Ankle-brachial Blood Pressure Index Research Articles

Association between ankle-brachial blood pressure index with all-cause and cardiovascular mortality in adults without arterial stiffness

PurposeTo explore the relationship between ankle-brachial blood pressure index (ABPI) and all-cause or cardiovascular mortality in adults without arterial stiffness.MethodsA total of 6784 participants without arterial stiffness were enrolled from National Health and Nutrition Examination Survey 1999–2004. The hazard ratio (HR) and 95% confidence interval (CI) of ABPI associating with the risk of all-cause and cardiovascular mortality was calculated by Cox proportional regression models adjusted for demographic and traditional risk factors. Dose-response relationship was explored with restricted cubic spines.ResultsAfter an average follow-up of 12.1 years, 1844 all-cause deaths and 299 cardiovascular deaths occurred. Compared with the lowest ABPI quartile, the second quartile was associated with the lowest risk of all-cause mortality (HR 0.89, 95%CI 0.79–0.98; p = 0.036) and cardiovascular mortality (HR 0.75, 95%CI 0.56–0.98; p = 0.048). Besides, dose-response analysis revealed that ABPI was nonlinearly correlated to all-cause mortality (p for nonlinearity < 0.001) and linearly correlated to cardiovascular mortality (p for nonlinearity = 0.459).ConclusionsThe relationship between ABPI and all-cause and cardiovascular mortality followed a L-shape curve. A lower ABPI was independently associated with an increased risk of all-cause and cardiovascular mortality in adults without arterial stiffness.

Comparison of arterial stiffness and ultrasound indices in patients with and without chronic obstructive pulmonary disease.

The purpose of this study was to compare arterial stiffness and ultrasound indices in patients with and without chronic obstructive pulmonary disease. In our retrospective study, 83 chronic obstructive pulmonary disease patients were assigned to the chronic obstructive pulmonary disease group and 80 healthy controls were enrolled. Pearson's correlation analysis software was used to analyze the correlation between arterial stiffness (including brachial ankle pulse wave velocity and ankle-brachial blood pressure index) and ultrasound index (including resistance index, pulsatility index, and intima-media thickness) at the carotid artery in chronic obstructive pulmonary disease patients. The ultrasound resistance index and pulsatility index level of chronic obstructive pulmonary disease group were lower than those of control group (t=6.326, 8.321, p<0.001). Compared with the control group, the chronic obstructive pulmonary disease group had higher intima-media thickness, total plaque area, and number of plaques (t=4.574, 7.493, 5.093, p<0.001). The arterial stiffness and ankle-brachial blood pressure index level in the chronic obstructive pulmonary disease group were higher than those in the control group (t=6.392, 5.109, p<0.001). Moreover, arterial stiffness in patients with chronic obstructive pulmonary disease was negatively correlated with the ankle-brachial blood pressure index, resistance index, and pulsatility index levels (p<0.05), while it is positively correlated with intima-media thickness, total plaque area, and number of plaques (p<0.05). Our results indicated that patients with chronic obstructive pulmonary disease have stiffer arteries compared with healthy control subjects; the ultrasound index could be used as an auxiliary indicator for clinical prediction of arterial stiffness, which is helpful to improve the accuracy of prediction and thus better guide clinical interventions in high-risk groups of chronic obstructive pulmonary disease in time.

