Analysis of the Characteristics of Peripheral Artery Disease in Patients with Hemiplegia After Ischemic Stroke and Their Mid- and Long-Term Outcomes.

Peripheral Arterial Disease, Stroke, and Mortality in Patients with Atrial Fibrillation

Positive correlation of serum indoxyl sulfate level with peripheral arterial disease in hemodialysis patients.

BACKGROUND AND AIMS Antibodies to oxidized LDL (anti-oxLDL antibodies) were found to indicate protection from coronary artery disease and possibly major adverse cardiovascular and cerebral events. Peripheral arterial disease (PAD), defined by a low ankle-brachial index (ABI), is associated with increased mortality in patients on peritoneal dialysis (PD). The present study aimed to determine the relationship between serum IgG anti-oxLDL antibodies level and PAD in PD patients. METHOD The present cross-sectional, a single-center study included 90 PD patients. Serum IgG anti-oxLDL antibody levels were determined by available enzyme-linked immunosorbent assays. ABI values were measured using an automated oscillometric device. Patients with ABIs of < 0.9 were categorized into the low ABI group. RESULTS In the study cohort, 23 of the 90 patients (25.6%) had low ABIs. The rates of diabetes mellitus (P = 0.010), older age (P = 0.006) as well as the serum levels of fasting glucose (P < 0.001), triglyceride (P = 0.008) and C-reactive protein (P < 0.001) were higher, while IgG anti-oxLDL antibodies (p < 0.001) were lower in the low ABI group compared with the normal ABI group. The multivariable logistic regression analysis revealed that serum levels of IgG anti-oxLDL antibodies [odds ratio (OR) 0.978, 95% confidence interval (95% CI) 0.958–1.000; P = .046) and C-reactive protein (each 0.1 mg/dL increase, OR 1.662, 95% CI 1.151–2.398; P = 0.007) were independently associated with PAD in PD patients. The area under the curve plotted to estimate the optimal level of IgG anti-oxLDL antibodies predicting PAD in PD patients by the receiver-operating characteristic curve analysis was 0.687 (95% CI 0.580–0.780; P = 0.0022). CONCLUSION Lower serum IgG anti-oxLDL antibodies together with higher C-reactive protein were associated with PAD in PD patients.

Subclinical peripheral arterial disease in patients with chronic kidney disease: Prevalence and related risk factors

BackgroundThe measurement of the ankle-brachial pressure index is a straightforward method for the detection of peripheral disease in the lower limbs. Only a few old studies with small numbers of patients have been conducted comparing the gold standard, ankle-brachial pressure index measurement, with strain gauge plethysmography and reactive hyperaemia for detecting peripheral arterial disease. The purpose of this study was to evaluate the feasibility and accuracy of strain gauge plethysmography values compared with the Doppler ultrasound method, ankle-brachial pressure index, in the assessment of peripheral arterial disease, especially in patients with severe aortic stenosis.Methods221 ankle-brachial pressure index measurements and strain gauge plethysmography measurements of patients with suspected peripheral arterial disease, diagnosed peripheral arterial disease with or without aortic stenosis were compared.ResultsIrrespective of aortic stenosis in patients with and without peripheral arterial disease, the resting arterial blood flow was within the normal range. In patients with aortic stenosis, the time-to-peak flow couldn’t detect peripheral arterial disease and was found to be a false negative. In patients without aortic stenosis, time-to-peak flow correlated well with the ankle-brachial pressure index for detecting peripheral arterial disease. Peak flow at 5 seconds was the one of the flow values that correlated with ankle-brachial pressure index and detected peripheral arterial disease in patients with and without aortic stenosis.ConclusionPeak flow at 5 seconds is one of flow value that correlated well with ankle-brachial pressure index in detecting peripheral arterial disease in patients with and without aortic stenosis. Detection of peripheral arterial disease in patients with severe aortic stenosis seems to be less sensitive with flow measurements than with ankle-brachial pressure index.

