Ankle Brachial Pressure Index Score Research Articles

Different Effects of Polymorphic Flavin-Containing Monooxygenase 3 and Cytochrome P450 2A6 Activities on an Index of Arteriosclerosis as a Lifestyle-Related Disease in a General Population in Japan.

The relationships between lifestyle-related diseases and polymorphic drug-metabolizing enzyme activities in the general population in Japan remain unclear. In this study, the relationships between an index of arteriosclerosis and the phenotypic activities of flavin-containing monooxygenase 3 (FMO3) and cytochrome P450 (P450) 2A6 were analysed. Subjects in a general population in Japan (age range 35-97 years, 640 men and 795 women, 12% were current smokers) who took part in a health check program were recruited. Subjects were divided into two groups using the median ankle-brachial pressure index (ABI) score. Subjects harbouring P450 2A6 wild-type allele had a significant age-adjusted odds ratio of 1.3 (95% CI, 1.0-1.6) of having a lower than median ABI score compared with subjects for mutant P450 2A6. For subjects with wild-type FMO3, the odds ratio of 0.89 was not significant. The proportions of P450 2A6 extensive metabolizers varied significantly across the inter-quartile ranges of the ABI scores (p = 0.008). Furthermore, the proportion of subjects with low ABI scores was also dependent on the phenotypic P450 2A6 activity (p = 0.025) as estimated from the P450 2A6 genotype. These results suggest that in a general population in Japan, the ABI score, as a risk index for arteriosclerosis, is associated with the predicted P450 2A6 phenotype but is not associated with FMO3 function. The P450 2A6 wild-type allele may be a possible candidate biomarker for arteriosclerosis in a general population in Japan with a variety of dietary habits.

A Systematic Review of Foot Exercises with Group Support to Improve the Foot Health of Diabetes Mellitus Patients

Introduction: Foot problems are a process and complication in patients with diabetes mellitus (DM). Foot complications can be prevented by routine foot exercises. Group support is needed to increase the routine of foot exercise. The effects of foot exercise can be seen by measuring the Ankle Brachial Pressure Index and foot sensation. The objective of this systematic review was to identify the prevention of DM foot complications in an easy way so then he patient can do it independently.Methods: The method used in this study was a systematic review focused on 2015 – 2019 using the PRISMA method. The literature was obtained from Scopus, Science Direct and Proquest. The results found 25 items of literature on foot exercise which was reduced to 4 studies on preventing damage to the feet of DM patients through routine foot exercise. The literature of this study is supported by 3 other studies that state that foot health can also be used to examine the foot’s blood circulation status and sensation.Results: These results have been presented concerning 7 studies regarding special group support in the form of exercise therapy for patients with DM. This study explains the prevention of foot complications through foot exercise. Group support is needed provide motivation to conduct routine foot exercise.Conclusion: Foot exercise can accelerate the blood circulation as can be seen by the Ankle Brachial Pressure Index score and the increase in the neurological system of the foot through foot sensation status.

A Systematic Review of Foot Exercises with Group Support to Improve the Foot Health of Diabetes Mellitus Patients

Introduction: Foot problems are a process and complication in patients with diabetes mellitus (DM). Foot complications can be prevented by routine foot exercises. Group support is needed to increase the routine of foot exercise. The effects of foot exercise can be seen by measuring the Ankle Brachial Pressure Index and foot sensation. The objective of this systematic review was to identify the prevention of DM foot complications in an easy way so then he patient can do it independently. Methods: The method used in this study was a systematic review focused on 2015 – 2019 using the PRISMA method. The literature was obtained from Scopus, Science Direct and Proquest. The results found 25 items of literature on foot exercise which was reduced to 4 studies on preventing damage to the feet of DM patients through routine foot exercise. The literature of this study is supported by 3 other studies that state that foot health can also be used to examine the foot’s blood circulation status and sensation. Results: These results have been presented concerning 7 studies regarding special group support in the form of exercise therapy for patients with DM. This study explains the prevention of foot complications through foot exercise. Group support is needed provide motivation to conduct routine foot exercise. Conclusion: Foot exercise can accelerate the blood circulation as can be seen by the Ankle Brachial Pressure Index score and the increase in the neurological system of the foot through foot sensation status.

Risk factors of peripheral arterial disease: a case control study in Sri Lanka.

