Ankle-brachial Blood Pressure Index Research Articles

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.

Ankle‐brachial index long‐term outcome after first‐ever ischaemic stroke

Ankle-brachial blood pressure index (ABI) is a clinical tool to identify the presence of peripheral artery disease. There is a scarcity of data associating ABI with long-term outcome in patients with IS. The association between ABI and long-term outcome in patients with first-ever acute IS was assessed. Ankle-brachial blood pressure index was assessed in all consecutive patients with a first-ever acute IS admitted at Alexandra University hospital (Athens, Greece) between January 2005 and December 2010. ABI was considered normal when > 0.90 and ≤ 1.30. The Kaplan-Meier product limit method was used to estimate the probability of 5-year composite cardiovascular event-free (defined as recurrent stroke, myocardial infarction or cardiovascular death) and overall survival. A multivariate analysis was performed to assess whether ABI is an independent predictor of 5-year mortality and dependence. Amongst 653 patients, 129 (19.8%) with ABI ≤ 0.9 were identified. Five-year cumulative composite cardiovascular event-free and overall survival rates were better in normal ABI stroke patients (log-rank test: 7.22, P = 0.007 and 23.40, P < 0.001, respectively). There was no difference in 5-year risk of stroke recurrence between low and normal ABI groups (hazard ratio, HR = 1.23, 95% CI 0.68-2.23). In multivariate Cox regression analysis, independent predictors of 5-year mortality included age (HR = 2.55 per 10 years, 95% CI 1.86-3.48, P < 0.001), the National Institutes of Health Stroke Scale (per point increase HR = 1.12, 95% CI 1.08-1.16, P < 0.001), and low ABI (HR = 2.22, 95% CI 1.22-4.03, P = 0.009). Age (HR = 1.21 per 10 years, 95% CI 1.01-1.45, P = 0.04) and low ABI (HR = 1.72, 95% CI 1.11-2.67, P = 0.01) were independent predictors of the composite cardiovascular end-point. Low ABI in patients with acute IS is associated with increased 5-year cardiovascular event risk and mortality. However, ABI does not appear to predict long-term stroke recurrence.

SAT0274 Peripheral Artery Disease in Psoriatic Arthritis: Overlooked?

BackgroundInflammation plays a role in the pathogenesis of psoriatic arthritis (PsA) and also in the pathogenesis of atherosclerosis. The importance of vascular disease related to atherosclerosis in terms of cardiovascular(CVS)...

Four-Limb Blood Pressure as Predictors of Mortality in Elderly Chinese

The predictive value of blood pressure (BP) for cardiovascular morbidity and mortality diminishes in the elderly, which may be confounded and compensated by the BP differences across the 4 limbs, markers of peripheral arterial disease. In a prospective elderly (≥60 years) Chinese study, we performed simultaneous 4-limb BP measurement using an oscillometric device in the supine position, and calculated BP differences between the 4 limbs. At baseline, the mean age of the 3133 participants (1383 men) was 69 years. During 4 years (median) of follow-up, all-cause and cardiovascular deaths occurred in 203 and 93 subjects, respectively. In multiple regression analyses, arm BPs on the higher arm side of systolic BP did not predict mortality (P≥0.06) except for a negative association between mean arterial pressure and total mortality (P=0.04). However, in adjusted analyses, the hazard ratios associated with a 1-SD decrease in ankle-brachial BP index or increase in interarm or interankle BP difference were 1.15 to 1.23 for total mortality (P≤0.01) and 1.17 to 1.24 for cardiovascular mortality (P≤0.04). In categorical analyses, similar results were observed for a decreased ankle-brachial index (≤0.90, ≤0.95, or ≤1.00) or increased interarm or interankle difference (≥15 mm Hg or ≥10 mm Hg). In conclusion, in the elderly, above and beyond arm BP level and together with ankle-brachial index, the interarm and interankle BP differences improve prediction of mortality. Simultaneous 4-limb BP measurement has become feasible with current technology and might be useful in cardiovascular prevention.

