low-ABI Group Research Articles

INCREASED SERUM SCLEROSTIN LEVEL IS A RISK FACTOR FOR PERIPHERAL ARTERY OCCLUSIVE DISEASE IN PATIENTS WITH HYPERTENSION

Objective: Sclerostin is associated with endothelial inflammation and vascular calcification and therefore contributes to atherosclerosis disease. Hypertension is one of risk factors of peripheral arterial occlusive disease (PAOD), is associated with increased mortality in patients with hypertension. The aim of this study was to determine the relationship between serum sclerostin level and PAOD in patients with hypertension. Design and method: Fasting blood samples and baseline characteristics were obtained from 92 hypertensive patients. ABI values were measured using an automated oscillometric device. Patients with ABIs of <0.9 were categorized into the low ABI group. The serum sclerostin and dickkopf-1 (DKK1) concentrations were determined using commercially available enzyme-linked immunosorbent assays. Results: In total, 14 patients with hypertension (15.2%) were in the low ABI group. When compared to those in the normal ABI group, the low ABI group had high rates of diabetes mellitus (P = 0.044) as well as the high serum C-reactive protein levels (P = 0.001) and sclerostin levels (P < 0.001), but the serum DKK1 level did not find this association (P = 0.639). The multivariable logistic regression analysis revealed that serum levels of sclerostin (odds ratio [OR]: 1.052, 95% confidence interval [CI]: 1.018–1.088, P = 0.002) was independently associated with PAD in patients with hypertension. Conclusions: Serum levels of sclerostin, but not DKK1, were associated with PAOD in patients with hypertension.

Low ankle brachial index predicts poor outcomes including target lesion revascularization during the long-term follow up after drug-eluting stent implantation for coronary artery disease

BackgroundPeripheral arterial disease (PAD) frequently coexists with coronary artery disease (CAD). The ankle-brachial index (ABI) is widely used for the screening for PAD. Low ABI is associated with short-term clinical outcomes in patients receiving coronary drug-eluting stent (DES) implantation. However, there is no report to examine the relationship between lower ABI and long-term clinical outcomes after DES implantation. Thus, we investigated the clinical long-term impact of low ABI after DES implantation. MethodsThis retrospective analysis included 181 CAD patients treated with DES from April 2010 to March 2013 in our institute. Based on ABI values, we divided the subjects into the low-ABI group (ABI<0.9, n=29) and the normal ABI group (0.9≤ABI<1.4, n=152). The incidence of target lesion revascularization (TLR), all-cause mortality, and major adverse cardiac and cerebrovascular events (MACCE) defined as a composite of cardiac death, myocardial infarction, stroke, and any repeat revascularization, were compared between the 2 groups. ResultsDuring the median follow-up period of 43 months, the incidences of TLR, all-cause mortality, and MACCE were significantly higher in the low ABI group than in the normal ABI group (TLR: 41.4% vs 9.9%, p<0.001, all-cause mortality: 31.0% vs 3.9%, p<0.001, MACCE: 48.3% vs 11.2%, p<0.001, respectively). ConclusionsLow ABI may predict poor long-term outcomes, including TLR, in CAD patients treated with DES.

Ankle Brachial Index (ABI) predicts 2-year mortality risk among older adults in the Republic of Congo: The EPIDEMCA-FU study

