly improve 6-minute walk distance (from a mean of 341.6 m to 343.0 m; within-group change: 1.32 m) compared with placebo (from a mean of 352.3 m to 364.8 m; within-group change: 12.5 m) and the adjusted between-group difference was -16.8 m (95% CI, -35.9 m to 2.2 m; P = .08). Compared with placebo, telmisartan did not significantly improve any of the 5 secondary outcomes. The most common serious adverse event was hospitalization for PAD (ie, lower extremity revascularization, amputation, or gangrene). Three participants (5.1%) in the telmisartan group and 2 participants (3.6%) in the placebo group were hospitalized for PAD. Conclusions and Relevance Among patients with PAD, telmisartan did not improve 6-minute walk distance at 6-month follow-up compared with placebo. These results do not support telmisartan for improving walking performance in patients with PAD. Trial Registration ClinicalTrials.gov Identifier: NCT02593110.
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Affiliation(s)
- Mary M. McDermott
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | | | - Robert Sufit
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Luigi Ferrucci
- Division of Intramural Research, National Institute on Aging, Bethesda, Maryland
| | - Kathryn Domanchuk
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lihui Zhao
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Tamar S. Polonsky
- Pritzker School of Medicine, University of Chicago, Chicago, Illinois
| | - Dongxue Zhang
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | | | - Jack M. Guralnik
- Department of Epidemiology, University of Maryland, College Park
| | | | | | | | - Lu Tian
- Department of Health Research and Policy, Stanford University, Stanford, California
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Clark CE, Warren FC, Boddy K, McDonagh STJ, Moore SF, Teresa Alzamora M, Ramos Blanes R, Chuang SY, Criqui MH, Dahl M, Engström G, Erbel R, Espeland M, Ferrucci L, Guerchet M, Hattersley A, Lahoz C, McClelland RL, McDermott MM, Price J, Stoffers HE, Wang JG, Westerink J, White J, Cloutier L, Taylor RS, Shore AC, McManus RJ, Aboyans V, Campbell JL. Higher Arm Versus Lower Arm Systolic Blood Pressure and Cardiovascular Outcomes: a Meta-Analysis of Individual Participant Data From the INTERPRESS-IPD Collaboration. Hypertension 2022; 79:2328-2335. [PMID: 35916147 PMCID: PMC9444257 DOI: 10.1161/hypertensionaha.121.18921] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Guidelines recommend measuring blood pressure (BP) in both arms, adopting the higher arm readings for diagnosis and management. Data to support this recommendation are lacking. We evaluated associations of higher and lower arm systolic BPs with diagnostic and treatment thresholds, and prognosis in hypertension, using data from the Inter-arm Blood Pressure Difference—Individual Participant Data Collaboration.
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Affiliation(s)
- Christopher E Clark
- Primary Care Research Group, University of Exeter Medical School, Exeter, Devon, England (C.E.C., F.C.W., S.T.J.M., S.F.M., R.S.T., J.L.C.)
| | - Fiona C Warren
- Primary Care Research Group, University of Exeter Medical School, Exeter, Devon, England (C.E.C., F.C.W., S.T.J.M., S.F.M., R.S.T., J.L.C.)
| | - Kate Boddy
- Patient and Public Involvement Team, PenCLAHRC, University of Exeter Medical School, South Cloisters, Exeter, Devon, England (K.B.)
| | - Sinéad T J McDonagh
- Primary Care Research Group, University of Exeter Medical School, Exeter, Devon, England (C.E.C., F.C.W., S.T.J.M., S.F.M., R.S.T., J.L.C.)
| | - Sarah F Moore
- Primary Care Research Group, University of Exeter Medical School, Exeter, Devon, England (C.E.C., F.C.W., S.T.J.M., S.F.M., R.S.T., J.L.C.)
| | - Maria Teresa Alzamora
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Mataró, Spain (M.T.A.)
| | - Rafel Ramos Blanes
- Unitat de Suport a la Recerca Girona. Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Institut d'Investigació Biomèdica de Girona (IdIBGi), Department of Medical Sciences, School of Medicine, University of Girona, Spain (R.R.B.)
| | - Shao-Yuan Chuang
- Institute of Population Health Sciences, National Health Research Institutes (NHRI), Zhunan, Taiwan, ROC (S.-Y.C.)
| | - Michael H Criqui
- Department of Family Medicine and Public Health, University of California, San Diego, School of Medicine, La Jolla, CA (M.H.C.)
| | - Marie Dahl
- Vascular Research Unit, Department of Vascular Surgery, Viborg Regional Hospital, Denmark and Department of Clinical Medicine, Aarhus University (M.D.)
| | - Gunnar Engström
- Department of Clinical Science in Malmö, Lund University, Sweden (G.E.)
| | - Raimund Erbel
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Germany (R.E.)
| | - Mark Espeland
- Division of Gerontology and Geriatric Medicine, Wake Forest School of Medicine, NC (M.E.)
| | | | - Maëlenn Guerchet
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Faculté de Médecine de l'Université de Limoges - 2 rue du Dr Marcland - 87 025 Limoges Cedex, France (M.G., V.A.)
| | - Andrew Hattersley
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, RILD, Exeter, Devon, England (A.H.)
| | - Carlos Lahoz
- Lípid and Vascular Risk Unit. Internal Medicine Service, Carlos III - La Paz Hospital, Madrid, Spain (C.L.)
| | | | - Mary M McDermott
- Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.)
| | - Jackie Price
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Scotland (J.P.)
| | - Henri E Stoffers
- Department of Family Medicine, CAPHRI Care and Public Health Research Institute, Maastricht University, The Netherlands (H.E.S.)
| | - Ji-Guang Wang
- Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, China (J.-G.W.)
| | - Jan Westerink
- Department of Vascular Medicine, University Medical Center Utrecht, The Netherlands (J.W.)
| | - James White
- DECIPHer, Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff (J.W.)
| | - Lyne Cloutier
- Département des sciences infirmières, Université du Québec à Trois-Rivières, Trois-Rivières, Québec, Canada (L.C.)
| | - Rod S Taylor
- Primary Care Research Group, University of Exeter Medical School, Exeter, Devon, England (C.E.C., F.C.W., S.T.J.M., S.F.M., R.S.T., J.L.C.).,MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow (R.S.T.)
| | - Angela C Shore
- NIHR Exeter Clinical Research Facility, Royal Devon and Exeter Hospital and University of Exeter, England (A.C.S.)
| | - Richard J McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, England (R.J.M.)
| | - Victor Aboyans
- INSERM, Univ. Limoges, CHU Limoges, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Faculté de Médecine de l'Université de Limoges - 2 rue du Dr Marcland - 87 025 Limoges Cedex, France (M.G., V.A.).,Department of Cardiology, Dupuytren University Hospital, and Inserm 1094, Tropical Neuroepidemiology, Limoges, France (V.A.)
| | - John L Campbell
- Primary Care Research Group, University of Exeter Medical School, Exeter, Devon, England (C.E.C., F.C.W., S.T.J.M., S.F.M., R.S.T., J.L.C.)