ASSA13-14-6 Effect of Different Body Mass Index and Waist Circumference on Arterial Elasticity in Essential Hypertension

<h3>Objective</h3> To investigate the effect of different body mass index (BMI) and waist circumference on arterial elasticity in essential hypertension. <h3>Methods</h3> The basic information was collected in a total of 776 essential hypertensive patients. According to BMI and waist circumference level, all patients were divided into four groups, namely, normal BMI and normal waist circumference group (Igroup, <i>n</i> = 194 cases), normal BMI and elevated waist circumference group (IIgroup, <i>n</i> = 195 cases), excessive BMI and normal waist circumference group (III group, <i>n</i> = 196 cases), excessive BMI and elevated waist circumference group (IVgroup, <i>n</i> = 191 cases). Brachial ankle pulse wave velocity (baPWV) and ankle-brachial blood pressure index (ABI) were observed in all patients. Arterial stiffness index (AI) was calculated using the blood lipid of all hypertension patients. <h3>Results</h3> baPWV (2120 ± 263) and AI (3.35 ± 0.87) in IV group were significantly higher than Igroup (<i>P</i> &lt; 0.01), IIgroup and III group (<i>P</i> &lt; 0.05). ABI (0.72 ± 0.15) in IV group were significantly lower than Igroup (<i>P</i> &lt; 0.01), IIgroup and III group (<i>P</i> &lt; 0.05). There were no statistical differences between IIgroup and III group in ABI and AI (<i>P</i> &gt; 0.05). Results of 2 × 2 factorial analysis showed that there was a distinctive and synergistic effect between excessive BMI and elevated waist circumference on arterial stiffness. <h3>Conclusions</h3> Arterial elasticity function was aggravated damaged in essential hypertension in patients with abdominal obesity. Excessive BMI and elevated waist circumference had interaction and synergistic effect on the damage of arterial elasticity function.

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Correlation between plasma lipoprotein-associated phospholipase A2 and peripheral arterial disease

Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a recently identified and potentially useful plasma biomarker for cardiovascular diseases. However, its role in peripheral arterial disease (PAD) remains unclear. The objective of this study was to assess the independent association of Lp-PLA2 and other inflammatory markers with the reduced ankle-brachial blood pressure index (ABI), a marker of PAD. We performed a cross-sectional study in 982 individuals aged ≥40 years who were recruited from the First Affiliated Hospital of Zhengzhou University. PAD was defined as an ABI <0.9 in at least one leg. The individuals were further divided into two groups, 145 with PAD and 837 without PAD. Following adjustment for traditional cardiovascular risk factors, the odds ratios of PAD when comparing the highest to the lowest quartiles were 3.24 (95% CI, 1.68–3.94) for Lp-PLA2, 2.14 (95% CI, 1.07–3.11) for homocysteine, 1.93 (95% CI, 1.02–4.01) for fibrinogen, 2.26 (95% CI, 1.32–5.74) for apolipoprotein B and 1.3 (95% CI, 0.75–2.49) for high-sensitivity C-reactive protein (hsCRP). When Lp-PLA2 and inflammatory markers were simultaneously included in the full model, the corresponding odds ratios were 1.81 (95% CI, 1.14–3.68) for Lp-PLA2, 1.15 (95% CI, 0.49–2.69) for homocysteine, 1.21 (95% CI, 0.88–5.57) for fibrinogen, 0.98 (95% CI, 0.51–3.85) for apolipoprotein B and 1.23 (95% CI, 1.12–3.51) for hsCRP. Lp-PLA2 levels were significantly and independently associated with PAD following adjustment for other inflammatory markers. These findings reflect the potential role of circulating Lp-PLA2 as a marker of atherosclerosis.