Background and aimsPeripheral artery disease (PAD) is known to be associated with mortality in high income countries but no data regarding Sub-Saharan Africa (SSA) populations are documented. This study aimed at assessing the prognostic value of the Ankle Brachial Index (ABI) among older adults in the Republic of Congo. MethodsCongolese subjects ≥65 years were included in a longitudinal population-based survey (EPIDEMCA-FU). Demographic, biological, and clinical data were collected at baseline. PAD was defined by an ABI≤0.90. Information on mortality was collected from key informants in participants' households. Cox proportional hazard models, adjusted for traditional and cardiovascular risk factors, were fitted to evaluate the association between an ABI≤0.90 and death. Results1029 participants were recruited at baseline. ABI measurement was obtained from 927 participants, of whom 17.4% presented an ABI≤0.90. During a 2-year follow-up, a total of 83 (9.1%) deaths were recorded. Mortality was higher in the low-ABI group with 23 deaths (14.7%) vs. 57 (7.8%) and 3 (12.0%), respectively among those with 0.90 < ABI<1.4 and ABI≥1.40 (p = 0.039). After adjustment, an ABI≤0.90 was associated with an increased risk of mortality (HR = 1.86; 95%CI 1.04–3.87). Mortality was also independently associated with increasing age (HR = 1.05; 95%CI 1.02–1.09), dementia (HR = 2.73; 95% CI 1.15–8.05), alcohol use (HR = 0.51; 95%CI 0.29–0.88) and female sex (HR = 0.37; 95%CI 0.19–0.72). ConclusionsIn this study, a low ABI predicted an increased mortality risk among older people. ABI may represent a simple and inexpensive tool to identify older people at high risk of death in SSA.

Predominant polarity in bipolar I and II disorders: a five-year follow-up study

Peripheral artery disease (PAD) is known to be associated with mortality in high income countries but no data regarding Sub-Saharan Africa (SSA) populations are documented. This study aimed at assessing the prognostic value of the Ankle Brachial Index (ABI) among older adults in the Republic of Congo.Congolese subjects ≥65 years were included in a longitudinal population-based survey (EPIDEMCA-FU). Demographic, biological, and clinical data were collected at baseline. PAD was defined by an ABI≤0.90. Information on mortality was collected from key informants in participants' households. Cox proportional hazard models, adjusted for traditional and cardiovascular risk factors, were fitted to evaluate the association between an ABI≤0.90 and death.1029 participants were recruited at baseline. ABI measurement was obtained from 927 participants, of whom 17.4% presented an ABI≤0.90. During a 2-year follow-up, a total of 83 (9.1%) deaths were recorded. Mortality was higher in the low-ABI group with 23 deaths (14.7%) vs. 57 (7.8%) and 3 (12.0%), respectively among those with 0.90 < ABI<1.4 and ABI≥1.40 (p = 0.039). After adjustment, an ABI≤0.90 was associated with an increased risk of mortality (HR = 1.86; 95%CI 1.04–3.87). Mortality was also independently associated with increasing age (HR = 1.05; 95%CI 1.02–1.09), dementia (HR = 2.73; 95% CI 1.15–8.05), alcohol use (HR = 0.51; 95%CI 0.29–0.88) and female sex (HR = 0.37; 95%CI 0.19–0.72).In this study, a low ABI predicted an increased mortality risk among older people. ABI may represent a simple and inexpensive tool to identify older people at high risk of death in SSA.

The value of ankle-branchial index screening for cardiovascular disease in type 2 diabetes.

To investigate the relationship between ankle-branchial index (ABI) and cardiovascular disease in type 2 diabetes patients. A total of 634 inpatients with type 2 diabetes were recruited in this cross-sectional study. All patients were measured with ABI and computed tomography angiography (CTA) scan for coronary artery disease (CAD). According to ABI values, patients were divided into three groups: low-ABI group (ABI<0.9, n=259), normal-ABI group (ABI=0.9-1.3, n=272), and high-ABI group (ABI>1.3, n=103). According to the manifestation of coronary CTA, the patients were divided into CAD group (n=348) and non-CAD group (n=286). Their clinical data and biochemical parameters were compared and analysed. The prevalence of CAD in low-ABI group (90%) was significantly higher than that of normal-ABI group (33%) and high-ABI group (25%) (both P<0.01). Spearman correlation analysis showed that age, sex, duration, spontaneous bacterial peritonitis, total cholesterol (TC), triglyceride, low-density lipoprotein cholesterol (LDL-C), serum creatinine, and glycosylated haemoglobin (HbA1c ) were positively correlated with CAD, and high-density lipoprotein cholesterol (HDL-C), glomerular filtration rate, and ABI were negatively correlated with CAD. Logistic regression analysis further revealed that age, sex, duration, TC, HDL-C, LDL-C, HbA1c , and ABI were independent risk factors of CAD. After all potential confounders is adjusted, the risk of CAD in low-ABI group still increased over four times than the normal-ABI group (odds ratio [OR], 5.32; 95% CI, 1.973-16.5; P<0.001). In female patients, this risk increased more than nine times (OR, 10.63; 95% CI, 3.416-17.8; P<0.001). Receiver-operating characteristic analysis indicated that ABI<1.045 predicted the occurrence of CAD (sensitivity, 79.7%; specificity, 71.5%; P<0.01). ABI is an independent risk factor for CAD and may be a potential simple screening instrument for CAD in Chinese type 2 diabetic patients, especially in elder women.