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Hammond MM, Spring B, Rejeski WJ, Sufit R, Criqui MH, Tian L, Zhao L, Xu S, Kibbe MR, Leeuwenburgh C, Manini T, Forman DE, Treat‐Jacobson D, Polonsky TS, Bazzano L, Ferrucci L, Guralnik J, Lloyd‐Jones DM, McDermott MM. Effects of Walking Exercise at a Pace With Versus Without Ischemic Leg Symptoms on Functional Performance Measures in People With Lower Extremity Peripheral Artery Disease: The LITE Randomized Clinical Trial. J Am Heart Assoc 2022; 11:e025063. [PMID: 35894088 PMCID: PMC9375509 DOI: 10.1161/jaha.121.025063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background In people with peripheral artery disease, post hoc analyses of the LITE (Low Intensity Exercise Intervention in Peripheral Artery Disease) randomized trial were conducted to evaluate the effects of walking exercise at a pace inducing ischemic leg symptoms on walking velocity and the Short Physical Performance Battery, compared with walking exercise without ischemic leg symptoms and compared with a nonexercising control group. Methods and Results Participants with peripheral artery disease were randomized to: home-based walking exercise that induced ischemic leg symptoms; home-based walking exercise conducted without ischemic leg symptoms; or a nonexercising control group for 12 months. Outcomes were change of walking velocity over 4 m and change of the Short Physical Performance Battery (0-12, with 12=best) at 6- and 12-month follow-up. A total of 264 participants (48% women, 61% Black race) were included. Compared with walking exercise without ischemic symptoms, walking exercise that induced ischemic symptoms improved change in usual-paced walking velocity over 4 m at 6-month (0.056 m/s [95% CI, 0.019-0.094 m/s]; P<0.01) and 12-month follow-up (0.084 m/s [95% CI, 0.049-0.120 m/s]; P<0.01), change in fast-paced of walking velocity over 4 m at 6-month follow-up (P=0.03), and change in the Short Physical Performance Battery at 12-month follow-up (0.821 [95% CI, 0.309-1.334]; P<0.01). Compared with control, walking exercise at a pace inducing ischemic symptoms improved change in usual-paced walking velocity over 4 m at 6-month follow-up (0.066 m/s [95% CI, 0.021-0.111 m/s]; P<0.01). Conclusions In people with peripheral artery disease, those who walked for exercise at a comfortable pace without ischemic leg symptoms slowed their walking speed during daily life and worsened the Short Physical Performance Battery score, a potentially harmful effect, compared with people who walked for exercise at a pace inducing ischemic leg symptoms. Compared with a control group who did not exercise, home-based walking exercise at a pace inducing ischemic leg symptoms significantly improved change of walking velocity over 4 m at 6-month follow-up, but this benefit did not persist at 12-month follow-up. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT02538900.
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Affiliation(s)
| | - Bonnie Spring
- Northwestern UniversityFeinberg School of MedicineChicagoIL
| | - W. Jack Rejeski
- Departments of Health and Exercise Science and Geriatric MedicineWake Forest UniversityWinston SalemNC
| | - Robert Sufit
- Northwestern UniversityFeinberg School of MedicineChicagoIL
| | | | - Lu Tian
- Department of Biomedical Data ScienceStanford UniversityPalo AltoCA
| | - Lihui Zhao
- Northwestern UniversityFeinberg School of MedicineChicagoIL
| | - Shujun Xu
- Northwestern UniversityFeinberg School of MedicineChicagoIL
| | | | | | | | - Daniel E. Forman
- University of Pittsburgh, Department of Medicine, Geriatric ResearchEducation, and Clinical CenterPittsburghPA
| | | | | | | | - Luigi Ferrucci
- National Institute on Aging Division of Intramural ResearchBethesdaMD
| | - Jack Guralnik
- Department of EpidemiologyUniversity of MarylandBaltimoreMD
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30
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Agius PA, Cutts JC, Song P, Rudan I, Rudan D, Aboyans V, McDermott MM, Criqui MH, Fowkes FGR, Fowkes FJI. The Global Epidemiological Transition in Cardiovascular Diseases: Unrecognised Impact of Endemic Infections on Peripheral Artery Disease. J Epidemiol Glob Health 2022; 12:219-223. [PMID: 35841531 PMCID: PMC9287714 DOI: 10.1007/s44197-022-00049-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 06/25/2022] [Indexed: 11/10/2022] Open
Abstract
An epidemiological transition in the prevalence of peripheral artery disease (PAD) is taking place especially in low- and middle-income countries (LMICs) where an ageing population and adoption of western lifestyles are associated with an increase in PAD. We discuss the limited evidence which suggests that infection, potentially mediated by inflammation, may be a risk factor for PAD, and show by means of an ecological analysis that country-level prevalence of the major endemic infections of HIV, tuberculosis and malaria are associated with the prevalence of PAD. While further research is required, we propose that scientists and health authorities pay more attention to the interplay between communicable and non-communicable diseases, and we suggest that limiting the occurrence of endemic infections might have some effect on slowing the epidemiological transition in PAD.
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Affiliation(s)
- Paul A Agius
- Burnet Institute, Melbourne, VIC, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Julia C Cutts
- Burnet Institute, Melbourne, VIC, Australia
- Department of Infectious Diseases, at the Peter Doherty Institute for Infection and Immunity, University of Melbourne, Melbourne, VIC, Australia
| | - Peige Song
- Centre for Global Health, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
- Department of Social Medicine, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Igor Rudan
- Centre for Global Health, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Diana Rudan
- Department of Cardiology, University Hospital Dubrava, Zagreb, Croatia
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, and U1094 Inserm & IRD, Limoges, France
| | - Mary M McDermott
- Department of Medicine and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael H Criqui
- Department of Family Medicine and Public Health, University of California San Diego, La Jolla, CA, USA
| | - F Gerald R Fowkes
- Centre for Global Health, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - Freya J I Fowkes
- Burnet Institute, Melbourne, VIC, Australia.
- Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia.