Ankle-brachial index and ocular diseases in a Russian population

BackgroundTo assess potential associations between the ankle-brachial blood pressure index (ABI) and ocular disorders.MethodsIn the population-based cross-sectional Russian Ural Eye and Medical Study including 5,899 (80.5%) out of 7328 eligible participants aged 40+ years, the participants underwent a series of ocular and medical examinations including measurement of ABI.ResultsBlood pressure measurements of both arms and ankles were available for 3187 (54.0%) individuals. The mean ABI was 1.26 ± 0.19 (median:1.20; range: 0.61, 2.20). In multivariate analysis, a higher ABI was associated with younger age (P < 0.001; non-standardized regression coefficient B: −0.001; 95% confidence interval (CI): −0.002, −0.001), female sex (P < 0.001; B: 0.03; 95% CI: 0.02, 0.04), lower body mass index (P < 0.001; B: −0.004; 95% CI: −0.006, −0.003), lower waist-to-hip ratio (P = 0.01; B: −0.10; 95% CI: −0.17, −0.02), lower glucose serum concentration (P = 0.008; B: −0.005; 95% CI: −0.009, −0.001), lower prevalence of arterial hypertension (P < 0.001; B: −0.14; 95% CI: −0.16, −0.12), higher mean systolic blood pressure (P < 0.001; B: 0.003; 95% CI: 0.002, 0.003), and higher prevalence of any alcohol consumption (P < 0.001; B: 0.03; 95% CI: 0.02, 0.04). In that multivariate model, prevalence of glaucoma (P = 0.67) as a whole, open-angle glaucoma (P = 0.86) and angle-closure glaucoma (P = 0.54), stage of glaucomatous optic neuropathy (P = 0.57), prevalence of age-related macular degeneration (P = 0.88), prevalence and stage of diabetic retinopathy (P = 0.30, and P = 0.29, respectively), nuclear cataract (P = 0.32, and P = 0.41, resp.), cortical cataract (P = 0.33, and P = 0.92, resp.), subcapsular cataract (P = 0.74 and P = 0.60, resp.), and pseudoexfoliation (P = 0.44 and P = 0.47, resp.), intraocular pressure (P = 0.52), axial length (P = 0.20), and peripapillary retinal nerve fibre layer thickness (P = 0.55) were not significantly associated with the ABI.ConclusionsIn this ethnically mixed population from Russia, none of the major ocular diseases was associated with ABI suggesting that subclinical atherosclerosis is not markedly associated with the aetiology of these ocular disorders.

Predictive value of clinical examination parameters for cardiovascular adverse events during treatment of chronic myeloid leukemia with tyrosine kinase inhibitors.

Treatment of chronic myelogenous leukemia (CML) requires management of long-term use of tyrosine kinase inhibitors (TKIs). Although cardiovascular adverse events (CAEs) caused by off-target effects of TKIs can be life-threatening, the optimal method of monitoring for CAEs has not been established. Here, we comprehensively evaluated the clinical utility of various cardiovascular parameters, including ankle-brachial blood pressure index (ABI), cardiac ankle vascular index (CAVI), and carotid ultrasonography and electrocardiogram measurements, for monitoring and predicting CAEs in 74 patients with CML receiving TKIs. Based on concordance statistics, the predictive value of established risk factor models was significantly improved by addition of both ABI and CAVI, as follows: model 1 (hypertension, smoking history, and dyslipidemia), 0.680 versus 0.817 (p = 0.041); model 2 (hypertension, dyslipidemia, and diabetes mellitus), 0.685 vs. 0.830 (p = 0.047); and model 3 (age, hypertension, dyslipidemia and diabetes mellitus) 0.737 versus 0.818 (p = 0.044). However, no single cardiovascular parameter independently improved the predictive value of established risk factor models. In conclusion, addition of combined assessment of ABI and CAVI to established risk factors can improve prediction of future CAEs and may enable better clinical management of patients with CML receiving TKIs.

Improving Limb Salvage for Chronic Limb-Threatening Ischemia With Spinal Cord Stimulation: A Retrospective Analysis

Introduction:Chronic limb-threatening ischemia (CLTI) represents the most severe form of peripheral artery disease (PAD). Up to a third of CLTI patients are not eligible to receive first-line treatments such as bypass surgery or endovascular interventions. Epidural spinal cord stimulation (SCS) has been used as a method to improve microcirculatory blood flow and relieve ischemic pain in CTLI patients. The aim of the study was to evaluate limb salvage, ulcer closure, and clinical changes of SCS implanted CTLI patients at 1-year follow-up.Methods:Eligible patients had end-stage lower limb PAD unresponsive to medical therapy and not amenable to surgical reconstruction. Patients were candidates for amputation, but limb loss was not inevitable (Fontaine stage III and IV). Pain intensity and skin temperature in the ischemic area (visual analogue scale), quality of life (WHOQoL-BREF), and ankle/brachial blood pressure index (ABI) were recorded at routine follow-up visits. Data were analyzed retrospectively.Results:29 patients underwent SCS implantation at one vascular center. The minimum follow-up period was 30 months. Limb survival at 1-year follow-up was 97% (28/29) and 73% (11/15) had complete closure of limb ulcers. Pain intensity, skin temperature, and quality of life progressively improved up to 12 months after implant, with Fontaine stage III patients improving more substantially than Fontaine stage IV patients. SCS therapy did not affect ABI measurement. No complications related to the device or procedure occurred.Conclusions:SCS is a valid alternative in patients unsuitable for revascularization. The quality of results depends on both a strict selection of patients by vascular specialists and the frequency of follow-up controls. The therapy may be more beneficial in patients classified as Fontaine stage III.