Factor Associated with Abnormal Ankle-Brachial Index Among Diabetic Patients in Songklanagarind Hospital: A Retrospective Cohort Study

Objective: To find the correlation between type 2 diabetic patients who had abnormal ankle-brachial index (ABI) among factors affected diabetes and cardiovascular outcomes including acute coronary syndrome (ACS), myocardial infarction (MI), coronary revascularization stroke, renal replacement therapy, leg revascularization and limb amputation Material and Methods: Retrospective cohort study collecting the data of 548 diabetic patients examined ABI at Outpatient Departments from 1st January 2009 to 31st December 2015. Results: From 548 medical records including only normal-ABI group and low-ABI group, we found that hypertension, chronic kidney disease (CKD), smoking, history of previous MI, history of previous stroke and age were the significant associated factor of low-ABI. The survival analyses revealed the significantly higher rate of ACS, MI, and coronary revascularization in low-ABI group (p-value=0.04, &lt;0.01, &lt;0.01 respectively) after exposed to low-ABI around 4 years. However, the study found no significant difference of other outcomes between the 2 groups. Conclusion: Songklanagarind’s diabetic patients with low-ABI were associated with the significantly higher rate of multiple cardiovascular risk factors including hypertension, CKD, smoking, history of previous MI, history of previous stroke and age and they tend to significantly experience more ACS, MI and coronary revascularization after 4 years exposed to low-ABI.

Association of Ankle-Brachial Index with the Angiographic Severity of Patient with Coronary Artery Disease

Background: The Ankle-Brachial Index has been shown to be a good marker of systemic atherosclerosis and a powerful indicator of cardiovascular morbidity and mortality This study evaluated the relation of ABI with the angiographic severity of patient with coronary artery disease.Methods: This is a hospital based cross-sectional analytical study. 100 adult Bangladeshi patients who were admitted and underwent coronary angiography according to inclusion and exclusion criteria were the study population. All patient’s ABI were measured and coronary angiography were done. Patients were divided into two groups according to ABI. Group I with ABI &gt;0.90 and group II with ABI &lt;0.90.Results: In group I 65(82.2%) were men and 16(19.8%) were women. In group II 18(94.7%) patients were men and 1(5.3%) was women. Significant co-relation was found between low ABI and severity of CAD. Low ABI group showed more severe form of CAD with higher prevalence of triple vessel diseases, significant stenosis and more involvement of left main (LM) and left anterior descending(LAD)artery. Single vessel disease was found more with normal ABI. Hypertension, diabetes mellitus and Low ABI showed predictors of significant severe stenosis of coronary arteries.Conclusion: Low ankle brachial index is a predictor of the severity of coronary artery disease. So it could be incorporated in our day to day clinical cardiology practice as non-invasive, bedside test to assess and predict the severity of coronary artery disease.Cardiovasc. j. 2018; 10(2): 201-205

GW26-e1547 Relationship between blood pressure variability and ankle brachial index in people aged 80 and over

Objective To investigate the relationship between pressure variability and ankle brachial index in people aged 80 and over A total of 111 people aged 80 and over were divided into two groups according to the ABI: low ABI group ( ABI≤0. 9, n = 56 ) or normal ABI group ( ABI ＞ 0. 9, n = 55).