BackgroundPeripheral artery disease (PAD) is an important global health problem and contributes to notable proportion of morbidity and mortality. This particular manifestation of systemic atherosclerosis is largely under diagnosed and undertreated. For sustainable preventive strategies in a country, it is mandatory to identify country-specific risk factors. We intended to assess the risk factors of PAD among adults aged 40–74 years.MethodsThis case control study was conducted in 2012–2013 in Sri Lanka. Seventy-nine cases and 158 controls in the age group of 40–74 years were selected for the study in order to have case to control ratio 1:2. The criterion for selecting cases and control was based on Ankle brachial pressure index (ABPI). Cases were selected from those who had ABPI 0.85 or less (ABPI ≤0.85) in either lower limb. Controls were selected from those ABPI score between 1.18 and 1.28 in both lower limbs. Only newly identified individuals with PAD were selected as cases. Controls were selected from the same geographical location and within the 5 year age group as cases.ResultsThe history of diabetes mellitus more than 10 years (OR 5.8, 95% CI 2.2–14.2), history of dyslipidemia for more than 10 years (OR 4.9, 95% CI 2.1–16.2), history of hypertension for more than 10 years (OR 3.8, 95% CI 1.8–12.7) and smoking (OR 2.9, 95% CI 1.2–6.9), elevated HsCRP (OR 3.7, 95% CI 1.2–12.0) and hyperhomocysteinemia (OR 3.0, 95% CI 1.1–8.1) were revealed as country specific significant risk factor of PAD.ConclusionsDiabetes mellitus, hypertension, dyslipidemia, smoking as well as elevated homocysteine and HsCRP found as risk factors of PAD. Longer the duration or higher level exposure to these risk factors has increased the risk of PAD. These findings emphasis the need for routine screening of PAD among patients with the identified risk factors.

Early Identification of Asymptomatic Peripheral Arterial Disease in Smokers

This study investigated whether daily tobacco smoking affects peripheral artery insufficiency in a cohort of middle-aged individuals. A matched nonexperimental study was used. Twenty smokers and 20 nonsmokers not suffering from any cardiovascular disease were recruited. The Huntleigh Dopplex Assist was used to measure the ankle brachial pressure index (ABPI) and quantitatively analyze the Doppler arterial waveforms. There was no significant difference in mean ABPI scores between smokers and nonsmokers; however, significant difference was noted in the Doppler waveforms on all arteries assessed between groups. Doppler waveforms should be used to assess smokers to screen for peripheral arterial disease.

Beyond the Ankle-Brachial Pressure Index for the Diagnosis of Peripheral Arterial Disease—Time for A New Look at Photoplethysmography

Peripheral arterial disease (PAD) is common, affecting about 20% of people over 60 years. The PAD confers a high cardiovascular risk and there is a need for an easy test to confirm its presence in the primary care so that appropriate specialist referral can be made. For many years, the ankle-brachial pressure index (ABPI) has been available as a first-line quantitative assessment of PAD. However, it has been unpopular due to concerns about its repeatability in a nonspecialist setting. In this issue, Ro et al describe a comparison continuous wave (CW) Doppler ultrasound with ABPI and photoplethysmography (PPG) in the detection of stenotic peripheral disease. They show that the sensitivity of ABPI is poor particularly in diagnosing the disease in the tibial segment and that an improvement in sensitivity is gained by performing CW Doppler together with ABPI and PPG. The ABPI has previously been shown to have good sensitivity and specificity compared to angiographic imaging. It is also readily available in the community in primary care with lowcost equipment. However, 2 important factors affect the quality of ABPI results. The first is the presence of calcified vessels seen in patients with diabetes, renal disease, and some elderly patients. This leads to underestimation of arterial disease through falsely high readings, as the calcified vessels are relatively incompressible. This can usually be recognized by a high ABPI score of >1.3. The second factor is the need to perform the test to a high standard using a clear protocol. Often, the failure to get reliable results has been due to poor training and performance of the test by relatively inexperienced health care professionals in primary care. The PPG is a low-cost, quick, and simple to do optical technique, but it is however seldom used in routine clinical assessments, largely because of a lack of normal reference ranges, uncertainties due to beat-to-beat variability in pulse characteristics and poorly applied quantitative analysis leading to subjective waveform interpretation. Allen and coworkers have employed systematic pulse wave analysis techniques to show that PPG at the great toe site has good sensitivity and specificity for PAD when compared to the ABPI reference. They provided evidence that normalized pulse shape and its deformity with disease ranks high as an accurate marker for the disease, followed closely second by exploiting bilateral timing differences between the toes. To achieve such confidence in the diagnostic performance of PPG for PAD detection, it has been established that beat-to-beat averaging of the pulse features was essential. Before other techniques for quantifying PAD are introduced there needs to be consideration of the sensitivity and specificity of the technique, ease of use, and the cost and training required to achieve reliable results. The question of training community carers is particularly pertinent, where the technique relies on interpreting waveform shapes rather than performing a protocol that gives a set of numbers that can be recorded. This would be the case with Doppler waveform and PPG techniques as described by Ro et al. Unless there is a very clear-cut distinction between significant and nonsignificant disease, the reliability and reproducibility are likely to be poor. In the case of Doppler waveform analysis, the cost, portability of equipment, and time taken to perform the measurements probably make this modality more suited to a referral center where a full duplex ultrasound can be performed giving both anatomical and hemodynamic information. The key factor in any screening technique is that all disease that warrants further assessment is picked up while recognizing those who clearly do not have significant disease, to avoid unnecessary referral. This implies a test with reasonable sensitivity and high specificity, so that those who definitely do not have disease are not referred unnecessarily. When performed outside a specialist center, it also implies a test that can be reliably performed by a range