The Association of Cardio-Ankle Vascular Index and Ankle-Brachial Index in Patients with Peripheral Arterial Disease

Introduction: The cardio-ankle vascular index (CAVI) is a well-known index to evaluate arterial stiffness and predict cardiovascular risk. Methods: We investigated whether CAVI can predict severity and extent of peripheral arterial disease. This study was a single-center, retrospective, observational study approved by the Ethics Committee of Yokohama Shintoshi Neurosurgical Hospital. A total of 96 patients (males, 63) with an abnormal ankle-brachial blood pressure index (ABI) of <0.9 and who underwent extremity arteriography at our hospital from 2015 to 2018 were enrolled in this study. We defined that CAVI with a range of <8.0 was normal. Results: Coronary angiography and extremity arteriography were performed for patients who had intermittent claudication and abnormal ABI. We divided the affected limbs into 3 categories: above-the-knee artery stenosis, above-the-knee artery chronic total occlusion, and only below-the-knee artery stenosis/occlusion groups. CAVI pseudonormalization was seen in 28, 76, and 19%, respectively. The above-the-knee artery stenosis and the only below-the-knee artery stenosis/occlusion groups had a high odds ratio of abnormalization of CAVI (3.1, 95% confidence interval [CI]: 1.39–7.22; p = 0.05, 4.56, 95% CI: 1.64–14.7). Discussion/Conclusion: In the presence of the above-the-knee artery chronic total occlusion, CAVI pseudonormalization was likely to be seen. The presence of CTO in the above-the-knee artery is one cause of pseudonormalized CAVI. In the range of ABI, in which stenotic lesions and obstructive lesions coexist, it may be possible to detect the existence of CTO by a combination of both ABI and CAVI.

P1094PULSE AMPLITUDE OF THE TOE MEASURED WITH A PORTABLE LASER DOPPLER FLOW METER IS USEFUL FOR SCREENING OF DIALYSIS PATIENTS FOR PERIPHERAL ARTERIAL DISEASE

Abstract Background and Aims Peripheral arterial disease (PAD) occurs at a high frequency in hemodialysis (HD) patients and is known to be associated with poor outcomes. Measurement of the ankle-brachial blood pressure index (ABI) or toe brachial index (TBI) has been used for screening, diagnosis and severity determination of PAD. However, the procedures for measurement of these indices are complicated and the measurements cannot be performed during dialysis sessions. The purpose of the present study was to clarify the ability of the toe blood flow and pulse amplitude measured with a portable laser Doppler flow meter (LDF) to detect PAD in dialysis patients, in comparison with the diagnostic abilities of ABI and TBI. Methods Fourteen patients on maintenance HD participated in this study. The mean age was 65.2 years old and the mean duration of HD was 9.1 years. We measured the ABI and TBI before HD, and the blood flow and pulse amplitude on the ventral side of the first toe with a portable LDF (pocket LDF®, JMS Co., Ltd., Tokyo, Japan) during the HD session on the same day. The correlations between the blood flow / pulse amplitude in the toe and the ABI / TBI were investigated. The sensitivity and specificity of the blood flow and pulse amplitude in the toe for PAD detection were determined by a receiver operating characteristic curve analysis. Statistical analysis was performed using the Fisher’s exact test. A p value of &amp;lt;5% was considered to indicate a significant difference. Results and Discussion No significant correlation was found between the blood flow and the pulse amplitude in the toe (p = 0.454). The blood flow was not correlated with either the ABI or the TBI (p = 0.286, p = 0.115, respectively). However, the pulse amplitude showed significant correlations with both the ABI and TBI (p &amp;lt; 0.001, p &amp;lt; 0.05). When we used the general reference cutoff values for ABI and TBI of 0.9 and 0.6, respectively, the sensitivity and specificity of ABI for the detection of PAD were 0.75 and 0.75, respectively, and those of TBI were 1.0 and 0.75, respectively. On the other hand, the sensitivity and specificity of blood flow in the toe were 0.50 and 1.0, respectively, when the cutoff value was set at 23.8 mL/min. The sensitivity and specificity of the pulse amplitude were 0.75 and 1.0, respectively, when the cutoff value was set at 7.6 mL/min. These results indicate that the pulse amplitude in the toe showed a high diagnostic ability, like ABI and TBI, for the detection of PAD. Although our results in this study were obtained from a small sample size and further investigation is warranted, the pulse amplitude measured with the portable LDF was correlated well with both the ABI and TBI, and its sensitivity and specificity for the detection of PAD were also high, indicating the high diagnostic ability of the pulse amplitude for PAD. As compared to the measurement of ABI or TBI, the pulse amplitude in the toe can be easily measured with a portable LDF, even during a dialysis session. Thus, we believe that the use of a portable LDF might be of great benefit as a screening tool for PAD. Conclusion The pulse amplitude in the toe measured with a portable LDF may have the potential to become a novel easily measurable index in the screening of dialysis patients for PAD.

