Impact Of Peripheral Arterial Disease Research Articles

Peripheral Artery Disease Is an Independent Predictor of Mortality After Implantable Cardioverter-Defibrillator Implantation in Patients With Severe Left Ventricular Dysfunction

The impact of peripheral artery disease (PAD) on survival in implantable cardioverter defibrillator (ICD) patients is poorly understood. Thus, we assessed the risk of PAD in our adult ICD patients with left ventricular dysfunction (ejection fraction [EF] ≤35%). Survival was estimated with Kaplan-Meier method and compared by the log-rank test; a Cox proportional hazards model assessed the effects of clinical variables on survival. Average age and EF of 1399 patients were 67.0 ± 12.1 years and 23.8% ± 7.2%, respectively. The ICD patients with PAD had significantly worse survival than those without (unadjusted P < .0001). The multivariate predictors of survival at implant were (hazard ratio, HR [95% confidence interval]) age (HR 1.05 [1.04-1.07] P < .0001), PAD (HR 2.07 [1.53-2.80] P < .0001), class III/IV heart failure (HR 1.36 [1.06-1.76] P = .016), creatinine 1.4-2.0 mg/dL (HR 1.36 [1.05-1.76] P = .019), and creatinine ≥2.0 mg/dL (HR 2.01 [1.42-2.85] P < .0001). The PAD is an independent predictor of mortality and should be considered in the preimplant risk assessment.

The impact of peripheral arterial disease on outcome after percutaneous transluminal angioplasty for arteriovenous fistula: a 1-year retrospective analysis

The impact of peripheral arterial disease on outcome after percutaneous transluminal angioplasty for arteriovenous fistula: a 1-year retrospective analysis

The PADQOL: Development and validation of a PAD-specific quality of life questionnaire

Understanding the impact of peripheral artery disease (PAD) requires broad evaluation of how functional limitations of PAD affect patients' perceptions of health-related quality of life (HRQL). The objective of this study was to describe the development, testing, and psychometric properties of the PAD Quality of Life Questionnaire (PADQOL). The PADQOL was developed in three steps: (1) interviews of symptomatic PAD patients provided content of the initial questionnaire; (2) co-administration with the SF-36 (a 36-item short-form health survey), Walking Impairment Questionnaire, and Profile of Mood States examined construct validity; and (3) a three-phased factor analysis identified factors and shortened the questionnaire. Data analyses from 297 symptomatic PAD patients resulted in a 38-item questionnaire of five factors: Social relationships and interactions, Self-concept and feelings, Symptoms and limitations in physical functioning, Fear and uncertainty, and Positive adaptation (α = 0.92-0.73) and items related to sexual function, intimate relationships and employment. Between-instrument correlations established construct validity. In conclusion, PADQOL is a validated measure to assess the disease-specific physical, psychosocial and emotional effects of PAD for research and practice.

The Impact of Neuropathic Pain in the Chronic Pelvic Pain Population

Patients with chronic pelvic pain disorders often present with neuropathic features. We examined a cohort of patients with a primary complaint of chronic pelvic pain for the presence of neuropathic pain symptoms. Patients with chronic pelvic pain disorders from 2 tertiary referral centers were prospectively evaluated. The validated S-LANSS (Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs) survey was used to examine pain symptoms of neuropathic origin. Patients completed SF-12v2™ to assess mental/physical health domains. The 2-tailed t test and chi-square analysis were used to compare physical and mental component summaries in patients with vs without neuropathic symptoms. A total of 142 patients mean age of 45 years were included in analysis. Of the patients 72.5% with chronic pelvic pain carried more than 1 primary diagnosis. The S-LANSS survey identified symptoms suggestive of neuropathic pain in 44 patients (31%). A greater proportion of patients with a neuropathic component had altered sensation in the affected area (86.4% vs 24.5%). Patients with neuropathic pain scored 4.28 and 5.45 points lower on the physical and mental component summaries (p = 0.053 and 0.008, respectively). A large proportion of patients with chronic pelvic pain present with neuropathic features and report decreased quality of life compared with the general population. Those with neuropathic symptoms have significantly lower quality of life than those without such symptoms. Clinicians can identify patients to use targeted therapies and use a multidisciplinary approach to care.