A Cross-Sectional Study in Kerman, Iran, on the Effect of Diabetic Foot Ulcer on Health-Related Quality of Life

This study describes the impact of diabetic foot ulcers (DFUs) on health-related quality of life (HRQoL) using a generic instrument including 8 domains. Data were obtained from 54 patients with DFU who were compared with 78 patients who had diabetes without foot ulcer. HRQoL was measured using the Iranian version of Medical Outcome Study-Short Form (SF-36). The fasting plasma glucose, creatinine, glycosylated hemoglobin (HbA1c), and urine microalbumin as well as ankle-brachial pressure index (ABI) were measured for all participants in the 2 groups. In all, 51.9% of patients with DFU had ABI scores of <0.9 compared with only 11.8% of the control group (P < .001). No differences were found in any of the treatment characteristics (oral/insulin therapy) between the 2 groups (case/control). HRQoL evaluated by the SF-36 questionnaire, in particular in the areas of physical function, is lower in patients with diabetes with foot ulcers compared with patients with diabetes without foot ulcers (41.04 ± 22.69 vs 56.67 ± 25.57; P < .01). After adjusting by sex, 2 domains of physical functioning and bodily pain as well as the total HRQoL score in patients with DFU were lower than in patients with diabetes (P < .001). This study showed that physical functioning and bodily pain along with total score of HRQoL were important aspects that were lower in patients with DFU than in patients with diabetes. Gender was considered as a confounding factor, which was omitted in multivariate analysis.

Ankle brachial pressure index as a marker of apathy in a community-dwelling population

Apathy is defined as a lack of interest or emotion. Several studies have shown the relationship between apathy and atherosclerotic change in poststroke patients. Although apathy is confused with depression, it might be a specific neuropsychiatric syndrome separate from depression. To clarify the relationship between atherosclerotic change and apathy in a community-dwelling population, which does not include the psychologic factors associated with stroke events. The ankle brachial pressure index (ABI) was measured using a volume-plethymographic apparatus in 860 volunteers (315 males and 545 females) who participated in the Iwaki Health Promotion Project 2008. Starkstein's apathy score and the Center for Epidemiologic Studies Depression Scale (CES-D) were used to assess the psychologic status. The association between the ABI and apathy was assessed by a multiple linear regression analysis. Gender and low-density lipoprotein (LDL)-cholesterol were independently and significantly associated with the CES-D score. We did not find any association between CES-D score and the ABI. In addition, the extent of education and the ABI were independently and significantly associated with the apathy scale (AS). In a community-dwelling population, a lower ABI score was an independent risk factor for a higher AS score, but not for a higher CES-D score. Apathy and depression may have different etiologies in vascular factors.