PB1932 PREDICTIVE POWERS OF VARIOUS CARDIOVASCULAR EXAMINATIONS FOR CARDIOVASCULAR OCCLUSION EVENTS IN CML PATIENTS RECEIVING TYROSINE KINASE INHIBITORS

Background:The prognosis of chronic myelogenous leukemia (CML) has been dramatically improved by tyrosine kinase inhibitors (TKI). Therefore, it has become very important to control off‐target adverse effects accompanying the long‐term administration of TKI. Among them, cardiovascular occlusion events (CVE) are becoming a problem. Although cardiovascular examinations such as electrocardiography and measurement of ankle‐brachial blood pressure index (ABI) are recommended, the clinical usefulness and predictive value of CVE have been not sufficiently evaluated. Furthermore, few reports have evaluated cardiac ankle vascular index (CAVI) and cervical echo.Aims:Here, we comprehensively investigated the usefulness of various cardiovascular evaluation tests for monitoring CVE and the predictive value of CVE in TKI treatment and performed a risk analysis of CVE.Methods:We performed cardiovascular evaluation tests including measurement of ABI and CAVI, cervical echo, and electrocardiography in CML patients receiving TKI treatment (imatinib, nilotinib, dasatinib, bosutinib, or ponatinib) between April 2017 and December 2018 in our institute.Results:A total of 74 patients aged 21–91 years (median age, 63.5 years) were evaluated. Comparison with TKI given at the time of the examination revealed no significant difference in frequency of abnormalities of cervical echo, CAVI abnormality rate, or QTc prolongation depending on TKI type. On the other hand, 11 of 22 (50.0%) patients who were taking nilotinib had an ABI &lt; 1.0, which was significantly more prevalent than for other TKIs.Ten patients developed CVE during TKI treatment. The TKIs that were taken when CVE occurred were nilotinib in 6 patients, imatinib in 2, and bosutinib in 2. Comparisons of the CVE and non‐CVE groups revealed a significant difference in age, and the proportion of renal dysfunction cases and dyslipidemia tended to be higher in the CVE group.The proportion of patients with an ABI &lt; 1.0 in the CVE group was significantly higher (50% vs. 18.8%, p = 0.044). However, the proportion of patients with an ABI &lt; 1.0 and those with an ABI ≤0.9 were only 50% and 30% in the CVE group, respectively. The QTc value was significantly prolonged (median 440 ms vs. 425 ms; p = 0.028). CAVI values tended to be high (median 8.5 vs. 8.0; p = 0.13). On the other hand, various parameters of cervical echo and the presence or absence of plaque showed no significant difference.To evaluate the predictive power of CVE for each examination, the sensitivity and specificity of CVE for each were evaluated. Regarding echo plaque, the area under the receiver operating characteristic curve was 0.5, suggesting absolutely no predictive power. The results of the remaining indicators are summarized in the Table. Using any index alone or a composite model consisting of ABI/CAVI, the predictive power of CVE was insufficient (Table).Summary/Conclusion:Although we found that measuring ABI was a better method for monitoring and predicting CVE, the sensitivity and positive predictive value of ABI were insufficient, probably because it is an indicator of lower‐limb artery occlusion and stenosis, and thus, does not reflect systemic vascular damage.imageAs monitoring of CVE associated with TKI treatment might be inadequate using existing routine methods and CVE can be a risk of sudden death, it is necessary to establish a more useful monitoring and/or predictive method for the early detection of CVE in CML patients under TKI treatment.

