Asymptomatic Peripheral Arterial Disease Research Articles

Urinary vanin-1 as a novel biomarker for survival in peripheral artery disease.

Chronic kidney disease is associated with increased rates of incidence, morbidity, and mortality in lower-extremity peripheral artery disease (PAD). No specific marker for a functional risk assessment of kidney disease in PAD is known, especially at the early stages. Thus, we speculated that urinary vanin-1 (uVNN1), a marker of oxidative stress even in early kidney injury, could further stratify outcome assessment in patients with PAD. Patients with stable PAD (n = 304) of the Vienna medical cohort were followed up for up to 10 years and the outcome was assessed by central death database queries. uVNN1 was measured by enzyme-linked immunosorbent assay (ELISA) at study inclusion and normalized to urinary creatinine (uVNN1/Cr). During the observation time (9.3, 7.0-9.8 years), 104 patients died, 54.8% of which were due to cardiovascular causes. uVNN1/Cr was associated with a urine albumin-creatinine ratio (UACR) (R = 0.166, p = 0.004) but not with an estimated glomerular filtration rate (R = 0.102, p = 0.077). Levels of uVNN1/Cr did not differ between asymptomatic and symptomatic PAD (p = 0.406). Kaplan-Meier curves showed a clear-cut association with higher all-cause (log-rank p = 0.034) and cardiovascular mortality (log-rank p = 0.032) with higher uVNN1/Cr levels. Similarly, significant associations for all-cause (hazard ratio [HR] 1.34, 95% CI [1.08-1.67], p = 0.009) and cardiovascular mortality (HR 1.45, 95% CI [1.06-1.99], p = 0.020) could be seen in multivariable Cox regression models. uVNN1/Cr showed an independent association with both all-cause and cardiovascular mortality in patients with PAD and was associated with early kidney disease. Thus, uVNN1 could be a useful marker for risk stratification of kidney disease in PAD.

Impact of a Quality Improvement Initiative on Medical Management of Veterans With Peripheral Artery Disease

Guideline-directed medical therapy (GDMT) for peripheral artery disease (PAD) remains severely underused. Prevention of Amputation in Veterans Everywhere (PAVE) is a screening program designed to prevent or delay major lower extremity amputation. This study aimed to determine whether diagnosis of PAD through the PAVE program improves the prescription of GDMT in veterans with asymptomatic PAD. Patients enrolled into the PAVE program from our institution from 2020 to 2021 were included. Patients with an abnormal ankle-brachial index (ABI), defined as ABI <0.9 or >1.2, were selected for further analysis. Primary outcome was adherence to GDMT, following class I and class IIa recommendations. Secondary outcomes included changes in low-density lipoprotein (LDL), blood pressure, and hemoglobin A1c (HbA1c). A total of 6,313 patients were enrolled into the PAVE program between 2020 and 2021. Of these, 211 had abnormal ABI and were included in our analysis. With enrollment into PAVE, there was significant increase in the prescription of aspirin (74.4% vs 64.9%, p = 0.044) and statins (91.5% vs 82%, p = 0.006). The overall adherence to GDMT significantly increased (56.9% vs 38.9%, p <0.001). The number of patients needed to enroll in PAVE to improve GDMT adherence is 5.6 (95% confidence interval 3.6 to 12.3). Patients enrolled into PAVE program saw significant decreases in HbA1c, with mean decrease of 0.3 (p = 0.012) and a decrease in LDL, with a mean decrease of 6.2 (p = 0.01). In conclusion, enrollment into an amputation prevention program secondarily increased adherence to GDMT, driven by increases in the prescription of statins and aspirin, with resulting decreases in HbA1c and LDL.

Ankle Brachial Index as Diagnostic Marker for Asymptomatic Peripheral Arterial Disease in Diabetes Mellitus

Objective: To determine ankle brachial index (ABI) as a diagnostic marker for asymptomatic peripheral arterial disease (PAD) in diabetes mellitus (DM). Study Design: Cross-sectional study. Place and Duration of Study: Combined Military Hospital, Hyderabad, Pakistan from Jan to Sep 2022. Methodology: A total of one hundred and seventy (n=170) asymptomatic patients with DM were included. Specific details were recorded, which include HbA1c levels, duration of diabetes and ankle brachial index. Results: There were 60.0% male and 40.0% female patients. With the mean age of 50.60±11.55 years. The mean duration of diabetes mellitus was 4.20±1.97 years. Mean HbA1c was 7.41±1.27%, mean ABI was 1.03±0.13. Peripheral arterial disease was observed in 17.05% of asymptomatic cases using ABI, with ABI sensitivity of 82.86% and specificity of 97.24% in detecting asymptomatic PAD patients. It was significantly associated with an increase in the duration of diabetes. Conclusion: Asymptomatic peripheral arterial disease diagnosed through the ankle brachial index showed that it is a reliable source for diagnosing patients with asymptomatic PAD in diabetes mellitus reported in routine clinical visits.