Quality of life in elderly diabetic patients with peripheral arterial disease

To study the impact of peripheral arterial disease (PAD) on quality of life and functional status in Egyptian elderly diabetic patients. This case-control study included 90 non-demented patients aged 60 years and older. Quality of life assessment was carried out using the Short Form 36 health survey (SF-36), Arterial duplex for diagnosis of peripheral arterial disease; Mini-Mental State Examination, Geriatric Depression Scale, Activity of Daily Living and Instrumental Activity of Daily Living were used. SF-36 domains (except emotional well-being) were significantly affected in diabetic patients with PAD compared with the diabetic patients without PAD. Most of functional assessment items were significantly affected in diabetic patients with PAD compared with diabetic patients without PAD. Increasing PAD severity and presence of PAD symptoms had a significant negative impact on SF-36 scores. Among diabetic complications in PAD patients, cardiovascular disease or stroke significantly affected quality of life. PAD significantly affects quality of life and functional status in elderly diabetic patients.

The impact of peripheral arterial disease on early outcome after transcatheter aortic valve implantation: Results From the German Transcatheter Aortic Valve Interventions Registry

A significant proportion of patients undergoing transcatheter aortic valve implantation (TAVI) have concomitant peripheral arterial disease (PAD), which plays a crucial role in the preinterventional selection process of determining an optimal vascular access site. The aim of our study was to determine the impact of PAD on clinical outcome after TAVI in a real-world setting. A total of 1,315 patients (mean logistic European System for Cardiac Operative Risk Evaluation 20.6% ± 13.7%) underwent TAVI in 27 centers and were included in the prospective German TAVI Registry. Of the 1,315 patients with TAVI, 330 (25.1%) had PAD. These patients had a higher logistic European System for Cardiac Operative Risk Evaluation score (27.7% ± 16.0% vs 18.3% ± 12.0%, P < .0001), mainly attributed to more frequent and severe comorbidities. Compared with patients without PAD, patients with PAD had a higher rate of vascular complications (28.5% vs 20.7%, P < .01), dialysis-dependent renal failure (11.2% vs 5.4%, P < .001), myocardial infarction (1.2% vs 0.3%, P < .05), and, subsequently, 30-day mortality (12.7% vs 6.9%, P < .001). Choosing a surgical approach, for example, transapical access, did not reduce the periprocedural risk associated with PAD; in-hospital mortality was 15.7% for surgical and 10.5% for percutaneous patients with TAVI having PAD (P < .001). In a multivariate regression analysis, PAD was an independent predictor of 30-day mortality (hazard ratio 1.8, 95% CI 1.2-2.7, P = .004) after TAVI. In this real-world TAVI Registry, PAD was an independent predictor of mortality in patients with percutaneous and surgical TAVI, including vascular complications. Assessment of PAD should play a crucial role in the preinterventional selection process, regardless of the access strategy.

Prevalence, Predictors, and Impact of Peripheral Arterial Disease in Hemodialysis Patients

We evaluated the prevalence, predictors, and outcome of peripheral arterial disease (PAD) among hemodialysis (HD) patients (n = 252) in a prospective study (3-year follow-up) conducted in Qatar. Those with PAD (n = 97; 38.5%) were older and more likely to be males and to have diabetes mellitus, prior coronary artery disease (CAD), or cerebrovascular disease. Diabetic retinopathy was an independent predictor of PAD (adjusted odds ratio: 2.7; P = .004). Women had a higher mortality. Three-year all-cause mortality was high in the PAD group (adjusted hazard ratios [HRs] 2.92; 95% confidence interval [CI] 1.55-5.51). Other predictors of mortality were age (HR 1.06; 95% CI 1.04-1.10), number of vascular access (HR 2.3; 95% CI 1.04-5.01), and prior CAD (HR 1.8; 95% CI 1.05-3.49). Prevalence of PAD was high among HD patients. Early detection of PAD as well as diabetic retinopathy is of value in identifying an even higher risk population among HD patients.