Pedal power measurement as a diagnostic tool for functional vascular problems

BackgroundCyclists with flow limitations in the iliac arteries complain of pain and loss of power. To investigate whether pedal power measurement has added value in diagnosing the underlying cause of flow limitations in the iliac arteries, we explored the sensitivity and specificity of various pedal power measurement variables. Moreover, it was assessed what the added value of pedal power measurement is compared to diagnosis based on the conventional ankle-brachial blood pressure index. Methods25 healthy participants and 45 patients with unilateral arterial flow limitations were recruited. Participants received Echo-Doppler examination to determine the condition of the iliac arteries. Subsequently, participants performed a maximal cycle ergometer test. During the cycling test the exerted left and right pedal power was measured. From these measurements several variables were derived to diagnose arterial flow limitations. A receiver operating characteristics curve based on a predicted cross-validated model was used to select the variable with the highest predictive value and its cut-off value. FindingsThe mean power difference between both legs relative to the exerted power at 95% of the maximal power showed the best predictive value with a sensitivity of 0.76 and a specificity of 0.88. Combining the pedal power measurement and ankle-brachial blood pressure index resulted in a sensitivity of 0.91 and a specificity of 0.88. InterpretationPedal power measurement improves sensitivity of diagnosis of iliac artery flow limitations, without increasing the burden of clinical investigation to the patients.

The associations of subclinical atherosclerotic cardiovascular disease with hip fracture risk and bone mineral density in elderly adults.

Clinically recognized cardiovascular disease (CVD) is associated with osteoporosis and hip fracture risk, but the relationship of subclinical atherosclerosis to bone health is not certain. We followed 3385 participants from the Cardiovascular Health Study (mean age 74.7 ± 5.3years) with a median time to fracture of 12.1years who underwent baseline carotid artery and aortic wall ultrasound scanning and ankle brachial blood pressure index (ABI) determinations. A subset underwent bone mineral density (BMD) testing. There were 494 hip fractures during follow-up. Among persons without clinical CVD, an average standard-deviation increase in a composite score of maximal common and internal carotid artery intimal medial thickness (cIMT) was associated with increased risk of hip fracture [(HR 1.18 [1.04, 1.35]), even though cIMT was positively associated with BMD. Neither aortic wall thickness nor ABI were associated with hip fracture risk or BMD. Among participants with clinical CVD, cIMT and aortic wall thickness, but not ABI, were associated with increased hip fracture risk. Subclinical cIMT is associated with an increased risk of hip fractures despite being associated with increased BMD. This finding suggests that vascular health, even in its early stages, is linked to bone health, by pathways other than BMD.

Acupuncture Combined with Hydrotherapy in Diabetes Patients with Mild Lower-Extremity Arterial Disease: A Prospective, Randomized, Nonblinded Clinical Study.

BackgroundThe aim of this pragmatic study was to explore the intervention of acupuncture combined with hydrotherapy and perceived effects in type 2 diabetic patients with recently diagnosed, mild, lower-extremity arterial disease (LEAD) in comparison with a control group.Material/MethodsOne hundred twenty-six diabetes patients who were diagnosed mild LEAD according to ankle-brachial blood pressure index (ABPI) and peripheral neuropathy symptom were randomly assigned to either an experimental (n=64) or control group (n=62). The experimental group attended and completed (1) a 30-min session of acupuncture in certain selected points, and (2) a 30-min hydrotherapy exercise every 2 days for 15 weeks. The outcome parameters were assessed at baseline, after intervention, and at 6-week follow-up.ResultsThe intervention was associated with an improvement in leg flow conductance and partial physical capacities, including chair-sit-and-reach, the walking impairment questionnaire (WIQ), and physical component summary score (PCS), compared to the control group. The treatment benefits were sustained throughout the 6-week follow-up endpoint. There was no difference in fasting glucose levels, Hb1Ac, blood pressure, or BMI after the intervention. At the endpoint of 6-week follow-up, acupuncture plus hydrotherapy appeared to reduce inflammatory response by decreasing IL-6, TNF-α, malondialdehyde, and SOD, and increasing glutathione.ConclusionsAcupuncture plus hydrotherapy, without significant glycemic-controlling effects in the type 2 diabetic patients with mild LEAD, exerts a measurable benefit in disease-specific physical functions and health-related quality of life. Our results suggest that the combined therapy regulates the inflammatory process and oxidative stress and contributes to immune protection.

Development and validation of optimal cut-off value in inter-arm systolic blood pressure difference for prediction of cardiovascular events