Serum Trefoil Factor-3 Predicts Survival in Peripheral Artery Disease.

Trefoil factor 3 (TFF3) has been studied in processes leading to atherosclerosis. Data are scarce in manifest disease and missing in peripheral artery disease (PAD). This study aims to elucidate TFF3 with disease stages, degrees of atherosclerosis, and outcomes. TFF3 was measured in serum in 364 PAD patients without critical limb ischemia and mild to moderate chronic kidney disease (CKD). Mortality data were retrieved from the Austrian central death registry (median observation 9.6years). Survival analyses were performed using Cox regression and the Kaplan-Meier method. A negative association between ankle-brachial index and TFF3 (P < .001) was observed, while levels were similar in asymptomatic and symptomatic PAD. TFF3 increased with history of cardiovascular and cerebrovascular disease (P < .001). TTF3 was associated with the estimated glomerular filtration rate (R = -0.617, P < .001) and urinary albumin-creatinine ratio (R = 0.229, P < .001). One SD increase in TFF3 showed a worsening in all-cause mortality (hazard ratio 1.68, CI 1.37-2.05) which persisted after multiple adjustment for cardiovascular risk, inflammatory, and angiogenetic markers (hazard ratio 1.35, CI 1.01-1.81). This study is the first to link TFF3 with both disease markers and outcomes in PAD. TFF3 demonstrated associations with renal function, PAD severity measured by ankle-brachial index, and additional atherosclerotic burden in PAD.

Clinical Practice Recommendations for Antithrombotic Management of Peripheral Artery Disease: An Indian Perspective

Abstract Currently, there are no guidelines or consensus recommendations on the antithrombotic management of peripheral artery disease (PAD) from an Indian perspective. In this article, we have summarized clinical practice recommendations on antithrombotic management of (i) asymptomatic chronic PAD (cPAD), (ii) symptomatic cPAD (intermittent claudication [IC] and chronic limb-threatening ischemia [CLTI]), and (iii) after revascularization (endovascular and surgical). An electronic search of the PubMed database was undertaken to identify relevant articles. Various combinations of keywords such as PAD, chronic peripheral arterial disease, asymptomatic chronic peripheral arterial disease, symptomatic chronic peripheral arterial disease, dual antiplatelet therapy, single antiplatelet therapy, dual pathway inhibition, antithrombotic, revascularization, endovascular, and surgical were used. Randomized controlled trials, case reports, practice guidelines, systematic literature reviews, and meta-analyses were screened and assessed. A roundtable meeting of experts (n = 13) was conducted to arrive at clinical practice recommendations. Experts made their decisions based on the evidence and guideline recommendations. In patients with asymptomatic cPAD and significant peripheral artery stenosis (PAS), long-term single antiplatelet therapy may be considered at the discretion of the clinician. There is no clear evidence in favor of long-term dual antiplatelet therapy in symptomatic cPAD. Experts agreed that low-dose rivaroxaban plus aspirin should be considered in patients with asymptomatic cPAD with &gt;50% PAS and conditions such as diabetes and polyvascular disease. This combination was also suggested in patients with IC, CLTI, postendovascular (stent based/nonstent), and surgical revascularization to reduce cardiovascular and limb ischemic risk, including major amputation in the absence of high bleeding risk or other contraindications.