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
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31
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McDermott MM. Home-Based Walking Exercise for Peripheral Artery Disease. JAMA 2022; 327:1339-1340. [PMID: 35412576 DOI: 10.1001/jama.2022.2457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Mary M McDermott
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Deputy Editor, JAMA
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32
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McDermott MM. Exercise therapy for peripheral artery disease in 2022: Progress and a prediction. Vasc Med 2022; 27:113-115. [PMID: 35388719 DOI: 10.1177/1358863x221082702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Mary M McDermott
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Oberdier MT, AlGhatrif M, Adelnia F, Zampino M, Morrell CH, Simonsick E, Fishbein K, Lakatta EG, McDermott MM, Ferrucci L. Ankle-Brachial Index and Energy Production in People Without Peripheral Artery Disease: The BLSA. J Am Heart Assoc 2022; 11:e019014. [PMID: 35253449 PMCID: PMC9075330 DOI: 10.1161/jaha.120.019014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 10/04/2021] [Indexed: 11/16/2022]
Abstract
Background Lower ankle-brachial index (ABI) values within the 0.90 to 1.40 range are associated with poorer mitochondrial oxidative capacity of thigh muscles in cross-sectional analyses. Whether ABI decline is associated with greater declines in thigh muscle oxidative capacity with aging is unknown. Method and Results We analyzed data from 228 participants (100 men) of the BLSA (Baltimore Longitudinal Study of Aging), aged 39 to 97 years, with an ABI between 0.9 and 1.40 at baseline and at follow-up (mean follow-up period of 2.8 years). We examined mitochondrial oxidative capacity of the left thigh muscle, by measuring the postexercise phosphocreatine recovery rate constant (kPCr) from phosphorus-31 magnetic resonance spectroscopy. Greater kPCr indicated higher mitochondrial oxidative capacity. Although kPCr was available on the left leg only, ABI was measured in both legs. Longitudinal rates of change (Change) of left and right ABI and kPCr of the left thigh muscle were estimated using linear mixed effects models, and their association was analyzed by standardized multiple linear regressions. In multivariate analysis including sex, age, baseline kPCr, both left and right baseline ABI, and ABI change in both legs, (kPCr)Change was directly associated with ipsilateral (left) (ABI)Change (standardized [STD]-β=0.14; P=0.0168) but not with contralateral (right) (ABI)Change (P=0.22). Adjusting for traditional cardiovascular risk factors, this association remained significant (STD-β=0.18; P=0.0051). (kPCr)Change was steeper in White race participants (STD-β=0.16; P=0.0122) and body mass index (STD-β=0.13; P=0.0479). There was no significant association with current smoking status (P=0.63), fasting glucose (P=0.28), heart rate (P=0.67), mean blood pressure (P=0.78), and low-density lipoprotein (P=0.75), high-density lipoprotein (P=0.82), or triglycerides (P=0.15). Conclusions In people without peripheral arterial disease, greater decline in ABI over time, but not baseline ABI, was associated with faster decline in thigh mitochondrial oxidative capacity in the ipsilateral leg. Further studies are needed to examine whether early interventions that improve lower extremity muscle perfusion can improve and prevent the decline of muscle energetics.
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Affiliation(s)
- Matt T. Oberdier
- Laboratory of Cardiovascular ScienceNational Institute on AgingBaltimoreMD
- Longitudinal Studies SectionNational Institute on AgingBaltimoreMD
| | - Majd AlGhatrif
- Laboratory of Cardiovascular ScienceNational Institute on AgingBaltimoreMD
- Longitudinal Studies SectionNational Institute on AgingBaltimoreMD
- Department of MedicineJohns Hopkins School of MedicineBaltimoreMD
| | - Fatemeh Adelnia
- Longitudinal Studies SectionNational Institute on AgingBaltimoreMD
| | - Marta Zampino
- Longitudinal Studies SectionNational Institute on AgingBaltimoreMD
| | - Christopher H. Morrell
- Laboratory of Cardiovascular ScienceNational Institute on AgingBaltimoreMD
- Loyola University MarylandBaltimoreMD
| | | | - Kenneth Fishbein
- Laboratory of Clinical InvestigationNational Institute on AgingBaltimoreMD
| | - Edward G. Lakatta
- Laboratory of Cardiovascular ScienceNational Institute on AgingBaltimoreMD
| | - Mary M. McDermott
- Department of MedicineNorthwestern University Feinberg School of MedicineChicagoIL
| | - Luigi Ferrucci
- Longitudinal Studies SectionNational Institute on AgingBaltimoreMD
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Rymer JA, Narcisse D, Cosiano M, Tanaka J, McDermott MM, Treat-Jacobson DJ, Conte MS, Tuttle B, Patel MR, Smolderen KG. Patient-Reported Outcome Measures in Symptomatic, Non-Limb-Threatening Peripheral Artery Disease: A State-of-the-Art Review. Circ Cardiovasc Interv 2021; 15:e011320. [PMID: 34937395 DOI: 10.1161/circinterventions.121.011320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patient-reported outcome measures (PROMs) are health outcomes directly reported by the patient that can be used to measure the effect of disease and treatments on patient perceived well-being. This review summarizes current evidence regarding the validation of PROMs in people with symptomatic, nonlimb-threatening peripheral artery disease. A literature search was conducted to identify studies of symptomatic peripheral artery disease without limb-threatening ischemia that included PROMs and had sample sizes ≥25. PROMs were summarized along a continuum of validation using classical test theory framework and according to whether they fulfilled defined criteria for (1) content validity; (2) psychometric validation; and (3) further validation evidence base expansion. Of 2198 articles identified, 157 (7.1%) met inclusion criteria. Twenty-four PROMs in patients with symptomatic peripheral artery disease were reviewed. Among disease-specific PROMs, 8 of 15 had excellent reliability as measured by a Cronbach alpha ≥0.80. Based on established criteria for PROM responsiveness, 6 of 15 disease-specific PROMs demonstrated excellent sensitivity to change. Of these, the disease-specific peripheral artery questionnaire, vascular quality of life questionnaire, and walking impairment questionnaire met criteria for validation at each stage of the continuum. For generic (nondisease specific) PROMs, the European Quality of Life 5-Dimension and SF-36 had the most extensive evidence of validation. Evidence from this review can inform selection of PROMs aligned with scientific and clinical goals, given the variable degree of validation and potential complementary nature of the measures.
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Affiliation(s)
- Jennifer A Rymer
- Duke University School of Medicine, Durham, NC (J.A.R., D.N., M.C., J.T., M.R.P.)
| | - Dennis Narcisse
- Duke University School of Medicine, Durham, NC (J.A.R., D.N., M.C., J.T., M.R.P.)
| | - Michael Cosiano
- Duke University School of Medicine, Durham, NC (J.A.R., D.N., M.C., J.T., M.R.P.)
| | - John Tanaka
- Duke University School of Medicine, Durham, NC (J.A.R., D.N., M.C., J.T., M.R.P.)
| | - Mary M McDermott
- Northwestern University Feinberg School of Medicine, Chicago, IL (M.M.M.)
| | | | - Michael S Conte
- University of California San Francisco School of Medicine (M.S.C.)
| | - Brandi Tuttle
- Duke University Center Medical Library, Durham, NC (B.T.)
| | - Manesh R Patel
- Duke University School of Medicine, Durham, NC (J.A.R., D.N., M.C., J.T., M.R.P.)