Effects of the Ankle-brachial Blood Pressure Index and Skin Perfusion Pressure on Mortality in Hemodialysis Patients

Clinically, the ankle-brachial blood pressure index (ABI) and skin perfusion pressure (SPP) are used to screen for subclinical peripheral artery disease. However, the association between the SPP and mortality in hemodialysis patients has not been previously reported. We investigated these factors and compared the ABI and SPP in patients receiving hemodialysis. A total of 102 patients receiving maintenance hemodialysis were enrolled in this study. The ABI was determined using an ABI-form (Colin, Japan). The SPP was measured using a SensiLase(TM) PAD3000 (Kaneka, Osaka, Japan). The mean follow-up period was 3.2 ± 1.4 years. A multivariate Cox analysis identified a low ABI (p=0.019) and a low SPP (p=0.047) as being independent predictors of mortality. A receiver operating characteristic (ROC) analysis of the ABI revealed a cutoff point of 1.1 and an area under the curve (AUC) of 0.79, with a sensitivity of 90% and a specificity of 62%. A ROC analysis of the SPP revealed a cutoff point of 54.0 mmHg and an AUC of 0.71, with a sensitivity of 55% and a specificity of 84%. Both low ABI and SPP values were found to be independent risk factors for mortality among hemodialysis patients. The cutoff point for ABI as a predictor of mortality was 1.1, while that for SPP was 54.0 mmHg.

Investigation on Cardiovascular Risk Prediction Using Physiological Parameters

Cardiovascular disease (CVD) is the leading cause of death worldwide. Early prediction of CVD is urgently important for timely prevention and treatment. Incorporation or modification of new risk factors that have an additional independent prognostic value of existing prediction models is widely used for improving the performance of the prediction models. This paper is to investigate the physiological parameters that are used as risk factors for the prediction of cardiovascular events, as well as summarizing the current status on the medical devices for physiological tests and discuss the potential implications for promoting CVD prevention and treatment in the future. The results show that measures extracted from blood pressure, electrocardiogram, arterial stiffness, ankle-brachial blood pressure index (ABI), and blood glucose carry valuable information for the prediction of both long-term and near-term cardiovascular risk. However, the predictive values should be further validated by more comprehensive measures. Meanwhile, advancing unobtrusive technologies and wireless communication technologies allow on-site detection of the physiological information remotely in an out-of-hospital setting in real-time. In addition with computer modeling technologies and information fusion. It may allow for personalized, quantitative, and real-time assessment of sudden CVD events.

Smoking, Menthol Cigarettes, and Peripheral Artery Disease in U.S. Adults

Cigarette flavorings, with the exception of menthol, have been banned in the United States under the Family Smoking Prevention and Tobacco Control Act. Given the large number of menthol cigarette smokers in the United States, we investigated whether cigarette type (nonmenthol or menthol) is associated with peripheral artery disease (PAD). The authors studied 5,973 adults, 40 years of age and older, who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2004. Smoking status and cigarette type were derived from self-reported questionnaires. PAD was defined as an ankle-brachial blood pressure index <0.9 in at least 1 leg. Fifty percent of participants were never-smokers compared to 31%, 14%, and 5% of former, current nonmenthol, and current menthol cigarette smokers, respectively. The weighted prevalence of PAD in the study population was 5%. After multivariable adjustment, the odds ratios for PAD were 1.44 (95% CI: 0.97, 2.15), 3.65 (95% CI: 1.57, 8.50), and 2.51 (95% CI: 1.09, 5.80) comparing former, current nonmenthol cigarette smokers, and current menthol cigarette smokers to never-smokers. The associations between smoking and PAD were similar for smokers of nonmenthol and menthol cigarettes (p value for heterogeneity = .59). In a representative sample of the U.S. population, current use of both menthol and nonmenthol cigarettes was associated with increased prevalence of PAD, with no difference in risk between cigarette types.