Ankle brachial pressure index usefulness as predictor factor for coronary heart disease in diabetic patients

Ankle brachial pressure index (ABPI) is a non-invasive marker of atherosclerosis, helpful to identify subjects at high-risk for coronary heart disease (CHD) among large populations with cardiovascular disease (CVD) risk factors. The diagnostic role of ABPI has been also recognized in patients with diabetes. In the present study, the role of an ABPI score < 0.90 in predicting CHD has been evaluated in a large series of patients with Type 2 diabetes mellitus and compared to other known CVD risk factors. Nine hundred and sixty-nine (mean age was 66.1 yr) consecutive patients with Type 2 diabetes mellitus were evaluated. The patients were followed-up for 18.3+/-5.2 months (range 12- 24) and all events of CHD, defined as myocardial infarction, unstable and resting angina or coronary atherosclerosis at the instrumental investigation (at the coronary angiography and/or perfusion stress testing) were recorded. A rate of 17.5% of CHD events were recorded in diabetic population during the follow-up period. The relative risk of CHD was significantly increased for male patients [odds ratio (OR): 1.6; 95% confidence interval (CI): 1.1-2.2], patients with age > or = 66 yr (OR: 1.8; 95% CI: 1.3-2.5), body mass index (BMI) > 30 (OR: 1.5; 95% CI: 1.1-2.1), waist circumference > 88 cm for females and 102 cm for males (OR: 1.5; 95% CI: 1.0-2.1), proteinuria > or = 30 microg per min (OR: 1.6; 95% CI: 1.1-2.3), LDL-cholesterol > or = 100 mg/dl (OR: 2.1; 95% CI: 1.5-3.0), glycated hemoglobin > 7% (OR: 1.6; 95% CI: 1.1-2.3), insulin therapy (OR: 1.9; 95% CI: 1.3-2.9), and ABPI < 0.90 (OR: 3.7; 95% CI: 2.2- 6.2). BMI was higher in patients with ABPI < 0.90 than in those with ABPI > or = 0.90 (p<0.05). At the multivariate analysis, ABPI < 0.90 was the best factor independently associated with CHD (p<0.001). APBI < 0.90 is strongly associated to CHD in Type 2 diabetic patients. We recommend to use ABPI in diabetic patients and to carefully monitor diabetic subjects with an ABPI lower than 0.90.

High-Energy Phosphate Metabolism During Calf Ergometry in Patients With Isolated Aorto-Iliac Artery Stenoses

Patients with peripheral arterial disease (PAD) and aorto-iliac atherosclerotic lesions suffer from a broad range of complaints, such as pain at the hip, the thigh, and calf claudication. The purpose of this study was to investigate the high-energy metabolism in the calf muscle of patients with PAD with isolated aorto-iliac stenoses during incremental plantar flexion exercise. Using a 1.5 T whole-body magnetic resonance (MR) scanner, 12 patients with PAD with uni- or bilateral aorto-iliac atherosclerotic lesions and 10 healthy male controls underwent serial phosphor-31 MR spectroscopy during incremental exercise at 2, 3, 4, and 5 W. The phosphocreatine (PCr) time constants were calculated for each increment and recovery using a monoexponential model. In the patient group, the run-off resistance was determined on MR angiograms. In both the patients and the controls, the ankle brachial pressure index was measured. The diseased legs exhibited significantly increased PCr time constants during the second and the third workload increment at 3 and 4 W, but not during the first increment at 2 W and recovery compared with normal controls. Only 3 diseased legs succeeded the last increment at 5 W. We detected significant correlations between the ankle brachial pressure index scores and the PCr time constants when including both the diseased and the control legs. The diseased legs showed a significant correlation with the run-off resistance only during the first increment. Our study shows that the impairment of muscle metabolism, expressed by prolonged PCr time constants, occurs with greater work intensities in patients with aorto-iliac disease compared with patients with multisegmental PAD, as recently published, whereas our patients collective exhibited normal PCr recovery time constants. Our findings may help to understand variability of clinical symptoms in aorto-iliac PAD.

Venous leg ulcer care: How evidence-based is nursing practice?