BackgroundAn inter-arm systolic blood pressure difference (IAD) is associated with cardiovascular disease. The aim of this study was to develop and validate the optimal cut-off value of IAD as a predictor of major adverse cardiac events in patients with arteriosclerosis risk factors. MethodsFrom 2009 to 2014, 1076 patients who had at least one cardiovascular risk factor were included in the analysis. We defined 700 randomly selected patients as a development cohort to confirm that IAD was the predictor of cardiovascular events and to determine optimal cut-off value of IAD. Next, we validated outcomes in the remaining 376 patients as a validation cohort. The blood pressure (BP) of both arms measurements were done simultaneously using the ankle-brachial blood pressure index (ABI) form of automatic device. The primary endpoint was the cardiovascular event and secondary endpoint was the all-cause mortality. ResultsDuring a median period of 2.8 years, 143 patients reached the primary endpoint in the development cohort. In the multivariate Cox proportional hazards analysis, IAD was the strong predictor of cardiovascular events (hazard ratio: 1.03, 95% confidence interval: 1.01–1.05, p=0.005). The receiver operating characteristic curve revealed that 5mmHg was the optimal cut-off point of IAD to predict cardiovascular events (p<0.001). In the validation cohort, the presence of a large IAD (IAD ≥5mmHg) was significantly associated with the primary endpoint (p=0.021). ConclusionsIAD is significantly associated with future cardiovascular events in patients with arteriosclerosis risk factors. The optimal cut-off value of IAD is 5mmHg.

Skin perfusion pressure predicts mortality in hemodialysis patients: long term follow-up

Peripheral artery disease (PAD) is not only a serious complication but also a risk factor to predict prognosis in the patients with hemodialysis (HD). Ankle-brachial blood pressure index (ABI) has been widely used for detection of PAD. Skin perfusion pressure (SPP) was used for early detection of PAD by measurement of microcirculation of subcutaneous tissue. We studied the effectiveness of ABI and SPP to predict prognosis of HD patients. Both SPP and ABI were measured in 45 HD outpatients in Nagahara Hospital. The patients were followed with a mean observational period of 44.4 months to evaluate the association of ABI or SPP value with any-cause mortality. The median ABI and SPP values in all patients were 1.15 and 70.0 mmHg, respectively, and the patients were classified into two groups with the median value used as the cutoff points. In Kaplan-Meier analysis, the lower SPP group showed significantly worse survival curve than the higher SPP group while there were no differences between ABI groups. Cox proportional hazards model demonstrated SPP values are independent and significant risk factors for mortality. These results suggest evaluation of PAD by SPP measurement is useful to predict prognosis of HD patients.

Changes in the ankle-brachial blood pressure index among hemodialysis patients

The ankle-brachial blood pressure index (ABI) is an independent predictor of mortality in hemodialysis patients. In the present study, we investigated the factors that predict changes in the ABI in hemodialysis patients. A total of 61 consecutive patients receiving maintenance hemodialysis who successfully underwent ABI examinations in 2005 and 2011 were enrolled in this study. The change in the ABI (2011 measurement versus 2005 measurement) was estimated. We set the baseline at 2011 and investigated the patient outcomes. Furthermore, we compared the change in the ABI and several clinical factors observed in 2005. The mean follow-up period was 3.1 ± 0.7 years. In the univariate Cox proportional hazard analysis, predictive variables for mortality included ABI (0.43 [0.25–0.64]; [per 0.1 increase]) and the change in the ABI (0.62 [0.49–0.79]; [per 0.1 increase]). Patient age was negatively correlated and the serum creatinine level was positively correlated with the change in the ABI (P = 0.030 and 0.022, respectively). We confirmed that not only the value of the ABI itself but also the change in the ABI was a risk factor for mortality among hemodialysis patients. The change in the ABI was negatively correlated with age and was positively correlated with the serum creatinine level. Careful observation of the ABI is needed for old patients and patients with a low serum creatinine level.

Association between Vitamin D Status and Risk of Peripheral Arterial Disease: The Dong-gu Study.

Low levels of vitamin D have been associated with increased cardiovascular disease risk. However, few studies have evaluated the association between vitamin D status and peripheral arterial disease (PAD). We therefore aimed to investigate whether low 25-hydroxyvitamin D (25(OH)D) levels were associated with increased risk of PAD in the Korean population. This cross-sectional study was conducted among 8,960 subjects aged 50 years or older without known myocardial infarction or stroke. PAD was defined by an ankle brachial blood pressure index <0.9. Multivariate logistic regression was used to evaluate the association between serum 25(OH)D levels and risk of PAD. Of the 8,960 subjects, 3.0% had PAD and the age and sex adjusted prevalence of PAD decreased with the increasing 25(OH)D quartile. After adjusting for potential confounders and parathyroid hormones, serum 25(OH)D levels were associated with a significantly decreased risk of PAD (OR for one SD increase, 0.98; 95% CI, 0.95-1.0, P for trend=0.040). Compared with the first 25(OH)D quartile, the odds of PAD were 0.86 (95% CI, 0.62-1.21), 0.67 (95% CI, 0.46-0.97), and 0.71 (95% CI, 0.49-1.04) for the second, third, and fourth quartiles, respectively. In this cross-sectional study, we found that low serum 25(OH)D levels were associated with an increased risk of PAD, independent of traditional cardiovascular risk factors and parathyroid hormone. Our findings suggest that low vitamin D levels may contribute to PAD in the Korean population.