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Hammond MM, Tian L, Zhao L, Zhang D, McDermott MM. One-Year Change in Walking Performance and Subsequent Mobility Loss and Mortality Rates in Peripheral Artery Disease: Longitudinal Data From the WALCS. J Am Heart Assoc 2021; 10:e021917. [PMID: 34913367 PMCID: PMC9075241 DOI: 10.1161/jaha.121.021917] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Associations of 1‐year change in functional performance measures with subsequent mobility loss and mortality in people with lower extremity peripheral artery disease are unknown. Methods and Results Six‐minute walk and 4‐meter walking velocity (usual and fastest pace) were measured at baseline and 1 year later in 612 people with peripheral artery disease (mean age 71±9 years, 37% women). Participants were categorized into tertiles, based on 1‐year changes in walking measures. Cox proportional hazards models were used to examine associations between 1‐year change in each walking measure and subsequent mobility loss and mortality, respectively, adjusting for potential confounders. Compared with the best tertile, the worst tertile (ie, greatest decline) in 1‐year change in each performance measure was associated with higher rates of mobility loss: 6‐minute walk (Tertile 1 [T1] cumulative incidence rate [IR], 72/160; Tertile 3 [T3] IR, 47/160; hazard ratio [HR], 2.35; 95% CI, 1.47–3.74), usual‐paced 4‐meter walking velocity (T1 IR, 54/162; T3 IR, 57/162; HR, 2.21; 95% CI, 1.41–3.47), and fast‐paced 4‐meter walking velocity (T1 IR, 61/162; T3 IR, 58/162; HR, 1.81; 95% CI, 1.16–2.84). Compared with the best tertile, the worst tertiles in 1‐year change in 6‐minute walk (T1 IR, 66/163; T3 IR, 54/163; HR, 1.61; 95% CI, 1.07–2.43) and fast‐paced 4‐meter walking velocity (T1 IR, 63/166; T3 IR, 44/166; HR, 1.75; 95% CI, 1.16, 2.64) were associated with higher mortality. Conclusions In people with peripheral artery disease, greater 1‐year decline in 6‐minute walk or 4‐meter walking velocity may help identify people with peripheral artery disease at highest risk for mobility loss and mortality.
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Affiliation(s)
| | - Lu Tian
- Department of Biomedical Data Science Stanford University Palo Alto CA
| | - Lihui Zhao
- Northwestern UniversityFeinberg School of Medicine Chicago IL
| | - Dongxue Zhang
- Northwestern UniversityFeinberg School of Medicine Chicago IL
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Keshvani N, Willis B, Leonard D, Gao A, DeFina L, McDermott MM, Berry JD, Kumbhani DJ. Midlife Cardiorespiratory Fitness and the Development of Peripheral Artery Disease in Later Life. J Am Heart Assoc 2021; 10:e020841. [PMID: 34854310 PMCID: PMC9075370 DOI: 10.1161/jaha.121.020841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Data are sparse on the prospective associations between physical activity and incidence of lower extremity peripheral artery disease (PAD). Methods and Results Linking participant data from the CCLS (Cooper Center Longitudinal Study) to Medicare claims files, we studied 19 023 participants with objectively measured midlife cardiorespiratory fitness through maximal effort on the Balke protocol who survived to receive Medicare coverage between 1999 and 2009. The study aimed to determine the association between midlife cardiorespiratory fitness and incident PAD with proportional hazards intensity models, adjusted for age, sex, body mass index, and other covariates, to PAD failure time data. During 121 288 person-years of Medicare follow-up, we observed 805 PAD-related hospitalizations/procedures among 19 023 participants (21% women, median age 50 years). Lower midlife fitness was associated with a higher rate of incident PAD in patients aged 65 years and older (low fit [quintile 1]: 11.4, moderate fit [quintile 2 to 3]: 7.8, and high fit [quintile 4 to 5]: 5.7 per 1000 person years). After multivariable adjustment for common predictors of incident PAD such as age, body mass index, hypertension, and diabetes, these findings persisted. Lower risk for PAD per greater metabolic equivalent task of fitness was observed (hazard ratio [HR], 0.93 [95% CI, 0.90-0.97]; P<0.001). Among a subset of patients with an additional fitness assessment, each 1 metabolic equivalent task increase from baseline fitness was associated with decreased risk of incident PAD (HR, 0.90 [95% CI, 0.82-0.99]; P=0.03). Conclusions Cardiorespiratory fitness in healthy, middle-aged adults is associated with lower risk of incident PAD in later life, independent of other predictors of incident PAD.
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Affiliation(s)
- Neil Keshvani
- Division of Cardiology University of Texas Southwestern Medical Center Dallas TX
| | | | | | | | | | | | - Jarett D Berry
- Division of Cardiology University of Texas Southwestern Medical Center Dallas TX
| | - Dharam J Kumbhani
- Division of Cardiology University of Texas Southwestern Medical Center Dallas TX
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Byskosh N, Pamulapati V, Xu S, Vavra AK, Hoel AW, Tian L, McDermott MM, Butt Z, Ho KJ. Identifying Gaps in Disease Knowledge among Patients with Peripheral Artery Disease. J Vasc Surg 2021; 75:1358-1368.e5. [PMID: 34793926 DOI: 10.1016/j.jvs.2021.11.036] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 11/08/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION An individual's understanding of disease risk factors and outcomes is important for the ability to make healthy lifestyle choices and decisions about disease treatment. Peripheral artery disease (PAD) is a condition with increasing global prevalence and high risk of adverse patient outcomes. This study seeks to understand the adequacy of disease understanding in patients with PAD. METHODS This was an observational study of patients with PAD recruited from vascular surgery outpatient clinic and PAD clinical studies at a single academic medical center over an 8-month period. A 44-item paper survey assessed demographic and socioeconomic information, knowledge of personal medical history, PAD risk factors, consequences of PAD, and health education preferences. Patients with documented presence of PAD were offered the survey. Patients unable to complete the survey or provide informed consent were not considered eligible. Disease "awareness" was defined as correct acknowledgement of the presence or absence of a disease, including PAD, in the personal medical history. "PAD knowledge score" was the percentage of correct responses to questions on general PAD risk factors and consequences. Of 126 eligible patients, 109 participated. Bivariate analysis was used to study factors associated with awareness of PAD diagnosis. Factors associated with the PAD knowledge score were studied using the Pearson correlation coefficient, two-sample T-test, or one-way ANOVA. P value < .05 was considered statistically significant. RESULTS Mean participant age was 69.4 ± 11.0 years and 39.4% (N=43) were female. Most participants (78.9%; N=86) had critical limb-threatening ischemia. Only 65.4% (N=70) of participants were aware of a diagnosis of PAD, which was less than their awareness of related comorbidities. Factors positively associated with PAD diagnosis awareness were female sex (81.4% vs. 54.7%; P=.004) and history of percutaneous leg revascularization (78.6% vs. 47.9%; p=.001). Among 17 patients who had undergone major leg amputation, 35% (N=6) were unaware of a diagnosis of PAD. PAD knowledge scores correlated positively with an awareness of PAD diagnosis (59.1% vs. 48.7%; P=.02) and negatively with a history of hypertension (53.4% vs. 68.1%; P=.001). Most participants (86.5%; N=90) expressed a desire to be further educated on PAD. The most popular education topics were dietary recommendations, causes, and treatment for PAD. CONCLUSION Patients with PAD have deficits in their awareness of this diagnosis and general knowledge about PAD. Future research priorities should further define these deficits and their causes in order to inform new strategies that foster information-seeking behavior and effective educational programs for PAD.