We assessed the association between high ankle-brachial index (ABI) and cardiovascular disease (CVD) and peripheral arterial disease (PAD) in Chinese patients with type 2 diabetes mellitus (T2DM). The ABI was measured, and foot inspection was performed in 2080 outpatients with T2DM. The clinical characters in different ABI levels were analyzed, and the diagnostic value of high ABI to CVD and PAD was determined. Compared with the normal ABI group, the high ABI (>1.3) group had a higher prevalence of CVD and PAD but less than the low ABI (≤0.9) group. High ABI was an independent risk factor for the development of CVD and PAD. Receiver-operating characteristic curve analysis showed that the optimal cutoff of high ABI to predict CVD and PAD was 1.43 and 1.45, respectively. The odds ratio of high ABI for CVD and PAD was 2.25 and 6.97, respectively, after adjusting for other confounding risk factors. In conclusion, high ABI indicated the risk of CVD and PAD in Chinese populations with T2DM.

Background: Coronary artery disease (CAD) is a leading cause of morbidity and mortality worldwide, accounting for 7.4 million of 17.9 million annual cardiovascular deaths. Acute coronary syndrome (ACS) is a symptomatic subset of CAD often associated with myocardial infarction, and includes ST-elevation (STEMI) and non-ST-elevation myocardial infarction (NSTEMI). Atherosclerosis is a systemic process; hence peripheral arterial disease (PAD) frequently coexists with CAD as a manifestation of diffuse atherosclerosis. Many CAD patients have coexistent PAD that is asymptomatic and underdiagnosed . Early identification of PAD in ACS patients is important for secondary prevention and risk stratification, but the local frequency of PAD in ACS is not well established. Objective: To determine the frequency of PAD in patients with CAD presenting with ACS to a tertiary care hospital, using ankle-brachial index (ABI) screening, and to analyze associations with patient demographics. Methodology: A cross-sectional study was conducted at the Cardiology Department of a Lady Reading Hospital Peshawar Pakistan. Over a 6-month period from May–Nov 2024, 159 patients aged 40–70 years with ACS (STEMI or NSTEMI confirmed by clinical, ECG and biomarker criteria) were enrolled by consecutive sampling. Patients with previously known PAD, limb deformity, edema, or incompressible arteries (ABI >1.3) were excluded. Demographic data (age, gender, body mass index [BMI], and CAD duration) were recorded. PAD was assessed by measuring ABI using an automated device after 15 minutes of supine rest; PAD was defined as ABI <0.90 in either leg (without prior PAD history). Frequency of PAD was calculated. Patients were stratified by age, gender, BMI, and CAD duration to evaluate effect modifiers; comparisons used chi-square tests with p ≤ 0.05 as significant. Results: Of the 159 ACS patients (mean age 56.8 ± 9.5 years, 78% male), PAD (ABI <0.9) was detected in 11 patients, yielding a PAD frequency of 6.9% (95% confidence interval ~3.0–10.8%). Among those with PAD, 4 (36%) reported intermittent claudication symptoms, while 7 (64%) were asymptomatic (incidentally identified via ABI). Patients with PAD were older on average than those without PAD (mean age 62 vs 55 years, p = 0.03). In patients aged ≥60 years, PAD prevalence was 20.5%, significantly higher than in those <60 years (2.7%, p < 0.001). PAD frequency was slightly higher in males (7.2%) than females (5.9%), but this difference was not statistically significant (p = 0.75). No significant associations were found between PAD presence and BMI or duration of known CAD (p > 0.05 for both). Conclusion: In this cohort of ACS patients, about 7% had coexisting PAD as determined by ABI screening. This relatively sizable minority underscores the importance of routine PAD screening in ACS patients. Early detection of PAD allows for more comprehensive cardiovascular risk management. Our findings, in line with regional data showing ~7–8% PAD prevalence in CAD, highlight that even asymptomatic PAD is prevalent in ACS and merits attention to improve secondary prevention and outcomes.