The Danish Cardiovascular Screening Trial (DANCAVAS): study protocol for a randomized controlled trial.

BackgroundThe significant increase in the average life expectancy has increased the societal challenge of managing serious age-related diseases, especially cancer and cardiovascular diseases. A routine check by a general practitioner is not sufficient to detect incipient cardiovascular disease.DesignPopulation-based randomized clinically controlled screening trial.MethodsParticipants: 45,000 Danish men aged 65–74 years living on the Island of Funen, or in the surrounding communities of Vejle and Silkeborg. No exclusion criteria are used.Interventions: One-third will be invited to cardiovascular seven-faceted screening examinations at one of four locations. The screening will include: (1) low-dose non-contrast CT scan to detect coronary artery calcification and aortic/iliac aneurysms, (2) brachial and ankle blood pressure index to detect peripheral arterial disease and hypertension, (3) a telemetric assessment of the heart rhythm, and (4) a measurement of the cholesterol and plasma glucose levels. Up-to-date cardiovascular preventive treatment is recommended in case of positive findings.Objective: To investigate whether advanced cardiovascular screening will prevent death and cardiovascular events, and whether the possible health benefits are cost effective.Outcome: Registry-based follow-up on all cause death (primary outcome), and costs after 3, 5 and 10 years (secondary outcome).Randomization: Each of the 45,000 individuals is, by EPIDATA, given a random number from 1–100. Those numbered 67+ will be offered screening; the others will act as a control group.Blinding: Only those randomized to the screening will be invited to the examination;the remaining participants will not.Numbers randomized: A total of 45,000 men will be randomized 1:2.Recruitment: Enrollment started October 2014.Outcome: A 5 % reduction in overall mortality (HR = 0.95), with the risk for a type 1 error = 5 % and the risk for a type II error = 80 %, is expected. We expect a 2-year enrollment, a 10-year follow-up, and a median survival of 15 years among the controls. The attendance to screening is assumed to be 70 %.DiscussionThe primary aim of this so far stand-alone population-based, randomized trial will be to evaluate the health benefits and costeffectiveness of using non-contrast full truncus computer tomography (CT) scans (to measure coronary artery calcification (CAC) and identify aortic/iliac aneurysms) and measurements of the ankle brachial blood pressure index (ABI) as part of a multifocal screening and intervention program for CVD in men aged 65–74.Attendance rate and compliance to initiated preventive actions must be expected to become of major importance.Trial registrationCurrent Controlled Trials: ISRCTN12157806 (21 March 2015).

Ankle-brachial blood pressure index predicts cardiovascular events and mortality in Japanese patients with chronic kidney disease not on dialysis.

The ankle-brachial blood pressure index (ABPI) has been recognized to have a predictive value for cardiovascular (CV) events and mortality in general or dialysis populations. However, the associations between ABPI and those outcomes have not been fully investigated in predialysis patients. The present study aimed to clarify the relationships between ABPI and both CV events and mortality in Japanese chronic kidney disease (CKD) patients not on dialysis. In this prospective observational study, we enrolled 320 patients with CKD stages 3-5 who were not on dialysis. At baseline, ABPI was examined and a low ABPI was defined as <0.9. CV events and all-cause deaths were examined in each patient. A Cox proportional hazards model was applied to determine the risk factors for CV events, as well as for mortality from CV and all causes. The median follow-up period was 30 months. CV events occurred in 56 patients and all-cause deaths occurred in 48, including 20 CV deaths. Multivariate analysis showed that age and low ABPI were risk factors for CV events. It was demonstrated that age, a history of cerebrovascular disease and low ABPI were determined as independent risk factors for CV mortality. In addition, age, body mass index and low ABPI were independently associated with all-cause mortality. In patients with CKD, low ABPI during the predialysis period is independently associated with poor survival and CV events, suggesting the usefulness of measuring ABPI for predicting CV events and patient survival in CKD.

25-Hydroxyvitamin D and ankle-brachial blood pressure index in adults without peripheral artery disease.