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Affiliation(s)
- Nina Byskosh
- Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Vivek Pamulapati
- Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Shujun Xu
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Ashley K Vavra
- Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Andrew W Hoel
- Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Lu Tian
- Department of Health Research and Policy, Stanford University, Stanford, California
| | - Mary M McDermott
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Zeeshan Butt
- Medical Social Sciences, Psychiatry and Behavioral Sciences and Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Karen J Ho
- Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
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Kusumoto FM, Bittl JA, Creager MA, Dauerman HL, Lala A, McDermott MM, Turco JV, Taqueti VR. High-Quality Peer Review of Clinical and Translational Research: A Practical Guide. J Am Coll Cardiol 2021; 78:1564-1568. [PMID: 34620414 DOI: 10.1016/j.jacc.2021.06.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/15/2021] [Accepted: 06/22/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Fred M Kusumoto
- Department of Cardiovascular Disease, Mayo Clinic Alix School of Medicine, Jacksonville, Florida, USA.
| | | | - Mark A Creager
- Heart and Vascular Center, Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
| | - Harold L Dauerman
- Department of Medicine, University of Vermont Medical Center, Burlington, Vermont, USA
| | - Anuradha Lala
- Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Mary M McDermott
- Northwestern University's Feinberg School of Medicine, Chicago, Illinois, USA
| | | | - Viviany R Taqueti
- Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Criqui MH, Matsushita K, Aboyans V, Hess CN, Hicks CW, Kwan TW, McDermott MM, Misra S, Ujueta F. Lower Extremity Peripheral Artery Disease: Contemporary Epidemiology, Management Gaps, and Future Directions: A Scientific Statement From the American Heart Association. Circulation 2021; 144:e171-e191. [PMID: 34315230 PMCID: PMC9847212 DOI: 10.1161/cir.0000000000001005] [Citation(s) in RCA: 212] [Impact Index Per Article: 70.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Lower extremity peripheral artery disease (PAD) affects >230 million adults worldwide and is associated with increased risk of various adverse clinical outcomes (other cardiovascular diseases such as coronary heart disease and stroke and leg outcomes such as amputation). Despite its prevalence and clinical importance, PAD has been historically underappreciated by health care professionals and patients. This underappreciation seems multifactorial (eg, limited availability of the first-line diagnostic test, the ankle-brachial index, in clinics; incorrect perceptions that a leg vascular disease is not fatal and that the diagnosis of PAD would not necessarily change clinical practice). In the past several years, a body of evidence has indicated that these perceptions are incorrect. Several studies have consistently demonstrated that many patients with PAD are not receiving evidence-based therapies. Thus, this scientific statement provides an update for health care professionals regarding contemporary epidemiology (eg, prevalence, temporal trends, risk factors, and complications) of PAD, the present status of diagnosis (physiological tests and imaging modalities), and the major gaps in the management of PAD (eg, medications, exercise therapy, and revascularization). The statement also lists key gaps in research, clinical practice, and implementation related to PAD. Orchestrated efforts among different parties (eg, health care providers, researchers, expert organizations, and health care organizations) will be needed to increase the awareness and understanding of PAD and improve the diagnostic approaches, management, and prognosis of PAD.
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McDermott MM, Zhang D. Effect of Low-Intensity vs High-Intensity Walking Exercise on Walk Distance in Patients With Peripheral Artery Disease-Reply. JAMA 2021; 326:769-770. [PMID: 34427606 DOI: 10.1001/jama.2021.9768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Mary M McDermott
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Dongxue Zhang
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Affiliation(s)
- Rita F Redberg
- Department of Medicine, University of California, San Francisco.,Editor, JAMA Internal Medicine
| | - Mary M McDermott
- Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Deputy Editor, JAMA
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McDermott MM, Dayanidhi S, Kosmac K, Saini S, Slysz J, Leeuwenburgh C, Hartnell L, Sufit R, Ferrucci L. Walking Exercise Therapy Effects on Lower Extremity Skeletal Muscle in Peripheral Artery Disease. Circ Res 2021; 128:1851-1867. [PMID: 34110902 DOI: 10.1161/circresaha.121.318242] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Walking exercise is the most effective noninvasive therapy that improves walking ability in peripheral artery disease (PAD). Biologic mechanisms by which exercise improves walking in PAD are unclear. This review summarizes evidence regarding effects of walking exercise on lower extremity skeletal muscle in PAD. In older people without PAD, aerobic exercise improves mitochondrial activity, muscle mass, capillary density, and insulin sensitivity in skeletal muscle. However, walking exercise increases lower extremity ischemia in people with PAD, and therefore, mechanisms by which this exercise improves walking may differ between people with and without PAD. Compared with people without PAD, gastrocnemius muscle in people with PAD has greater mitochondrial impairment, increased reactive oxygen species, and increased fibrosis. In multiple small trials, walking exercise therapy did not consistently improve mitochondrial activity in people with PAD. In one 12-week randomized trial of people with PAD randomized to supervised exercise or control, supervised treadmill exercise increased treadmill walking time from 9.3 to 15.1 minutes, but simultaneously increased the proportion of angular muscle fibers, consistent with muscle denervation (from 7.6% to 15.6%), while angular myofibers did not change in the control group (from 9.1% to 9.1%). These findings suggest an adaptive response to exercise in PAD that includes denervation and reinnervation, an adaptive process observed in skeletal muscle of people without PAD during aging. Small studies have not shown significant effects of exercise on increased capillary density in lower extremity skeletal muscle of participants with PAD, and there are no data showing that exercise improves microcirculatory delivery of oxygen and nutrients in patients with PAD. However, the effects of supervised exercise on increased plasma nitrite abundance after a treadmill walking test in people with PAD may be associated with improved lower extremity skeletal muscle perfusion and may contribute to improved walking performance in response to exercise in people with PAD. Randomized trials with serial, comprehensive measures of muscle biology, and physiology are needed to clarify mechanisms by which walking exercise interventions improve mobility in PAD.