Comments regarding ‘Prevalence and Predictors of Persistent Health Status Impairment in Patients Referred to a Vascular Clinic with Intermittent Claudication’

As the risk of major amputation is exceedingly small for patients with intermittent claudication, management, besides cardiovascular risk reduction, aims essentially at symptomatic relief and improved quality of life. Treatment efficacy has traditionally been assessed using walking distances. Patient-related factors associated with failure to improve quality of life, however, have largely been ignored. In this issue of the European Journal of Vascular and Endovascular Surgery, Safley et al. propose a set of such criteria to identify a vulnerable subset of patients with intermittent claudication in which treatment failure is likely. The issue is important for several reasons. The burden of symptomatic peripheral arterial disease on quality of life is substantial and is in the same range as for other forms of arterial disease. In contrast to the coronary or the cerebrovascular territories, however, prognostic significance of peripheral arterial disease and its management are likely underestimated within primary care. Already a decade ago, the US PARTNERS programme reported a striking degree of negligence among primary care providers vis-a-vis suspicion and appropriate treatment of peripheral arterial disease.

Peripheral Arterial Disease in Patients Presenting with Acute Coronary Syndrome in Six Middle Eastern Countries

To describe prevalence and impact of peripheral arterial disease (PAD) in patients with acute coronary syndrome (ACS), data were collected over 5 months from 6 Middle Eastern countries. Patients were divided into 2 groups (with and without PAD). Out of 6705 consecutive ACS patients, PAD was reported in 177 patients. In comparison to non-PAD, PAD patients were older and more likely to have cardiovascular risk factors. They were more likely to have high Killip class, high GRACE risk score, and non-ST elevation ACS (NSTEACS) at presentation. Thrombolytics, antiplatelet use, and coronary intervention were comparable in both groups. When presented with ST-elevation myocardial infarction (STEMI), patients with PAD had worse outcomes, while in NSTEACS; PAD was associated with higher rate of heart failure in comparison to non-PAD patients. In diabetics, PAD was associated with 2-fold increase in mortality when compared to non-PAD (P = 0.028). After adjustment, PAD was associated with high mortality in STEMI (adjusted OR 2.6; 95% CI 1.23–5.65, P = 0.01). Prevalence of PAD in ACS in the Gulf region is low. Patients with PAD and ACS constitute a high risk group and require more attention. PAD in patients with STEMI is an independent predictor of in-hospital death.

240 Long-term pronostic value of peripheral vascular disease in patients undergoing isolated coronary artery bypass grafting

The concept of global vascular risk is recognized as an important predictor of major events in patients with coronary artery disease. We aimed to evaluate long term clinical outcome among patients with peripheral vascular disease (PVD) following coronary artery bypass grafting. We studied 589 consecutive patients who underwent isolated coronary artery bypass grafting between January 2003 and June 2005. The impact of peripheral artery disease was assessed by comparing a two year follow-up of 2 groups of patients: patients with (n=243) and without (n=346) PVD. Patients with PVD were significantly older (70±9 vs 64±11 years p<0.001) and were more often men (80.3% vs 74.2% p=0.04) than those without PVD. They had a higher incidence of hypertension (p=0.002), chronic renal dysfunction (p<0.01), chronic pulmonary disease (p=0.005) with higher EuroSCORE cardiac risk (9.6±6 vs 3.8±3 p<0.01). No significant difference was noted between the 2 groups with regard to left ventricular ejection fraction. The analysis of ischemic events showed that peripheral ischemic events (19.7% vs 4.6% p<0.001) and more specifically cerebrovascular events (9% vs 3.5% p<0.01) were significantly higher in PVD group. Neither myocardial infarction (6.2% vs 6.7% p=ns) nor new coronary revascularization (9.8% vs 14.5% p=ns) differed significantly among the 2 groups; The two-year follow up showed a rate of survival markedly lower for patents with PVD than those with isolated coronary disease. Two-year cumulative survival rates were 76.6% for patients with PVD and 94.1% for those with isolated coronary disease (p<0.001). Differences in outcome remained significant after adjusting all variables including medical treatment, PVD appeared as an independent predictive factor of all cause mortality with a hazard ration of 3.2 [95%CI (1.8-5.7) p<0.001]. PVD was not only highly prevalent but also strongly associated with long term mortality after coronary artery bypass surgery.