TO STUDY OCCURRENCE OF PERIPHERAL ARTERIAL DISEASE IN YOUNG PATIENTS WITH CORONARY ARTERY DISEASE USING ANKLE BRACHIAL INDEX -A SMS HOSPITAL BASED OBSERVATIONAL STUDY

Background: Coronary artery disease (CAD) and peripheral arterial disease (PAD) both are manifestations of systemic atherosclerosis. Many patients with CAD have associated PAD however, many patients are asymptomatic and thus remain underdiagnosed. Currently, little is known about the actual incidence and clinical implications of asymptomatic PAD in young patients less than 50-year-old undergoing coronary angiography in Indian population, so we will conduct this study to assess the prevalence of previously unrecognized PAD among patients with suspected ischemic heart disease undergoing coronary angiography, and to determine the relationship among PAD, severity of coronary angiographic stenosis, and major cardiovascular risk factors, in western Indian population. Method: This is an observational study conducted at a tertiary referral hospital. A total of 395 patients referred for coronary angiography without a prior diagnosis of PAD, between January 2023 to June 23 who fulfilling eligibility criteria of study, were included. Patients were evaluated through detailed medical history taking, a questionnaire survey to assess symptoms and functional status, ankle-brachial index (ABI) measurement, and coronary angiography. PAD was considered present if the ABI was&lt; 0.90 in either leg. Result: In all patients, the prevalence of previously unrecognized PAD was 5.8%. There was significant difference between men and women (7.2% vs 1.1%, P=0.027). Abnormal angiographic results were seen in 63% (249 of 395). The prevalence of PAD was 7.2% in patients with abnormal coronary angiographic result, higher than that in patients with normal results but not statistically significant (3.2%, P=0.119). Patients with PAD were significantly older, and had higher rates of hypertension, dyslipidaemia, diabetes mellitus, current smoking, history of CAD than patients without PAD demonstrating high occurrence of PAD strongly associated with conventional risk factor for CAD. The occurrence of asymptomatic PAD was more among stable ischemic heart disease group(p=0.04). In our analysis, patients with PAD had a more severe form of CAD manifested by a higher frequency of multivessel coronary disease(p=0.002). Conclusion: The high occurrence of asymptomatic PAD in young patients with CAD confirms the importance of active screening for PAD by using ABI even in young patients. Routine determination of ABI in the clinical evaluation of all patients with CAD may helpful inidentifyhigh-risk patients.

A cross-sectional study in type 2 diabetes patients reveals that elevated pulse wave velocity predicts asymptomatic peripheral arterial disease associated with age and diabetes duration

BackgroundPeripheral arterial disease (PAD) reduces functional capacity and raises cardiovascular risks, but underdiagnosis is common, resulting in less comprehensive care than other cardiovascular conditions. While diabetes has long been viewed as a key risk factor for PAD, recent studies indicate that its impact is influenced by the presence of concurrent cardiovascular risk factors. The aim of this study is to elucidate the intricate relationship between the prevalence of PAD, diabetic complications, and cardiovascular risk factors among asymptomatic patients with type 2 diabetes mellitus (T2DM). MethodsNinety-one patients with T2DM and no symptoms or previous diagnosis of PAD were recruited from the outpatient diabetic clinic. Clinical data were extracted from electronic medical records, and the screening for PAD was conducted using MESI mTABLET. ResultsScreening for PAD among asymptomatic individuals with T2DM revealed that 5.49 % of patients exhibit a low ankle-brachial index (ABI). Patients who had previously experienced major adverse cardiovascular events or exhibited albuminuria displayed lower ABI values. Furthermore, a striking 45.05 % of the participants displayed an abnormally high carotid-femoral pulse wave velocity (cfPWV) value, with elevated PWV values correlating with advanced age and longer diabetes duration. ConclusionsThe prevalence of elevated cfPWV is more pronounced than that of decreased ABI in T2DM patients with asymptomatic PAD and is associated with older age and longer diabetes duration, therefore measurement of both ABI and PWV is crucial for the cardiovascular risk assessment protocol for patients with T2DM and timely PAD diagnosis.

Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Asymptomatic Lower Limb Peripheral Arterial Disease and Intermittent Claudication

Editor's Choice -- European Society for Vascular Surgery (ESVS) 2024 Clinical Practice Guidelines on the Management of Asymptomatic Lower Limb Peripheral Arterial Disease and Intermittent Claudication

The Indian Consensus Statement for the Management of Lower Extremity Peripheral Artery Disease