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Affiliation(s)
- Mary M McDermott
- Department of Medicine and Preventive Medicine (M.M.M., J.S.), Northwestern University Feinberg School of Medicine
| | - Sudarshan Dayanidhi
- Shirley Ryan Ability Laboratory (S.D.), Northwestern University Feinberg School of Medicine
| | - Kate Kosmac
- Center for Muscle Biology, University of Kentucky (K.K.)
| | - Sunil Saini
- Jawaharlal Nehru University, School of Biotechnology, New Delhi, India (S.S.)
| | - Joshua Slysz
- Department of Medicine and Preventive Medicine (M.M.M., J.S.), Northwestern University Feinberg School of Medicine
| | | | - Lisa Hartnell
- Division of Intramural Research, National Institute on Aging (L.H., L.F.)
| | - Robert Sufit
- Department of Neurology (R.S.), Northwestern University Feinberg School of Medicine
| | - Luigi Ferrucci
- Division of Intramural Research, National Institute on Aging (L.H., L.F.)
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Affiliation(s)
- Mark A Creager
- Dartmouth-Hitchcock Medical Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Marc P Bonaca
- University of Colorado School of Medicine; Colorado Prevention Center, Denver, CO, USA
| | | | | | - Heather L Gornik
- University Hospitals Cleveland Medical Center; Case Western Reserve University, Cleveland, OH, USA
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Slysz JT, Tian L, Zhao L, Zhang D, McDermott MM. Effects of supervised exercise therapy on blood pressure and heart rate during exercise, and associations with improved walking performance in peripheral artery disease: Results of a randomized clinical trial. J Vasc Surg 2021; 74:1589-1600.e4. [PMID: 34090987 DOI: 10.1016/j.jvs.2021.05.033] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 05/01/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Supervised exercise therapy (SET) improves walking ability in people with peripheral artery disease (PAD). However, the effects of SET on cardiovascular health in PAD remain unclear. Using data from a randomized clinical trial, this post hoc analyses investigated the effects of a 6-month SET intervention, compared with a control group, on changes in blood pressure (BP) and heart rate (HR) during a graded treadmill exercise test in people with PAD. METHODS We randomized 210 participants with PAD to either SET (3× weekly) or control (1× weekly health lectures) for 6 months. A graded treadmill exercise test, 6-minute walk test, and Walking Impairment Questionnaire were completed at baseline and the 6-month follow-up. BP and HR were measured at the end of each 2-minute stage of the graded treadmill exercise test. Mixed effects regression models compared the overall mean 6-month change in systolic BP, diastolic BP, pulse pressure (PP), and HR during the first 5 stages of the graded treadmill exercise test between groups. RESULTS Of the 210 randomized participants with PAD, 176 (67 ± 9 years; 72 [41%] female, 115 [65%] Black) completed the graded treadmill exercise test at baseline and the 6-month follow-up. Compared with the control group at the 6-month follow-up, SET significantly decreased overall mean systolic BP (-12 mm Hg; P < .001), PP (-9 mm Hg; P < .001), and HR (-7 b/min; P < .01) during a graded treadmill exercise test but not diastolic BP. Among participants randomized to SET, a greater decrease in systolic BP, PP, and HR during a graded treadmill exercise test was significantly associated with a greater improvement in 6-minute walk distance (systolic BP, r = -0.19 [P = .03] and PP, r = -0.23 [P < .01]; and HR, r = -0.21 [P < .01]) and with maximal treadmill walking distance (systolic BP, r = -0.21 [P < .01] and PP, r = -0.17 [P = .03]) at the 6-month follow-up. A greater decrease in the HR during a graded treadmill exercise test was significantly associated with a better WIQ distance score (r = -0.27; P = .03) at the 6-month follow-up. CONCLUSIONS In people with PAD, compared with a control group, SET improved cardiovascular health, measured by changes in BP and HR during exercise. The degree of improvement in cardiovascular health correlated with the degree of improvement in walking performance in people with PAD. NCT: 01408901.
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Affiliation(s)
- Joshua T Slysz
- Deparment of Medicine, Feinberg School of Medicine, Northwestern Univeristy, Chicago
| | - Lu Tian
- Department of Biomedical Data Science, Stanford University, Palo Alto, Calif
| | - Lihui Zhao
- Deparment of Medicine, Feinberg School of Medicine, Northwestern Univeristy, Chicago
| | - Dongxue Zhang
- Deparment of Medicine, Feinberg School of Medicine, Northwestern Univeristy, Chicago
| | - Mary M McDermott
- Deparment of Medicine, Feinberg School of Medicine, Northwestern Univeristy, Chicago.
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McDermott MM, Tian L, Criqui MH, Ferrucci L, Greenland P, Guralnik JM, Kibbe MR, Li L, Sufit R, Zhao L, Polonsky TS. Perceived Versus Objective Change in Walking Ability in Peripheral Artery Disease: Results from 3 Randomized Clinical Trials of Exercise Therapy. J Am Heart Assoc 2021; 10:e017609. [PMID: 34075780 PMCID: PMC8477873 DOI: 10.1161/jaha.120.017609] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background In people with lower‐extremity peripheral artery disease, the effects of exercise on patient‐reported outcomes remain unclear. Methods and Results Four hundred four people with peripheral artery disease in 3 clinical trials were randomized to exercise (N=205) or a control group (N=199) and completed the 6‐minute walk and the Walking Impairment Questionnaire distance score (score 0–100, 100=best) at baseline and 6‐month follow‐up. Compared with the control group, exercise improved 6‐minute walk distance by +39.8 m (95% CI, 26.8–52.8, P<0.001) and the Walking Impairment Questionnaire distance score by +7.3 (95% CI, 2.4–12.1, P=0.003). In all, 2828 individual Walking Impairment Questionnaire distance score questions were completed at baseline and follow‐up. Among participants who perceived no change in ability to walk 1 or more distances between baseline and follow‐up, 6‐minute walk improved in the exercise group and declined in the control group (+26.8 versus −6.5 m, P<0.001). Among participants who perceived that their walking ability worsened for 1 or more distances between baseline and follow‐up, the 6‐minute walk improved in the exercise group and declined in the control group (+18.4 versus –27.3 m, P<0.001). Among participants who reported worsening calf symptoms at follow‐up, the exercise group improved and the control group declined (+28.9 versus −12.5 m, P<0.01). Conclusions In 3 randomized trials, exercise significantly improved the 6‐minute walk distance in people with peripheral artery disease, but many participants randomized to exercise reported no change or decline in walking ability. These findings suggest a significant discrepancy in objectively measured walking improvement relative to perceived walking improvement in people with peripheral artery disease. Registration Information clinicaltrials.gov. Identifiers: NCT 00106327, NCT 01408901.