Nutritional Status and Intrarenal Resistive Indices after Kidney Transplantation

Background: Accumulation of adipose tissue is an important factor known to initiate and accelerate the development of atherosclerosis. On the other hand, intrarenal resistive indices are associated with age, surrogates of atherosclerosis (intima-media thickness, pulse wave velocity, ankle-brachial blood pressure index) and past cardiovascular episodes in kidney transplant patients. The aim of this study is to analyze the influence of nutritional status on intrarenal resistive parameters measured by Doppler ultrasound in an early period after kidney transplantation. Methods: 552 consecutive first cadaveric kidney graft recipients transplanted from 1998 to 2010 were analyzed. Patients with primary graft nonfunction and acute rejection episodes within an early posttransplant period were excluded from the study. Nutritional status was scored according to WHO criteria. Both pulsatility (PI) and resistance (RI) indices in the kidney graft were measured by Doppler sonography twice: at 2-4 day after transplant and before the patient's discharge from the hospital [at mean 22 (95%CI 21-23) posttransplant day]. Results: There was 30 underweight (UW), 295 normal weight (NW), 188 overweight (OW) and 39 obese (OB) in the analyzed group. In both measurements PI and RI values were significantly higher (p< 0.02) in obese than in underweight and normal weight patients. In the first measurement, PI and RI were as followed: UW 1.57 (1.32-1.82) and 0.76 (0.71-0.81); NW 1.60 (1.53-1.67) and 0.79 (0.77-0.80); OW 1.68 (1.59-1.76) and 0.82 (0.80-0.84); OB 2.02 (1.81-2.23) and 0.87 (0.84-0.91), respectively. While, in the second measurement they were: UW 1.35 (1.27-1.43) and 0.71 (0.69-0.73); NW 1.43 (1.39-1.48) and 0.73 (0.72-0.74); OW 1.53 (1.47-1.59) and 0.75 (0.74-0.76); OB 1.70 (1.51-1.88) and 0.79 (0.76-0.81), respectively. In the multiple regression analysis, the influence of BMI on PI and RI values was independent of diabetes mellitus comorbidity and the recipient's age. Conclusions: 1. Obesity is associated with increased vascular resistance within the kidney graft. 2. Nutritional status has to be taken under consideration in the proper interpretation of intrarenal Doppler measurements in these patients.

Perfluorooctanoic Acid and Cardiovascular Disease in US Adults

Cardiovascular disease (CVD) is a major public health problem. Identifying novel risk factors for CVD, including widely prevalent environmental exposures, is therefore important. Perfluorooctanoic acid (PFOA) is a manmade chemical used in the manufacture of common household consumer products. Biomonitoring surveys have shown that PFOA is detectable in the blood of more than 98% of the US population. Experimental animal studies suggest that an association between PFOA and CVD is plausible. However, this association in humans has not been previously examined. We therefore examined the independent relationship between serum PFOA levels and CVD outcomes in a representative sample of Americans. We examined 1216 subjects (51.2% women) from the 1999-2003 National Health and Nutritional Examination Survey. Serum PFOA levels were examined in quartiles. The main outcomes of interest were self-reported CVD, including coronary heart disease and stroke, and objectively measured peripheral arterial disease (PAD), defined as an ankle-brachial blood pressure index of less than 0.9. We found that increasing serum PFOA levels are positively associated with CVD and PAD, independent of confounders such as age, sex, race/ethnicity, smoking status, body mass index, diabetes mellitus, hypertension, and serum cholesterol level. Compared with quartile 1 (reference) of PFOA level, the multivariable odds ratio (95% CI) among subjects in quartile 4 was 2.01 (1.12-3.60; P = .01 for trend) for CVD and 1.78 (1.03-3.08; P = .04 for trend) for PAD. Exposure to PFOA is associated with CVD and PAD, independent of traditional cardiovascular risk factors.