Peripheral arterial disease (PAD) is one of the underdiagnosed and undertreated vascular diseases despite its significant burden in India. In India, the etiological aspects, diagnostic approaches, treatment modalities, and other preventive measures probably vary in different regions. Therefore, this consensus was developed that provides a unified approach for physicians to effectively diagnose and manage PAD in India. In this consensus, we identify that the prevalence of PAD varies from 5% to 25% in Indian setting. Both atherosclerotic and non-atherosclerotic risk factors may underlie PAD. Asymptomatic PAD remains the most common presentation of the disease. The detailed clinical history, physical changes in the lower leg skin, and examination of peripheral pulses can provide clues to the diagnosis. Ankle-brachial index and Duplex ultrasound are advised as the initial choice of diagnostic measures. Besides control of risk factors such as hypertension, diabetes, dyslipidemia, and smoking, pharmacological treatment with anti-platelet and antithrombotic drugs is advised. By efficacy, ticagrelor is considered equivalent to clopidogrel and cilostazol is advised in intermittent claudication. In the revascularization of tibio-pedal lesions, endovascular therapy is effective and arterial bypass with vein graft may be needed in difficult and extensive revascularization scenarios. In these lesions, prosthetic grafts must be avoided. Diabetic foot ulcer management is challenging as foot care among diabetics is poor. In limb, salvation should always be a priority with avoidance of amputation if possible. Stem cell therapy has been successful in PAD which can be advised to “no-option” patients to prevent amputation. Physicians should undertake effective screening of PAD and be considered “PAD Clinics” in India.

Asymptomatic peripheral arterial disease in HIV patients in Ghana: A case-control study

BackgroundPeripheral arterial disease (PAD) is common in HIV patients and can be diagnosed noninvasively using the ankle-brachial index (ABI). The burden of PAD has not been investigated in Ghanaian HIV patients. We investigated the prevalence and risk factors associated with PAD in HIV patients at a periurban hospital in Ghana. MethodsIn a case-control design, ABI was measured in 158 cART-treated HIV patients, 150 cART-naïve HIV patients and 156 non-HIV controls with no clinical symptoms of CVDs. PAD was defined as ABI ≤ 0.9. A structured questionnaire was used to collect socio-demographic and clinical data. Fasting venous blood samples were collected to measure plasma levels of glucose, lipid profile, and CD4+ lymphocytes. ResultsThe prevalence of PAD was 13.9% among cART-treated HIV patients, 21.3% among cART-naïve HIV patients, and 15.4% among non-HIV controls. Patients with PAD had increased odds of having low CD4+ cell counts [OR (95% CI) = 3.68 (1.41–12.85)]. In cART-treated HIV patients, those on TDF-based [5.76 (1.1–30.01), p = 0.038] and EFV-based [9.28 (1.51–57.12), p = 0.016] regimens had increased odds of having PAD. ConclusionIn our study population, there was no difference in the prevalence of PAD between cART-treated HIV patients compared to cART-naïve HIV patients or non-HIV controls. Having a low CD4 cell count and being on TDF- or EFV-based regimens were associated with an increased likelihood of having PAD.

Characteristics of Peripheral Arterial Disease in Women

Objective: Peripheral arterial disease (PAD) affects more than 200 million people.1 With an estimated prevalence of 3 – 29% in women.2 Asymptomatic PAD is more common in women than in men.3 However, when symptomatic, women have a more complex and severe disease, affecting several arterial sectors (with chronic limb threatening ischaemia, CLTI) and with worse outcomes.3–6 Women present with symptoms, on average, 10 – 20 years later than men.4 There has been a low representation of women in PAD studies and clinical trials.7 This study aims to characterise PAD in hospitalised women. It is an objective to compare the cardiovascular risk factors, clinical presentation, therapeutic strategies, and outcomes between women and men.

How Common Peripheral Arterial Disease is in Patients Undergoing Coronary Angiography?

Background: Cardiovascular disease is the leading cause of death in the world. The detection and treatment of risk factors for CV events is critical to improving health and longevity1. The most common among cardiovascular diseases is atherosclerotic coronary artery disease.Objective: To determine the frequency of previously undiagnosed peripheral arterial disease in patients undergoing coronary angiography.Material and Methods: This Descriptive Cross-sectional study was conducted in Cardiology Department, Hayatabad Medical Complex Peshawar from 17th June, 2020 to 16th December, 2020. The patients of 40-80 years age of both genders were included through Non probability consecutive sampling. The data was collected through a proforma specially designed for this study and was analyzed through SPSS 22. Results: A total of 171 patients were included in the study. Age wise distribution among 171 patients was analyzed as 30-40 Years 9(5.3%), 41-50 Years 51(29.8%), 51-60 Years 72(42.1%), 61-70 Years 32(18.7 %), 71-80 Years 7(4.1%). Mean age was 55.56(±9.23) years. Gender wise distribution among patients, Male were 108(63.2%) Female were 63(36.8%). Distribution of Diabetes Mellitus was 50(29.2%). Hypertension was documented in 100 (58.5%). Smoking Status 51(29.8%). Distribution of peripheral arterial disease among 171 patients was analyzed as 22(12.9%). Distribution of Types of ACS was non-ST elevation among patients was 32(18.7%), STEMI was 62(36.3%) and USA was 77 (45%). Conclusion: The study demonstrated that the frequency of asymptomatic Peripheral arterial disease (PAD) in patients with CAD was 12.9% and was strongly associated with higher incidence of cardiovascular risk factors, and multivessel disease. Keywords: Peripheral arterial disease, coronary artery disease.