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Affiliation(s)
- Mary M McDermott
- Department of Medicine Northwestern University Feinberg School of Medicine Chicago IL.,Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Lu Tian
- Biomedical Science Data Stanford University Palo Alto CA
| | - Michael H Criqui
- Department of Family Medicine and Public Health University of California La Jolla CA
| | - Luigi Ferrucci
- Division of Intramural Research National Institute on Aging Baltimore MD
| | - Philip Greenland
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Jack M Guralnik
- Department of Epidemiology University of Maryland Baltimore MD
| | - Melina R Kibbe
- Department of Surgery Division of Vascular and Endovascular Surgery University of North Carolina Chapel Hill NC
| | - Lingyu Li
- Department of Medicine Northwestern University Feinberg School of Medicine Chicago IL
| | - Robert Sufit
- Department of Neurology Northwestern University Feinberg School of Medicine Chicago IL
| | - Lihui Zhao
- Department of Preventive Medicine Northwestern University Feinberg School of Medicine Chicago IL
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Abstract
IMPORTANCE Lower extremity peripheral artery disease (PAD) affects approximately 8.5 million people in the US and approximately 230 million worldwide. OBSERVATIONS Peripheral artery disease is uncommon before aged 50 years but affects up to 20% of people aged 80 years and older. It can be noninvasively diagnosed with the ankle-brachial index (ABI), a ratio of Doppler-recorded pressures in the dorsalis pedis and/or posterior tibial artery in each leg to brachial artery pressures. An ABI value less than 0.90 is 57% to 79% sensitive and 83% to 99% specific for arterial stenosis of at least 50%. Intermittent claudication, consisting of exertional calf pain that does not begin at rest and that resolves within 10 minutes of rest, is considered the classic symptom of PAD. However, 70% to 90% of people with an ABI value less than 0.90 either report no exertional leg symptoms (ie, asymptomatic) or report leg symptoms with walking that are not consistent with classic claudication. Over time, people with PAD restrict walking activity or slow walking speed to avoid leg symptoms. Thus, although approximately 75% of people with PAD report no change in leg symptoms over time, those with PAD have significantly greater annual declines in 6-minute walk performance compared with those without it. Approximately 11% of people with PAD develop chronic limb-threatening ischemia, the most severe form of PAD. Compared with people without PAD, those with the disease have approximately twice the rate of all-cause mortality, cardiovascular mortality, and major coronary events at 10-year follow-up. High-dose statins and antiplatelet therapy with or without antithrombotic therapy reduced rates of coronary events and stroke in people with PAD. Supervised treadmill exercise improved 6-minute walk distance by 30 to 35 m, consistent with a clinically meaningful change, whereas effective home-based walking exercise interventions improved 6-minute walk by 42 to 53 m. Effective home-based exercise programs require behavioral methods, including monitoring by a coach. CONCLUSIONS AND RELEVANCE Peripheral artery disease affects approximately 230 million people worldwide and is associated with increased rates of cardiovascular events, lower extremity events, and functional decline compared with that of people without PAD. People with PAD should be treated with the highest dose of statin tolerated, antithrombotic and/or antiplatelet therapy, and exercise.
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Affiliation(s)
- Tamar S Polonsky
- Department of Medicine, University of Chicago Medicine, Chicago, Illinois
| | - Mary M McDermott
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Deputy Editor, JAMA
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Affiliation(s)
- Mary M McDermott
- Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Deputy Editor, JAMA
| | - Anne B Newman
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
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Slysz JT, Rejeski WJ, Treat-Jacobson D, Bazzano LA, Forman DE, Manini TM, Criqui MH, Tian L, Zhao L, Zhang D, Guralnik JM, Ferrucci L, Kibbe MR, Polonsky TS, Spring B, Sufit R, Leeuwenburgh C, McDermott MM. Sustained physical activity in peripheral artery disease: Associations with disease severity, functional performance, health-related quality of life, and subsequent serious adverse events in the LITE randomized clinical trial. Vasc Med 2021; 26:497-506. [PMID: 33829920 DOI: 10.1177/1358863x21989430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study investigated cross-sectional associations of peripheral artery disease (PAD) severity (defined by the ankle-brachial index (ABI)) and amounts of daily sustained physical activity (PA) (defined as > 100 activity counts per minute lasting 5 consecutive minutes or more). This study also investigated associations of amounts of daily sustained PA with 6-minute walk (6MW) distance and the Short Form-36 physical functioning domain (SF-36 PF) score in cross-sectional analyses and with serious adverse events (SAEs) in longitudinal analyses of people with PAD. PA was measured continuously for 10 days using a tri-axial accelerometer at baseline in 277 participants with PAD randomized to the LITE clinical trial. In regression analyses, each 0.15 lower ABI value was associated with a 5.67% decrease in the number of daily bouts of sustained PA (95% CI: 3.85-6.54; p < 0.001). Every additional bout of sustained PA per day was associated with a 4.56-meter greater 6MW distance (95% CI: 2.67-6.46; p < 0.0001), and a 0.81-point improvement in SF-36 PF score (95% CI: 0.34-1.28; p < 0.001). Participants with values of daily bouts of sustained PA below the median had higher rates of SAEs during follow-up, compared to participants above the median (41% vs 24%; p = 0.002). In conclusion, among participants with PAD, lower ABI values were associated with fewer bouts of daily sustained PA. A greater number of bouts of daily sustained PA were associated with better 6MW performance and SF-36 PF score, and, in longitudinal analyses, lower rates of SAEs. Clinicaltrials.gov ID: NCT02538900.