To investigate the association between serum 25-hydroxyvitamin D (25(OH)D) level and peripheral arterial disease (PAD) in patients with type 2 diabetes mellitus (T2DM). This retrospective study analyzed data from 752 T2DM patients treated at Shaoyang Central Hospital between September 2020 and September 2023. Patients were divided into two groups: those with T2DM alone and those with T2DM and PAD. We compared demographic data, biochemical indices, and ankle-brachial index (ABI) values. Pearson correlation and multivariate logistic regression with a forward likelihood ratio method assessed the relationship and risk factors. The predictive value of serum 25(OH)D levels for PAD was evaluated using receiver operating characteristic (ROC) analysis. The T2DM+PAD group was older and had a longer duration of diabetes compared to the T2DM group. This group also had lower BMI, diastolic blood pressure, and ABI values, but higher levels of low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) (all P<0.05). Serum 25(OH)D levels were significantly lower in the T2DM+PAD group (P<0.05). ABI negatively correlated with age, diabetes duration, LDL-C, and TC, and positively with BMI and 25(OH)D levels (all P<0.05). Older age, lower BMI, higher LDL-C, and lower 25(OH)D levels were independent risk factors for PAD (ORs: 1.060, 0.781, 1.083, and 0.959, respectively; all P<0.05). The risk of PAD was significantly higher in the 25(OH)D deficiency group (P<0.05). The AUC for serum 25(OH)D in predicting PAD occurrence was 0.629. Lower serum 25(OH)D levels are associated with higher risk of PAD in patients with T2DM. Early identification and management of 25(OH)D deficiency may be crucial for preventing PAD in this population.

The Prevalence, Clinical Characteristics, and Functional Significance of Ankle Brachial Index Defined Peripheral Arterial Disease in Patients with Heart Failure

Aim. The presence of peripheral arterial disease (PAD) in patients with other manifestations of cardiovascular disease identifies a population at increased risk of complications both during acute coronary events and on a long-term basis and possibly a population in whom secondary prevention of cardiovascular events should be addressed aggressively. The present study was aimed at providing a valid estimate on the prevalence of PAD in patients attending their general practitioner and having previously suffered a cardio- or cerebrovascular event. Patients and methods. 1000 patients with a previous cardiovascular event were screened and PAD was considered present when the ankle–brachial index (ABI) of systolic blood pressure was less than 0.90 using the current recommended technique. Results. 965 (659 men) patients met the inclusion criteria and had detectable systolic blood pressures on the arms and ankles. Mean age was 70±8 years, 77% were current or previous smokers, and 188 patients were diabetics. The medical history included stroke in 392, transitory ischemic attacks in 77, acute coronary syndrome in 298, and ST-elevation myocardial infarction in 253. Brachial systolic and diastolic blood pressures were 139±18 mmHg and 79±12 mmHg, respectively. Total and LDL-cholesterols were 4.5±1.0 mmol/l and 2.4±0.8 mmol/l, respectively. 625 patients were without PAD, 322 had mild to moderate PAD and 18 had severe PAD. The overall prevalence of PAD was 35.3%. Conclusion. In patients with previous coronary or cerebrovascular events, PAD occurs with a much higher prevalence than previously estimated. It is suggested that screening for PAD is justified and that it should be carried out in these patients in order to regulate the possible lifestyle and medical intervention.

Introduction: Hypertension is one of the leading causes of global burden of disease. In a study, prevalence of hypertension in India was quoted 13.1% and only 16.7% of the person had achieved BP control of 140/90mm Hg. Peripheral vascular disease (PVD) is a slow and progressive circulation disorder which is characterized by narrowing of the vessels that carry blood to the leg and arm muscles. It is estimated that PAD affects 2 billion people worldwide. It is also estimated that of all the hypertensives at presentation, 2-5% have claudication. Similarly 50-92% of patients with PAD have hypertension. The Ankle-brachial Index (ABI) is the ratio of the systolic blood pressures between the dorsalis pedis and the posterior tibial artery to the higher of the systolic blood pressures in the two brachial arteries. The ABI’s sensitivity is 90% and its specificity is 98%. Normal ABI range of 1.00 to 1.40.The patient is diagnosed with PAD when the ABI is ? 0.90, ABI Acts as an independent predictor of coronary and cardiovascular morbidity and mortality.Materials and methods: In this study 100 patients were registered who were suffering from hypertension, which include both indoor and outdoor patients, were studied. These patients were between the age group 45-75 years. In this study 82 were males and 18 were females. .Patients with history of Diabetes, Smoking, Hyperlipidemia, and with other risk factors excluding hypertension were excluded from the study. Ankle Brachial Index (ABI) was measured for the patients. A Doppler ultrasound blood flow detector and a sphygmomanometer (blood pressure cuff) was used to measure ABI. The patient is diagnosed with PAD when the ABI is ? 0.90Observation: Total number of patients 100. Prevalence rate of peripheral arterial disease in hypertensive patients with age group (45-75) was 7%. The highest prevalence rate was seen in patients in age group 65-75 years. Males had slightly higher prevalence of peripheral arterial disease than females. Prevalence of ECG abnormalities suggesting cardiovascular disease was higher in patients with peripheral arterial disease than patients without peripheral arterial disease. Abnormal ABI (&lt;0.9) was found in significantly higher proportion of patients with clinical evidence of peripheral arterial disease (86%) than in patients without clinical evidence of peripheral arterial disease (1.1%).Conclusion: The present study shows that ABI is a valuable method for the diagnosis of peripheral arterial disease in patients of Hypertension and should be applied in routine practices which may improve cardiovascular risk predictionBangladesh Journal of Medical Science Vol.15(4) 2016 p.556-564