Impact of peripheral arterial disease on health status: A comparison with chronic heart failure

To further document the experienced burden in patients with peripheral arterial disease (PAD), we compared the health status of patients with PAD and chronic heart failure (CHF). As a secondary aim, we studied clinical and socio-demographic correlates of health status in both conditions. We conducted a cross-sectional observational study in four outpatient clinics in the Southern part of The Netherlands, with subjects consisting of ambulatory (346 PAD and 188 CHF) patients. All patients completed the Short-Form 12 to assess their physical and mental health status. Information about socio-demographic, clinical risk factors, and disease severity indices was obtained from patients' medical records. Propensity methodology was applied to enhance comparability between both medical conditions. Type of medical condition explained differences in health status (F = 33.1, P < .0001, Effect Size = 0.27). Impaired physical health status was more often reported in PAD patients (48.4%) compared with CHF patients (17.4%, Odds Ratio [OR] = 4.4, 95% Confidence Interval [CI] 2.3-8.8, P < .0001); impaired mental health status was more noted in CHF patients (43.5% vs. 22.0%, OR = 1.7, 95% CI 1.2-2.6, P = .002). In PAD, younger age (P = .002), low education (P = .02), cardiac history (P = .02), diabetes mellitus (P = .03), and a lower ankle brachial index (P = .003) were associated with worse physical health status; younger age (P = .01) and living without partner (P = .01) were associated with lower mental health status scores. In CHF, patients with comorbid diabetes mellitus (P < .001) and females (P = .001) reported worse physical health, whereas no clinical or socio-demographics were associated with mental health status. By contrasting PAD patients' health status with another chronic disabling condition, the impact of PAD on patients' physical health status became evident; whereas mental health status was more affected in CHF, patients with PAD reported a greater physical burden as compared with CHF patients. PAD patients who were younger, lower-educated, without a partner or had a cardiac history especially reported a higher disease burden. Clinicians need to be aware of these differences in order to develop tailor-made disease management programs for different groups of cardiovascular patients.

Functional Limitation in Heart Failure: Assessing the Impact of Peripheral Arterial Disease

Introduction: Heart Failure (HF) is a common progressive medical condition characterized by functional limitation. It shares similar risk factors with peripheral arterial disease (PAD), which can also cause functional limitation. When both HF and PAD co-exist in the same patient, it is more likely for functional limitation to be attributed to HF. Consequently, PAD may not be diagnosed or diagnosed late resulting in considerable morbidity. Objectives: To determine the prevalence of PAD in HF patients and to ascertain the impact of PAD on functional limitation in HF.

Impact of peripheral arterial disease in patients with diabetes—Results from PROactive (PROactive 11)

We compared cardiovascular disease outcomes according to the presence of peripheral arterial disease (PAD) at baseline in a post hoc analysis from the PROactive study. Of the 5238 patients in PROactive (a study of pioglitazone versus placebo in patients with type 2 diabetes and macrovascular disease; mean follow-up = 34.5 months), 1274 had PAD at baseline (619 = pioglitazone; 655 = placebo). Patients with PAD at baseline showed significantly higher rates of the primary endpoint, main secondary endpoint, all-cause mortality (all P < 0.0001), and stroke ( P = 0.0175) than those with no PAD at baseline. The risk of PAD alone was similar to that of myocardial infarction alone. In patients with no PAD at baseline, the event rates of the primary endpoint ( P = 0.0160), main secondary endpoint ( P = 0.0453), and acute coronary syndrome ( P = 0.0287) were significantly lower with pioglitazone than with placebo. This beneficial effect of pioglitazone was not seen in patients with PAD at baseline. In the total population, there was a higher frequency of leg revascularizations with pioglitazone than placebo—this was wholly due to first events that occurred within the initial 12 months of treatment. The presence of PAD increased the risk of all major cardiovascular events. Those without PAD at baseline seemed to benefit more from pioglitazone treatment than the overall PROactive population.