Biological Determinants of Postural Disorders in Elderly Women

ABSTRACTPostural control impairments and dizziness, which are major health problems with high secondary morbidity and mortality, increase with aging. Elevated homocysteine (Hcy) level is an age-related metabolic disorder, known to be involved in cardiovascular, neurological, and multisensory dysfunctions. Elevated Hcy level might be involved in sensory balance control systems impairment and dizziness occurrence. Dizziness, fitness Instrumental Activity of Daily Living scale (fitness IADL), systolic arterial pressure with ankle-brachial blood pressure index and homocysteinemia were studied in 61 noninstitutionized elderly women. Clinical balance tests (timed “Up and Go”, 10-m walking and one-leg balance) and posturography (including sensory conflicting situations [SCS] and cognitive conflicting situations [CCS]) were performed. Clinical balance control was lower in dizzy women who presented particularly poor stability in SCS. Dizziness was related to low fitness IADL scores (odds ratio [OR] 0.452, 95% CI 0.216–0.946) and to elevated Hcy (OR 8.084, 95% CI 1.992–32.810). Elevated Hcy was correlated with balance disorders both in SCS and CCS. Dizziness is associated with a reduced ability in balance control management. Hcy is related both to dizziness and low postural performance. This relation between elevated Hcy levels and balance impairments, resulting in dizziness, may be explained by its angiotoxicity and neurotoxicity.

409 USE OF ANKLE-BRACHIAL BLOOD PRESSURE INDEX AND PULSE WAVE VELOCITY IN THE PREDICTION OF MORTALITY IN ELDERLY CHINESE

Objectives: We investigated the usefulness of combining ankle-brachial blood pressure index (ABI) with pulse wave velocity (baPWV) in the prediction of mortality in elderly Chinese. Methods: The subjects of our prospective observational study were older persons (≥60 years) living in a suburb town of Shanghai. In addition to the measurement of ABI and baPWV using an Omron device, we also measured conventional cardiovascular risk factors at baseline, and collected vital information during follow-up. Results: At baseline, the study participants (n = 3161, 1391 men [44.0%]) had a mean age of 69 years (±7 [SD]), and included 1897 (60.0%) hypertensive and 291 (9.2%) diabetic patients. During a mean follow-up of 4 years, the number of all-cause and cardiovascular deaths was 205 and 95, respectively. Subjects with an ABI of ≤0.9 (n = 84 [2.7%]), compared to those with an ABI greater than 0.9, had a significantly (P < 0.0001) higher incidence rate (per 1000 person-years) of total (73.4 vs. 15.0) and cardiovascular mortality (43.3 vs. 5.9). After exclusion of 84 subjects with an ABI of ≤0.9, we performed analysis on baPWV, and found that subjects in the top quartile of baPWV (>20 m/s), compared to rest 3 quartiles, had a significantly (P < 0.01) higher incidence rate of total (28.2 vs. 10.9) and cardiovascular mortality (15.5 vs. 3.9). However, after adjustment for sex, age and conventional cardiovascular risk factors, only the association between ABI and total mortality remained significant (P = 0.009). Conclusions: In conclusion, in elderly Chinese, ABI but not baPWV is independently predictive of total mortality.

Low ankle-brachial index is an independent predictor of poor functional outcome in acute cerebral infarction

ObjectiveThe ankle-brachial blood pressure index (ABI) is an established clinical test for assessment of peripheral arterial disease and an indicator of generalized atherosclerosis. We investigated whether low ABI is associated with long-term functional outcome in patients with acute cerebral infarction. MethodsWe included 775 patients with acute cerebral infarction who were admitted within 7 days from stroke onset and had completed an ABI measurement during admission. Poor functional outcome was defined as a modified Rankin Scale of more than 2 at three months from stroke onset. The association between low ABI and poor functional outcome was analyzed using logistic regression analysis. ResultsA low ABI (<0.9) was present in 10.1% of patients. At three months from stroke onset, 16.9% of patients showed poor functional outcome (mRS > 2). After adjusting for conventional cardiovascular risk factors and the presence of cerebral atherosclerosis, a low ABI was independently associated with poor functional outcome (odds ratio 2.523, 95% CI 1.330–4.785, p = 0.005). ConclusionsThe presence of a low ABI was associated with an increased risk of poor functional outcome in patients with acute cerebral infarction. Screening for low ABI among stroke patients may be necessary to identify individuals at increased risk of poor functional outcome. Proper and individualized treatment for patients with a low ABI may improve long-term functional outcome following acute cerebral infarction.