BackgroundThe ankle-brachial index measurement is used for screening and diagnosis of lower-extremity peripheral artery disease and cardiovascular risk assessment. However, the value is occasionally unreliable since the oscillometric ankle-brachial index can be elevated and falsely normalized despite the presence of lower-extremity peripheral artery disease because of the incompressibility of infrapopliteal arteries at the ankle, potentially leading to a missed diagnosis of lower-extremity peripheral artery disease or underestimation of cardiovascular risk.Case presentationWe report two cases of lower extremity peripheral artery disease with normal ankle-brachial index (a 76-year-old Asian man and a 66-year-old Asian man). In both cases, the ankle-brachial index was within the normal range (1.00–1.40) despite the presence of lower-extremity peripheral artery disease, whereas upstroke time at the ankle calculated from the pulse volume waveform simultaneously obtained by plethysmography during the ankle-brachial index measurement was prolonged (≥ 180 milliseconds). Diagnostic imaging tests revealed the presence of occlusive arterial disease in the lower extremity and severe calcification of infrapopliteal arteries.ConclusionsIn both cases, the oscillometric ankle-brachial index might have been falsely normalized despite the presence of lower-extremity peripheral artery disease because of calcified incompressible infrapopliteal arteries. Sole reliance on the ankle-brachial index value may lead to a missed diagnosis of lower-extremity peripheral artery disease or underestimation of cardiovascular risk. Upstroke time at the ankle was helpful for suspecting the presence of lower-extremity peripheral artery disease in both patients with normal ankle-brachial index. In addition to history-taking and vascular examination, upstroke time at the ankle should be carefully checked for accurate diagnosis of peripheral artery disease and cardiovascular risk assessment in patients with normal ankle-brachial index.

PurposeHigh glucose concentrations and swings are associated with endothelial dysfunction. We examined the effects of variability in fasting plasma glucose on peripheral artery disease (PAD) in patients with diabetes mellitus (DM).Patients and MethodsIn this screening study for the risk factors of PAD, we retrospectively collected data on the ankle-brachial index (ABI) and the percentage of mean arterial pressure (%MAP) at the ankle between August 01, 2016 and July 31, 2017. We defined low ABI ≤0.90, high %MAP ≥45%, or both as high-risk PAD and others as low-risk PAD. We compared the standard deviation (SD) of the first fasting plasma glucose data available each year after January 01, 2007.ResultsIn 2577 patients, a higher SD of annual fasting glucose was observed in those with an ABI ≤0.90 than in patients with an ABI >0.90 (2.6 ± 2.1 vs 2.2 ± 2.3, P = 0.009), and in patients with %MAP ≥45% than in those with %MAP <45% (2.4 ± 2.1 vs 2.2 ± 2.3, P = 0.034). A high-risk PAD was significantly associated with the SD (P = 0.032) but not with the mean (P = 0.338) of annual fasting glucose. The former was an independent risk factor for high-risk PAD (odds ratio = 1.424; 95% CI = 1.118‒1.814; P = 0.004).ConclusionVariability but not mean of annual fasting plasma glucose was significantly associated with a high risk of PAD in patients with DM.

Peripheral artery disease: A highly prevalent untreated and uncontrolled independent cardiovascular disease

LOX-1 is a novel marker for peripheral artery disease in patients with type 2 diabetes