Abstract P105: Peripheral Artery Disease and Subsequent Risk of Cancer: The Atherosclerosis Risk in Communities (ARIC) Study

Introduction: Cardiovascular disease (CVD) and cancer share risk factors, including smoking and obesity. Indeed, an increased cancer risk was reported among patients with CVD, such as myocardial infarction. Lower extremity peripheral artery disease (PAD) has also been explored in this context, but most previous studies included only Whites, had follow-up &lt;10 years, or did not account for key confounders like smoking. Hypothesis: PAD is independently associated with long-term cancer risk in a bi-racial cohort. Methods: We studied 13,102 ARIC participants without prevalent cancer at visit 1 (1987-89) (mean age 54 [SD 6] years, 54% women, and 26% Black) (funding: NHLBI, NCI, and NPCR). Incident cancer was ascertained by linkage to cancer registries and medical record review. We categorized PAD status at visit 1 into symptomatic PAD (intermittent claudication or a history of lower extremity revascularization), asymptomatic PAD (ankle brachial index [ABI] ≤0.9), and other ABI categories of &gt;0.9-1.0, &gt;1.0-1.1, &gt;1.1-1.2, &gt;1.2-1.3 and &gt;1.3. We ran multivariable Cox models. Results: During the median follow-up of 25 years (IQI 15-27 years), there were 4,142 incident cancer cases. 25-year cumulative cancer incidence was 48% in symptomatic PAD, 39% in asymptomatic PAD, and 31-34% in the other categories. When we adjusted for demographic factors, both symptomatic and asymptomatic PAD showed significant hazard ratios for incident cancer (1.79 [95%CI 1.33-2.43] and 1.39 [1.18-1.63], respectively, vs. ABI 1.1-1.2, Model 1 in Table ). After adjusting for additional potential confounders, including smoking and diabetes, these associations were somewhat attenuated but remained consistent (Models 2-4 in Table ). Conclusion: Both symptomatic and asymptomatic PAD were associated with an increased risk of cancer independently of smoking and diabetes. Although potential mechanisms should be explored, clinicians should be aware of this excess cancer risk among patients with PAD when considering cancer prevention and screening.

Subclinical lower limb Peripheral Arterial Disease in Patients with Type 2 Diabetes Mellitus: A cross-sectional study.

Background: Peripheral artery disease (PAD) is highly prevalent in patients with diabetes mellitus. The ankle-brachial index (ABI) measurement is used to diagnose peripheral arterial disease, and little is known about its prevalence in asymptomatic type 2 Diabetic patients. This study aimed to determine the prevalence of subclinical peripheral artery disease in patients with type II diabetes mellitus.&#x0D; Methodology: It was a descriptive study conducted at the Peshawar Institute of Medical Sciences, from Feb 2022 to Aug 2022. Two hundred sixty-four patients with type II diabetes (for more than three years) with no clinical features of peripheral arterial disease were assessed by measuring ankle brachial pressure index for subclinical peripheral arterial disease. Reading less than 0.9 was positive for peripheral artery disease in the lower limbs.&#x0D; Results: Peripheral Arterial Disease was present in 115 (43.6%) patients and absent in 149 (56.4%) patients. The peripheral artery disease was significantly more in males, those with age greater than 55 years, smokers, and hypertensive patients (p-value ≤ 0.05) but was not associated with the duration of diabetes or BMI of the patient (p-value &gt; 0.05)&#x0D; Conclusion: There was a high prevalence of asymptomatic peripheral artery disease in Type 2 Diabetic patients using ankle-brachial pressure index measurement. Those with ages greater than 55 years, smokers, hypertensive, and males were particularly at higher risk.