Role and Management of Coagulation Disorders in Peripheral Arterial Disease

Peripheral arterial disease (PAD) has often underlying risk factors, of which diabetes and cigarette smoking are the most common. Enhanced platelet activation and interaction with vessel wall associate with atherothrombotic disease, but also increased fibrinogen levels, thrombin generation and fibrin turnover are typical for PAD. The pathogenic role of fibrinogen, thrombin formation and fibrin degradation is suggested not only in acute thrombotic complications, but also in the stable form of PAD, where these markers associate with the functional severity (ankle-brachial blood pressure index). The coagulation-specific etiologies of PAD should be suspected if the atherothrombotic disease has severe manifestations, especially while the traditional risk factors are absent, or if the patient has also a history of venous thromboembolism. Malignant disease may be present in form of peripheral arterial thrombosis as well. Thrombophilia may expose patients to idiopathic thrombosis--both spontaneously and after vascular interventions. The management of these patients includes often combination therapies with antiplatelet agents and anticoagulants. Obviously, the strict policy to avoid risk factors and to treat them well in avoidance of progression of arterial disease is highly important. In the absence of published follow-up data the evidence to support the management strategies is weak and individual tailoring of efficacious and safe antithrombotic drug therapy remains our challenge. These patients benefit from continuous medical attention by the experts in the field of angiology. Management of PAD is an excellent example of the multidisciplinary approach where the hematologist meets the vascular surgeon or interventional radiologist to secure the best available patient care.

Clinical fi ndings associated with cardiovascular autonomic dysfunction in adult sickle cell anaemia patients

Background Involvement of the cardiovascular autonomic nervous system in various diseases is often associated with increased morbidity and mortality.Objective The objective of this study was to examine the clinical features associated with cardiovascular autonomic neuropathy (CAN) in adult Nigerians with sickle cell anaemia.Methods A cross-sectional study was carried out on 62 steady state sickle cell anaemia patients recruited from the adult out-patient clinic. Cardiovascular autonomic dysfunction was determined based on abnormal values in at least two of fi ve non-invasive tests: Valsalva manoeuvre, heart rate variation during deep breathing, heart rate response to standing, blood pressure response to sustained handgrip, and blood pressure response to standing. All the subjects were initially evaluated in the clinic for symptoms of cardiovascular disease and peripheral vascular disease, and then clinically examined to assess their cardiovascular and neurological status at rest.Results Out of the 44 patients with cardiovascular autonomic neuropathy 23 were males, while 21 were females. The mean ages were 28.3 ± 5.8 y for patients with CAN and 28.0 ± 5.0 y for patients without CAN (P= 0.817). Sickle cell anaemia patients with CAN had signifi cantly lower ankle systolic blood pressure, reduced ankle brachial blood pressure index, mean arterial blood pressure and haematocrit than patients without CAN. Of all the variables evaluated leg ulcers, postural dizziness, erectile dysfunction in men, and history of recurrent acute chest syndromes were found signifi cantly more in patients with CAN than without. Clinical abnormalities tend to worsen with increasing degree of cardiovascular autonomic dysfunction.Conclusion Signifi cant cardiac morbidity is associated with abnormal cardiovascular autonomic function in sickle cell anaemia.

Abstract P144: Smoking, Menthol Cigarettes and Peripheral Arterial Disease in the 1999– 2004 National Health and Nutrition Examination Survey (NHANES)