The impact of peripheral arterial disease on health-related quality of life in the Peripheral Arterial Disease Awareness, Risk, and Treatment: New Resources for Survival (PARTNERS) Program

This study tested the hypothesis that patients with PAD have impaired health-related quality of life (HRQoL) to a degree similar to that of patients with other types of cardiovascular disease (other-CVD), and also evaluated the clinical features of PAD associated with impaired HRQoL. This was a cross-sectional study in 350 primary care practice sites nationwide with 6,499 participants. The reference group had no clinical or hemodynamic evidence of PAD or other-CVD; the PAD group had an ankle-brachial index < 0.90 or a prior history of PAD; the other-CVD group had a clinical history of cardiac or cerebral vascular disease (but no PAD), and the combined PAD-other-CVD group included both diagnoses. Individuals were assessed using four HRQoL questionnaires including the Walking Impairment Questionnaire (WIQ), Medical Outcomes Study SF-36 (SF-36), Cantril Ladder of Life and the PAD Quality of Life questionnaire. PAD patients had lower WIQ distance scores than the other-CVD group. Both the PAD and other-CVD groups had significantly lower SF-36 Physical Function scores compared with the reference group. The WIQ revealed that PAD patients were more limited by calf pain, whereas other-CVD patients were more limited by chest pain, shortness of breath and palpitations. In conclusion, in this nationwide study, one of the first to directly compare the HRQoL burden of CVD with that of PAD, the evaluation of PAD in office practice revealed a HRQoL burden as great in magnitude as in patients with other forms of CVD.

Estrogen-TNF interactions and vascular inflammation

cardiovascular disease (CVD), especially coronary heart disease (CHD), is by far the leading cause of death in women ([29][1], [40][2]). As the prevalence of these diseases increases after menopause, much effort has been devoted to determining whether endogenous estrogen confers a protective effect

Impact of peripheral arterial disease and acute ischemic stroke.

Peripheral arterial disease (PAD) is associated with coronary artery disease (CAD) and stroke, but data on the relationship between PAD and acute ischemic stroke are lacking. Therefore, we investigated this relationship. A total of 101 patients were enrolled on admission to Harasanshin General Hospital (Fukuoka, Japan) with their first ischemic stroke. All 101 patients underwent cranial CT and/or brain magnetic resonance imaging, duplex ultrasonography of the extracranial carotid arteries, and transthoracic echocardiography. The subjects were aged 41 to 92 years. PAD was present in 81/101 patients (80.2%), including 57/73 (78.1%) with small artery occlusion, 11/13 (84.6%) with large artery occlusion, and 13/15 (86.7%) with cardiogenic embolism. In 42 of these 81 patients (51.9%), PAD was asymptomatic. Serum apoprotein A1 levels were significantly higher and the intima-media thickness was significantly greater in the patients with PAD than in those without PAD. The modified Rankin scale score was significantly higher on admission in patients with PAD than in those without PAD. Stepwise logistic regression analysis revealed that the apoprotein A1 level and the modified Rankin scale score on admission were strongly associated with the occurrence of stroke in patients with PAD. Our results suggest that PAD is frequently associated with acute ischemic stroke. It may be important to perform screening for PAD in patients who have suffered an ischemic stroke.

Identifying Unrecognized Peripheral Arterial Disease Among Asymptomatic Patients in the Primary Care Setting

National initiatives to enhance recognition of the detrimental impact of peripheral arterial disease on the health of adult Americans have been advocated. The objective of this study was to evaluate a strategy for identifying patients with unrecognized peripheral arterial disease from among persons without known atherosclerotic disease in the primary care setting. A cross-sectional design was used. Participants were patients receiving care from a multispecialty group practice in Massachusetts between July 2002 and July 2003, with a scheduled appointment with a primary care physician. Persons 70 years of age or older who were not already known to have atherosclerotic disease were enrolled. In addition, persons aged 50-69 with a diagnosis of diabetes mellitus, dyslipidemia, hypertension, and/or smoking based on information derived from administrative databases, and not known to have atherosclerotic disease, were enrolled. Before the scheduled appointment, potential study participants completed a telephone interview to ascertain their medical history. The ankle-brachial index (ABI) of eligible patients was measured at the time of the scheduled primary care office visit. Peripheral arterial disease was diagnosed if 1 or both legs had an ABI of <or=0.90. Also assessed was the time spent in performing ABI testing in a convenience sample of the study participants. ABI testing was performed on 717 patients. Among 359 study subjects aged >or=70 years, 45 (12.5%) were diagnosed with peripheral arterial disease. Nine (2.5%) of 358 subjects aged 50-69 years were diagnosed with peripheral arterial disease. The average total time (n = 52) for ABI testing was 13.7 (SD: +/-3.3) minutes. Patients aged >or=70 years required more time for ABI testing compared to those aged 50-69 (mean: 15.0 vs 13.0 minutes, p=0.04). Unrecognized asymptomatic peripheral arterial disease can be commonly detected among patients in the primary care setting who are not already known to have atherosclerotic disease. The yield from screening is substantially greater among unselected older patients compared with younger patients specifically identified as having risk factors for PAD. These findings should help inform the development and implementation of new initiatives to enhance the early detection of peripheral arterial disease among asymptomatic patients in the primary care setting.