Peripheral Atherosclerotic Profile in Type 1 Diabetic Patients: Lipid Ratios as a Predictive Marker of Asymptomatic Patients

Objective: To investigate the relationship between Lipid ratios and asymptomatic peripheral artery disease (aPAD) in type 1 diabetic patients.&#x0D; Materials and Methods: This cross-sectional study was performed among 223 diabetics. Patients were segregated with aPAD when their ankle-brachial index (ABI) was abnormal (ABI ≤ 0.90, or ABI &gt; 1.20). Patients were segregated into the following groups (patients with normal ABI vs. patients with arterial stiffness). The association between lipid ratios and aPAD was analyzed using multivariate logistic regression analysis and the receiver operator characteristic curve.&#x0D; Results: Our study reported a slight preponderance of females (108 males vs. 115 females), with a mean age of 30.70±9.69 years and a diabetes duration of 11.13±8.95 years. The prevalence of arterial stiffness was 38.11%. TC/HDL-C ratio was a significant predictor for atherosclerosis with a sensitivity of 77.3%, specificity of 62.5%, and diagnostic accuracy of 0.758%. The results revealed that the 4th quartile (odds ratio [OR]=12.52 [5.06-31.00], p=&lt;0.001) of TC/HDL-C ratio was statistically higher in patients with arterial stiffness. Similarly, the last quartiles of LDL-C/HDL-C and TG/HDL-C ratio were higher in the arterial stiffness group (OR=3.70 [1.68-8.11], p=0.001; OR=4.74 [2.12-10.59], p=&lt;0.001; respectively). In the arterial stiffness group, non-traditional lipid values were significantly higher in males compared to females.&#x0D; Conclusion: Lipid ratios are correlated with aPAD in type 1 diabetic patients, and should thus be assessed in clinical decision-making and risk stratification on atherosclerotic cardiovascular disease.

Achilles tendon thickness normalized to body surface area as a marker of asymptomatic peripheral arterial disease.

The normalisation of Achilles tendon thickness (ATT) to anthropometric parameters may increase the diagnostic efficiency of the assessment of ATT. The aim of this study was to compare the diagnostic value of AT dimensions depending on their normalization to body surface area (BSA) in patients with asymptomatic peripheral arterial disease (PAD). All patients underwent duplex scanning of the carotid arteries and the lower limb arteries. Asymptomatic PAD was defined as the presence of ≥50% stenosis in the carotid and/or lower limb arteries. ATT was measured using a longitudinal scan, width (ATW) and cross-sectional area (AT CSA), which was determined during a cross-sectional scan. The study included 369 patients, among whom asymptomatic PAD was detected in 18 (4.88%) patients. Only the ATT demonstrated diagnostic value for asymptomatic PAD. After normalizing the size of the AT to the BSA, the diagnostic performance of ATT, ATW and AT CSA became statistically significant. Among the studied parameters, only an increase in ATT/BSA >0.29cm/m2 was associated with a significant increase in the odds ratio (OR) of asymptomatic PAD by 4.11 times (95% CI 1.08-15.7; p = .038) after adjustments. An increase in ATT/BSA >0.29cm/m2 predicted the presence of asymptomatic PAD with a sensitivity of 61.1% and a specificity of 77.9%. ATT/BSA values of less than 0.29cm/m2 made it possible to exclude asymptomatic PAD with a probability of 97.5%. An increase in ATT/BSA >0.29cm/m2 was associated with a 4.11-fold increase in the OR of asymptomatic PAD (95% CI 1.08-15.7).

Prospective Assessment of the Diagnostic Accuracy of Multi-site Photoplethysmography Pulse Measurements for Diagnosis of Peripheral Artery Disease in Primary Care.

Peripheral arterial disease (PAD) is associated with cerebral and coronary artery disease. Symptomatic PAD affects about 5% of people over 55years; many more have asymptomatic PAD. Early detection enables modification of arterial disease risk factors. Diagnostically, assessment of symptoms or signs can be unreliable; ankle brachial pressure index (ABPI) testing is time-consuming and few healthcare professionals are properly trained. This study assessed the diagnostic accuracy of multi-site photoplethysmography (MPPG), an alternative non-invasive test for PAD, in primary care. PAD patients identified from general practice registers were age- and sex-matched with controls. Participants were assessed using MPPG, ABPI and duplex ultrasound (DUS). Outcome measures were sensitivity and specificity of MPPG and ABPI (relative to DUS) and concordance. MPPG test results were available in 249 of 298 eligible participants from 16 practices between May 2015 and November 2016. DUS detected PAD in 101/249 (40.6%). MPPG sensitivity was 79.8% (95% confidence interval [CI] 69.9-87.6%), with specificity 71.9% (95% CI 63.7-79.2%). ABPI sensitivity was 80.2% (95% CI 70.8-87.6%), with specificity 88.6% (95% CI 82-93.5%). With comparable sensitivity to ABPI, MPPG is quick, automated and simpler to do than ABPI; it offers the potential for rapid and accessible PAD assessments in primary care.