Inverse association between lower level of 25-hydroxyvitamin D [25(OH)D] and higher prevalence of peripheral arterial disease (PAD) among individuals with cardiovascular diseases (CVD) is known. Less is known about the relationship between 25(OH)D and ankle-brachial blood pressure index (ABPI) in asymptomatic adults. We hypothesized a nonlinear relationship between 25(OH)D and ABPI in asymptomatic adults without PAD. Data from the continuous NHANES (2001-2004) was used. Minimum of the two reported ABPI value was chosen for each individual (>18 years). Linear regression models with spline adjusted for demographic and traditional risk factors for CVD were used to examine nonlinear relationship between 25(OH)D and ABPI. Mean changes in ABPI per 10 ng/mL change in 25(OH)D were reported. Mean (SD) age and 25(OH)D levels of 4979 participants (48% females) were 60.4 (13.22) years and 22.1 (8.68) ng/mL, respectively, while mean (SD) ABPI was 1.07 (0.15). We observed positive association between 25(OH)D and ABPI both in the univariable and multivariable regression models (all p < 0.05). In univariable regression with spline, a significant increase in ABPI (ß = 0.03, 95% CI: 0.02-0.04) was observed until 25(OH)D reached but not above 27 ng/mL. Similarly, in multivariable spline models, 25(OH)D was positively associated with ABPI (ß = 0.02, 95% CI: 0.01-0.03) only up to 27 ng/mL. In asymptomatic adults without PAD, rising serum 25(OH)D concentration but not above 27 ng/mL was associated with statistically significant increase in ABPI.

Association of depressive symptoms, trait anxiety, and perceived stress with subclinical atherosclerosis: Results from the Chicago Healthy Aging Study (CHAS)

ObjectiveExamine the association between multiple psychological factors (depressive symptoms, trait anxiety, perceived stress) and subclinical atherosclerosis in older age. MethodThis cross-sectional study included 1101 adults ages 65–84 from the Chicago Healthy Aging Study (CHAS — 2007–2010). Previously validated self-report instruments were used to assess psychological factors. Non-invasive methods were used to assess subclinical atherosclerosis in two regions of the body, i.e., ankle-brachial blood pressure index (ABI) and coronary artery calcification (CAC). Multivariate logistic regression was used to examine the association between each psychological measure and subclinical atherosclerosis, after the adjustment for socio-demographic factors, sleep quality, young adulthood/early middle age and late-life CVD risk status, and psychological ill-being as appropriate. ResultsThe burden of major cardiovascular disease risk factors did not significantly differ across tertiles of psychological factors. In multivariate adjusted models, trait anxiety was associated with calcification: those in the second tertile were significantly more likely to have CAC >0 compared to those in the lowest anxiety tertile [OR=1.68; 95% CI=1.09–2.58], but no significant difference was observed for Tertile III of trait anxiety [OR=1.31; 95% CI=0.75–2.27]. No association was seen between psychological measures and ABI. ConclusionOf several psychological factors, only trait anxiety was significantly associated with CAC.

Relationship between the ankle-brachial index and the risk of coronary heart disease and stroke: the circulatory risk in communities study.

Patients with peripheral artery disease (PAD) are at a high risk of cardiovascular disease (CVD) among Western populations. However, evidence for an elevated risk in Asian populations is limited. This prospective cohort study examined 939 Japanese men 60-74 years of age at the time of the baseline survey. A total of 115 cases of CVD were detected during a median 9.3 years of follow-up, and the ankle brachial blood pressure index (ABI) functioned as a surrogate measurement of PAD. The age-adjusted risks of coronary heart disease, ischemic stroke and ischemic CVD (coronary heart disease and ischemic stroke) were higher among men in the lowest ABI tertile compared with that observed in the men in the highest tertile (<1.08 vs. >1.17). These associations did not change substantially after adjusting for cardiovascular risk factors. The respective multivariable hazard ratios (HRs, 95% CI) for the three conditions were as follows: 2.48 (1.08-5.71), p for trend=0.03; 1.95 (0.94-4.02), p for trend=0.04; and 2.16 (1.25-3.72), p for trend=0.004. These results did not vary based on a comparison of the three ABI categories: ≤0.90, 0.91-1.10 and >1.10. The multivariable HRs (95% CI) for an ABI ≤0.90 versus >1.10 were as follows: 2.04 (0.67-6.20), p for trend=0.14 for coronary heart disease; 3.39 (1.10-10.5), p for trend=0.006 for ischemic stroke; and 2.61 (1.19-5.76), p for trend=0.003 for ischemic CVD. There were no associations between the ABI and the risk of hemorrhagic stroke. A low ABI is associated with the risk of coronary heart disease, ischemic stroke and ischemic CVD in elderly Japanese men.