The mandate for creation of a national peripheral arterial disease public awareness program: an opportunity to improve cardiovascular health

There has been increasing recognition of the detrimental impact of peripheral arterial disease (PAD) on the health of Americans, and yet there is no common national program of public PAD education designed to diminish this impact. To heighten awareness of this problem, a 2-day PAD Public Education Strategy Meeting was recently attended by representatives of 17 professional societies and public health associations whose missions support the prevention, diagnosis, treatment, and rehabilitation of vascular diseases. This Public Education Strategy Meeting was intended to provide the rationale and structure to create a national PAD public awareness campaign to diminish the health impact of PAD, and to improve cardiovascular outcomes in the USA. This paper: (1) provides the rationale for creation of a national PAD public education program; (2) reviews the development and success of national hypertension, hypercholesterolemia, and Women’s Heart Health public education programs as models of educational efficacy; (3) elucidates how the work of many vascular professionals has led to a national consensus for creation of a national PAD public educational program; (4) provides an overview of the National Heart, Lung and Blood Institute PAD education meeting; and (5) outlines the ‘next steps’ required to accomplish these goals. This meeting achieved consensus that we share responsibility for developing accurate, unified messages to promote PAD awareness and improved care. Participants agreed that the creation of such messages should be linked to plans to disseminate them to all Americans at risk. A consensus was reached that such messages, when commonly created and offered to the public, are most likely to achieve the rewards in better health that all Americans deserve. The Vascular Disease Foundation, a not-for-profit foundation whose mission includes public education regarding the prevention, diagnosis, treatment, and rehabilitation of PAD, will devote its resources to guide a new coalition in this process and to create a national PAD awareness campaign. During 2003 and 2004, the coalition will create the organizational underpinnings and timeline for what will undoubtedly be a multi-year effort. In conclusion, participants of the Public Education Strategy Meeting agreed to create a broad coalition to develop a national PAD public awareness program, with the objectives to develop and disseminate public education messages on PAD. A successful national PAD education program will contribute to the creation of a broader mandate to improve global cardiovascular health in the USA.

The impact of peripheral arterial disease on circulating platelets

Introduction: To test the hypothesis that circulating platelets display evidence of reversible interactions with atherosclerotic lesions, platelet α-granule content and propensity for microaggregate formation were measured in samples from normal donors ( n=65) and from patients with either peripheral arterial disease ( n=47) or renovascular hypertension ( n=22). To measure the effect of a defined arterial injury on platelet function, platelet samples were compared before and 30 min after elective angioplasty. Materials and methods: P-selectin was measured after strong stimulation of ultra-dilute platelets with thrombin (10 nM). Microaggregation was measured as a platelet count deficit in citrate-anticoagulated platelet-rich plasma (PRP) relative to that predicted from the count in EDTA-anticoagulated blood. Results: Platelet α-granule P-selectin was significantly lower from platelets of patients compared to normal donors. In addition, platelets from patients have a significantly greater propensity to form microaggregates in citrate anticoagulant. In contrast to atherosclerotic renovascular hypertension, platelets from patients with fibromuscular dysplasia, a distinct non-inflammatory cause of arterial stenosis, do not differ significantly from normal donors. Other than the PRP platelet count, which rose transiently following angioplasty, other platelet measures were unchanged by the injury. Conclusions: Atherosclerotic arterial disease is associated with an increased share of platelets unable to express P-selectin and an increased fraction of platelets that microaggregate in citrate anticoagulant. These platelet alterations are not completely explained by either focal arterial injury or abnormal rheology associated with arterial stenosis but appear to be an effect of the atherosclerotic process.