Objectives: The objectives of this study were to (1) determine how congruent community-provided leg ulcer care was with best practice for venous leg ulcers and (2) identify organizational and clinical factors associated with the provision of best practice for venous leg ulcers. Design: The practice variation study group was an audit of nursing agency client records to determine the provision of care. Setting and subjects: The study population was a home care cohort of persons with venous leg ulcers (n = 66) who received care from one Ontario home care nursing agency between March 1999 and November 1999. Instrument: The audit tool was developed with a checklist reflecting the common recommendations from 3 international practice guidelines, as well as organizational and clinical factors that may influence or reflect best practice. Results: Half of client records (35/66) included an identified etiology of the leg ulcer. An Ankle Brachial Pressure Index score was documented prior to the initiation of compression on fewer than half of the records (21/44). Regular ulcer measurement was done for 11% of the clients (7/64). Two thirds of the clients (44/66) were treated with compression. More than 60% of the clients (40/66) had been seen by either a dermatologist or a vascular surgeon. Topical antibiotics were prescribed for two thirds of clients (44/64). Fifteen percent of clients (10/66) were assessed for pain, and 17% (11/66) received some form of pain management. Documentation of client education specific to the leg ulcer was present on 3% of records (2/66). The mean number of different nurses providing leg ulcer care to each client was 19. A registered practical nurse was the classification of nurse assigned to 43.8% (29/66) of the clients. Conclusion: Several gaps were identified in the care provided. A standardized approach to care is needed that includes a comprehensive leg ulcer assessment to determine the ulcer etiology, determination of an Ankle Brachial Pressure Index score to screen for the presence of arterial disease, and compression for all clients who meet the criteria for venous disease. A reorganization of services is required, which includes an increased role for community nurses in leg ulcer assessment and management. Organizational and clinical factors influencing the delivery of best practice need to be identified and addressed. (J WOCN 2003;30:132-42.)

Venous Leg Ulcer Care

Objectives The objectives of this study were to (1) determine how congruent community-provided leg ulcer care was with best practice for venous leg ulcers and (2) identify organizational and clinical factors associated with the provision of best practice for venous leg ulcers. Design The practice variation study group was an audit of nursing agency client records to determine the provision of care. Setting and subjects The study population was a home care cohort of persons with venous leg ulcers (n = 66) who received care from one Ontario home care nursing agency between March 1999 and November 1999. Instrument The audit tool was developed with a checklist reflecting the common recommendations from 3 international practice guidelines, as well as organizational and clinical factors that may influence or reflect best practice. Results Half of client records (35/66) included an identified etiology of the leg ulcer. An Ankle Brachial Pressure Index score was documented prior to the initiation of compression on fewer than half of the records (21/44). Regular ulcer measurement was done for 11% of the clients (7/64). Two thirds of the clients (44/66) were treated with compression. More than 60% of the clients (40/66) had been seen by either a dermatologist or a vascular surgeon. Topical antibiotics were prescribed for two thirds of clients (44/64). Fifteen percent of clients (10/66) were assessed for pain, and 17% (11/66) received some form of pain management. Documentation of client education specific to the leg ulcer was present on 3% of records (2/66). The mean number of different nurses providing leg ulcer care to each client was 19. A registered practical nurse was the classification of nurse assigned to 43.8% (29/66) of the clients. Conclusion Several gaps were identified in the care provided. A standardized approach to care is needed that includes a comprehensive leg ulcer assessment to determine the ulcer etiology, determination of an Ankle Brachial Pressure Index score to screen for the presence of arterial disease, and compression for all clients who meet the criteria for venous disease. A reorganization of services is required, which includes an increased role for community nurses in leg ulcer assessment and management. Organizational and clinical factors influencing the delivery of best practice need to be identified and addressed.

Current home care expenditures for persons with leg ulcers

Objective: The purpose of this study was to gain a better understanding of the home care expenditures incurred in providing care to the population with leg ulcers. Design: The study was designed as a descriptive survey and was conducted over a 4-week period during March 1999. Setting and Subjects: Persons in a large Ontario urban center with an ulcer below the knee, including the foot, who were receiving nursing services in the home, were eligible for inclusion in the study. Instruments: A leg assessment tool, a supply usage form, and a visiting nurses log (all developed by the researchers for the study) were used to collect data. Methods: Home care nurses visited all clients and completed an in-depth assessment of their social, medical, and leg ulcer history. Legs were inspected, an ankle brachial pressure index score was determined, and ulcers were examined and measured. For each nursing visit, supply usage, travel and treatment times, and mileage were tracked. Results: During the study period, 2270 visits were made (mean treatment time = 26 minutes, mean travel time = 17 minutes) costing $80.62 (Canadian dollars). Supply costs were $21.06. The regional annual home care expenditures were conservatively estimated to be $1.3 million. Conclusion: Costs could potentially be reduced by cutting the 40% visit time attributed to travel, decreasing the visit frequency to clients with minimal drainage, and attention to “best practice.” (J WOCN 2002;29:186-92.)