Epidemiology of Peripheral Artery Disease: Narrative Review.

Past decades have witnessed a major epidemiologic transition with a considerable increase in the disease burden associated with atherosclerotic cardiovascular diseases (CVDs), with low-income and middle-income countries (LMICs) experiencing substantial increase in CVDs. As the global population is aging and peripheral artery disease (PAD) is strongly age-related, it is estimated to become increasingly prevalent in the future. PAD shares risk factors with coronary and cerebrovascular risk factors, particularly diabetes mellitus and smoking, and is associated with significant CVD morbidity and mortality. Despite advances in therapeutic modalities, 236 million people were estimated to be suffering from PAD worldwide in 2015, and numbers have been rising since. The prevalence of asymptomatic PAD has remained high; PAD prevalence seems higher among women and is related to ethnicity. Although several epidemiological studies have been published on PAD during the past decades, data from LMICs are scarce. Besides providing up-to-date epidemiological data retrieved from the literature and the Global Burden of Disease (GBD) study database, this narrative review also intends to draw attention to the substantial disease burden of PAD manifesting in more Years of Life Lost (YLL), age-adjusted mortality and amputation rates, with a special focus on some European countries and especially Hungary, i.e., the country with the highest amputation rate in Europe.

The Nevada peripheral artery disease screening effort in a Medicare Advantage population and subsequent mortality and major adverse cardiovascular event risk

Background: Contemporary estimates of undetected asymptomatic lower extremity peripheral artery disease (PAD) in the community and its association with adverse outcomes in the population are lacking. We investigated the long-term association between previously undetected PAD and subsequent all-cause mortality and major adverse cardiovascular events (MACE) for Medicare Advantage beneficiaries aged ≥65 years in a large metropolitan area characterized by concentrations of atherosclerotic risk factors and a more vulnerable socioeconomic risk profile.

Peripheral Arterial Disease Prevalence in a Population-Based Sample of People with Diabetes on the Caribbean Island of Barbados.

BackgroundPeripheral arterial disease (PAD) is a risk factor for amputation and systemic atherosclerotic disease. Barbados has a high diabetes prevalence, and 89% of diabetes-related hospital admissions are for foot problems. Foot examination is infrequent in Barbados primary care. The prevalence and potential risk factors for PAD in people with diabetes in Barbados were studied.MethodsMultistage probability sampling was used to select a representative population sample of people ≥25 years of age with known diabetes or fasting blood glucose ≥7 mmol/L or HbA1c ≥6.5%. We administered the Edinburgh claudication questionnaire and assessed the ankle brachial pressure index (ABI) and Doppler waveform in both dorsalis pedis and posterior tibial arteries. Participants were classified into categories based on ABI as follows: PAD ≤0.90 in any leg; borderline 0.91 to 0.99 in one leg and the other not ≤0.90 or >0.4; normal 1.00 to 1.40 in both legs; and non-compressible >1.40 in one leg and the other not ≤0.9. Waveforms crossing the zero-flow baseline were categorised as normal. Multivariable logistic regression assessed the associations of potential risk factors with PAD.ResultsOf 236 participants (74% response rate, 33% male, median age 58.6 years), 51% had previously diagnosed diabetes. Of nine people with symptoms of definite or atypical claudication, four had PAD and one had non-compressible arteries. ABI prevalence (95% CI) was PAD 18.6% (13.8, 24.6), borderline 21.9% (16.6, 28.4), normal 55.5% (49.4, 61.5) and non-compressible 3.9% (1.6, 9.3). Increasing age and female gender were independently associated with PAD. Over 80% of normal legs (ABI 1.00 to 1.40) had normal posterior tibial and dorsalis pedis waveforms, while only 23% legs with PAD (ABI ≤0.90) had normal waveforms in both arteries (Kappa = 0.43).ConclusionAsymptomatic PAD is common in people with diabetes and requires ABI screening to detect it. Female gender is associated with PAD.