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Affiliation(s)
- Joshua T Slysz
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - W Jack Rejeski
- Department of Health and Exercise Science and Geriatric Medicine, Wake Forest University, Winston Salem, NC, USA
| | | | - Lydia A Bazzano
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Daniel E Forman
- School of Medicine, University of Pittsburgh, Pittsburg, PA, USA
| | - Todd M Manini
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
| | - Michael H Criqui
- Department of Family Medicine and Public Health, University of California at San Diego, San Diego, CA, USA
| | - Lu Tian
- Department of Biomedical Data Science, Stanford University, Palo Alto, CA, USA
| | - Lihui Zhao
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Dongxue Zhang
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Jack M Guralnik
- Department of Epidemiology, University of Maryland, Baltimore, MD, USA
| | - Luigi Ferrucci
- National Institute of Aging, The Intramural Research Program, Baltimore, MD, USA
| | - Melina R Kibbe
- Department of Surgery, University of North Carolina, Chapel Hill, NC, USA
| | | | - Bonnie Spring
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Robert Sufit
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Mary M McDermott
- Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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McDermott MM, Spring B, Tian L, Treat-Jacobson D, Ferrucci L, Lloyd-Jones D, Zhao L, Polonsky T, Kibbe MR, Bazzano L, Guralnik JM, Forman DE, Rego A, Zhang D, Domanchuk K, Leeuwenburgh C, Sufit R, Smith B, Manini T, Criqui MH, Rejeski WJ. Effect of Low-Intensity vs High-Intensity Home-Based Walking Exercise on Walk Distance in Patients With Peripheral Artery Disease: The LITE Randomized Clinical Trial. JAMA 2021; 325:1266-1276. [PMID: 33821898 PMCID: PMC8025122 DOI: 10.1001/jama.2021.2536] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Supervised high-intensity walking exercise that induces ischemic leg symptoms is the first-line therapy for people with lower-extremity peripheral artery disease (PAD), but adherence is poor. OBJECTIVE To determine whether low-intensity home-based walking exercise at a comfortable pace significantly improves walking ability in people with PAD vs high-intensity home-based walking exercise that induces ischemic leg symptoms and vs a nonexercise control. DESIGN, SETTING, AND PARTICIPANTS Multicenter randomized clinical trial conducted at 4 US centers and including 305 participants. Enrollment occurred between September 25, 2015, and December 11, 2019; final follow-up was October 7, 2020. INTERVENTIONS Participants with PAD were randomized to low-intensity walking exercise (n = 116), high-intensity walking exercise (n = 124), or nonexercise control (n = 65) for 12 months. Both exercise groups were asked to walk for exercise in an unsupervised setting 5 times per week for up to 50 minutes per session wearing an accelerometer to document exercise intensity and time. The low-intensity group walked at a pace without ischemic leg symptoms. The high-intensity group walked at a pace eliciting moderate to severe ischemic leg symptoms. Accelerometer data were viewable to a coach who telephoned participants weekly for 12 months and helped them adhere to their prescribed exercise. The nonexercise control group received weekly educational telephone calls for 12 months. MAIN OUTCOMES AND MEASURES The primary outcome was mean change in 6-minute walk distance at 12 months (minimum clinically important difference, 8-20 m). RESULTS Among 305 randomized patients (mean age, 69.3 [SD, 9.5] years, 146 [47.9%] women, 181 [59.3%] Black patients), 250 (82%) completed 12-month follow-up. The 6-minute walk distance changed from 332.1 m at baseline to 327.5 m at 12-month follow-up in the low-intensity exercise group (within-group mean change, -6.4 m [95% CI, -21.5 to 8.8 m]; P = .34) and from 338.1 m to 371.2 m in the high-intensity exercise group (within-group mean change, 34.5 m [95% CI, 20.1 to 48.9 m]; P < .001) and the mean change for the between-group comparison was -40.9 m (97.5% CI, -61.7 to -20.0 m; P < .001). The 6-minute walk distance changed from 328.1 m at baseline to 317.5 m at 12-month follow-up in the nonexercise control group (within-group mean change, -15.1 m [95% CI, -35.8 to 5.7 m]; P = .10), which was not significantly different from the change in the low-intensity exercise group (between-group mean change, 8.7 m [97.5% CI, -17.0 to 34.4 m]; P = .44). Of 184 serious adverse events, the event rate per participant was 0.64 in the low-intensity group, 0.65 in the high-intensity group, and 0.46 in the nonexercise control group. One serious adverse event in each exercise group was related to study participation. CONCLUSIONS AND RELEVANCE Among patients with PAD, low-intensity home-based exercise was significantly less effective than high-intensity home-based exercise and was not significantly different from the nonexercise control for improving 6-minute walk distance. These results do not support the use of low-intensity home-based walking exercise for improving objectively measured walking performance in patients with PAD. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02538900.
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Affiliation(s)
- Mary M. McDermott
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Bonnie Spring
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Lu Tian
- Department of Health Research and Policy, Stanford University, Stanford, California
| | | | - Luigi Ferrucci
- Division of Intramural Research, National Institute on Aging, Bethesda, Maryland
| | | | - Lihui Zhao
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Tamar Polonsky
- Department of Medicine, Medical School, University of Chicago, Chicago, Illinois
| | - Melina R. Kibbe
- Department of Surgery, School of Medicine, University of North Carolina, Chapel Hill
| | | | - Jack M. Guralnik
- Department of Epidemiology, University of Maryland, College Park
| | | | - Al Rego
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Dongxue Zhang
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Kathryn Domanchuk
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | - Robert Sufit
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Brittany Smith
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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50
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Beavers DP, Kritchevsky SB, Gill TM, Ambrosius WT, Anton SD, Fielding RA, King AC, Rejeski WJ, Lovato L, McDermott MM, Newman AB, Pahor M, Walkup MP, Tracy RP, Manini TM. Elevated IL-6 and CRP levels are associated with incident self-reported major mobility disability: A pooled analysis of older adults with slow gait speed. J Gerontol A Biol Sci Med Sci 2021; 76:2293-2299. [PMID: 33822946 DOI: 10.1093/gerona/glab093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Elevated Interleukine-6 (IL-6) and C-reactive protein (CRP) are associated with aging-related reductions in physical function, but little is known about their independent and combined relationships with major mobility disability (MMD), defined as the self-reported inability to walk a quarter-mile. METHODS We estimated the absolute and relative effect of elevated baseline IL-6, CRP, and their combination on self-reported MMD risk among older adults (≥68 years; 59% female) with slow gait speed (<1.0m/s). Participants were MMD-free at baseline. IL-6 and CRP were assessed using a central laboratory. The study combined a cohort of community dwelling high-functioning older adults (Health ABC) with two trials of low-functioning adults at risk of MMD (LIFE-P, LIFE). Analyses utilized Poisson regression for absolute MMD incidence and proportional hazards models for relative risk. RESULTS We found higher MMD risk per unit increase in log IL-6 [HR=1.26 (95% CI 1.13 to 1.41)]. IL-6 meeting pre-determined threshold considered to be high (>2.5 pg/mL) was similarly associated with higher risk of MMD [HR=1.31 (95% CI: 1.12 to 1.54)]. Elevated CRP (CRP >3.0 mg/L) was also associated with increased MMD risk [HR=1.38 (95% CI: 1.10 to 1.74)]. The CRP effect was more pronounced among participants with elevated IL-6 [HR=1.62 (95% CI: 1.12 to 2.33)] compared to lower IL-6 levels [HR=1.19 (95% CI: 0.85 to 1.66)]. CONCLUSIONS High baseline IL-6 and CRP were associated with increased risk of MMD among older adults with slow gait speed. A combined biomarker model suggests CRP was associated with MMD when IL-6 was elevated.
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Affiliation(s)
- Daniel P Beavers
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Thomas M Gill
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | | | | | - Abby C King
- Departments of Epidemiology & Population Health and of Medicine (Stanford Prevention Research Center), Stanford University School of Medicine, California, USA
| | - W Jack Rejeski
- Wake Forest University, Winston-Salem, North California, USA
| | - Laura Lovato
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | | | | | - Michael P Walkup
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
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