Introduction: Cigarette flavorings, with the exception of menthol, have been banned under the Family Smoking Prevention and Tobacco Control Act. Previous studies have found strong associations between active smoking and peripheral arterial disease. While there is substantial interest in evaluating the health effects of menthol as compared to regular cigarette use, no information is available on the influence of cigarette type (non-menthol or menthol) on the risk of peripheral arterial disease. Objective: To investigate the association of cigarette smoking, menthol cigarette use and the prevalence of peripheral arterial disease in US adults Methods: We studied 5,978 adults 40 years of age and older who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999–2004. Information on participant smoking status and cigarette type were derived from self-reported questionnaire data. Peripheral arterial disease was defined as an ankle-brachial blood pressure index &lt;0.9 in at least one leg. Results: The weighted prevalence of peripheral arterial disease in the study population was 4.9%. Fifty percent of participants were never smokers compared to 31%, 14% and 5% of former, current non-menthol and current menthol cigarette smokers, respectively. After adjustment for demographics and cardiovascular risk factors, the odds ratio for peripheral arterial disease was 1.98 (95% CI: 1.41, 2.80), 5.24 (95% CI: 3.41, 8.05), 3.37 (95% CI: 1.86, 6.10) comparing former, current regular cigarette smokers and current menthol cigarette smokers to never smokers. After further adjustment for pack-years and serum cotinine, the odds ratio for peripheral arterial disease was 1.44 (95% CI: 0.97, 2.15), 3.65 (95% CI: 1.57, 8.50) and 2.51 (95% CI: 1.09, 5.80) comparing former, current regular cigarette smokers and current menthol cigarette smokers to never smokers. The significant association between smoking and peripheral arterial disease was similar for smokers of non-menthol and menthol cigarettes (p-value for heterogeneity= 0.53). Conclusions: In a representative sample of the US population, current menthol cigarette use was associated with increased prevalence of peripheral arterial disease with no difference compared to smoking non-menthol cigarettes.

An evaluation of ankle-brachial blood pressure index in adult Nigerians with sickle cell anaemia

There are few studies to be found in the literature on ankle-brachial index in sickle cell disease. The aim of this study was to compare ankle-brachial index of steadystate adult sickle cell anaemia patients with that of normal controls. A descriptive cross-sectional study of 62 sickle cell anaemia patients and 62 age- and gender-matched normal controls was carried out in the adult outpatient sickle cell clinics and the cardiac centre of the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria from February to August 2007. The supine brachial and ankle blood pressures were measured separately with the cuff of the mercury sphygmomanometer applied to the right arm and right calf, respectively. The ankle systolic blood pressure was lower in patients with sickle cell anaemia than in the controls (p < 0.001). The mean indices for ankle-brachial index were 0.88 ± 0.09 and 1.03 ± 0.06, respectively for patients and controls. This difference was statistically significant (p < 0.001). Seventy three per cent of the patients had ankle-brachial index less than 0.9 compared with controls (5%). This was also significant (p < 0.001).

Low serum adiponectin level is predictor of arterial stiffness in new onset diabetes after renal transplantation

Background: The purpose of this study was to determine whether the level of adiponectin in serum of renal transplant patients is associated with arterial stiffness related to new onset diabetes after transplantation (NODAT). Methods: A total of 90 previously non-diabetic patients who underwent renal transplantation between 1999 and 2009 were enrolled. We evaluated their diabetic risk factors, lipid profiles, brachial-ankle pulse wave velocity (baPWV), ankle-brachial blood pressure index (ABPI) and serum adiponectin level before and after transplantation. Results: Eleven (12.2%) patients were diagnosed with NODAT and 79 (87.8%) without (non-NO-DAT). The mean post-transplant serum adiponectin level in NODAT patients was significantly lower than that in non-NODAT patients (11.9 vs. 16.4 μg/ml, p = 0.01), whereas the mean baPWV level in NODAT patients was significantly higher (1686 vs. 1468 cm/s, p = 0.016). We found a significant inverse correlation between mean pre-transplant serum adiponectin and baPWV level (r = -0.27, p = 0.011). Furthermore, patients with lower pretransplant serum adiponectin levels (<20 μg/ml) developed NODAT significantly more frequently than those with higher levels (p = 0.038) and the mean baPWV level in the former was also significantly higher (1520 vs. 1412 cm/s, p = 0.047). Conclusion: Our results indicate that low pre-transplant serum adiponectin level is associated with arterial stiffness in development of NODAT in patients who undergo renal transplantation.