The association of very-low-density lipoprotein with ankle-brachial index in peritoneal dialysis patients with controlled serum low-density lipoprotein cholesterol level

BackgroundPeripheral artery disease (PAD) represents atherosclerotic disease and is a risk factor for death in peritoneal dialysis (PD) patients, who tend to show an atherogenic lipid profile. In this study, we investigated the relationship between lipid profile and ankle-brachial index (ABI) as an index of atherosclerosis in PD patients with controlled serum low-density lipoprotein (LDL) cholesterol level.MethodsThirty-five PD patients, whose serum LDL cholesterol level was controlled at less than 120mg/dl, were enrolled in this cross-sectional study in Japan. The proportions of cholesterol level to total cholesterol level (cholesterol proportion) in 20 lipoprotein fractions and the mean size of lipoprotein particles were measured using an improved method, namely, high-performance gel permeation chromatography. Multivariate linear regression analysis was adjusted for diabetes mellitus and cardiovascular and/or cerebrovascular diseases.ResultsThe mean (standard deviation) age was 61.6 (10.5) years; PD vintage, 38.5 (28.1) months; ABI, 1.07 (0.22). A low ABI (0.9 or lower) was observed in 7 patients (low-ABI group). The low-ABI group showed significantly higher cholesterol proportions in the chylomicron fraction and large very-low-density lipoproteins (VLDLs) (Fractions 3–5) than the high-ABI group (ABI>0.9). Adjusted multivariate linear regression analysis showed that ABI was negatively associated with serum VLDL cholesterol level (parameter estimate=-0.00566, p=0.0074); the cholesterol proportions in large VLDLs (Fraction 4, parameter estimate=-3.82, p=0.038; Fraction 5, parameter estimate=-3.62, p=0.0039) and medium VLDL (Fraction 6, parameter estimate=-3.25, p=0.014); and the size of VLDL particles (parameter estimate=-0.0352, p=0.032).ConclusionsThis study showed that the characteristics of VLDL particles were associated with ABI among PD patients. Lowering serum VLDL level may be an effective therapy against atherosclerosis in PD patients after the control of serum LDL cholesterol level.

PAD as a Risk Factor for Mortality Among Patients with Elevated ABI – A Clinical Study

Objective: This study aims to evaluate mortality across ankle–brachial index (ABI) values and to assess the association between elevated ABI, peripheral arterial disease (PAD) and mortality. Design: This is a retrospective clinical study. Material and methods: A total of 2159 patients referred with a suspicion of PAD had their ABI and toe brachial index (TBI) measured by photoplethysmography. ABI ≥1.3 was considered falsely elevated while TBI <0.60 was the diagnostic criterion for PAD among the subjects. The cohort was followed up for total and cardiovascular mortality until 30 June 2008, by record linkage with the National Causes-of-Death Register. Results: The average follow-up time was 39 months. A total of 576 (26.7%) patients died during the follow-up. Mortality was highest in the elevated ABI group (35.7% for elevated ABI; 30.1% for low ABI and 16.0% for normal ABI, p < 0.001). There was a greater than twofold risk of total, and an increased but statistically non-significant risk of, cardiovascular mortality among patients with elevated ABI. Similar risk ratios were noted for the low ABI (≤0.9) group. More pronounced associations were observed at both ends of the scale when ABI was divided into sub-categories. The overall survival was significantly worse for the elevated ABI group than for both the normal and the low-ABI group (p < 0.01 and p = 0.013, respectively). PAD was found to be independently associated with both total and cardiovascular mortality among those with elevated ABI (odds ratio (OR): 2.21; 95% confidence interval (CI): 1.01–4.85 and OR: 4.90; 95% CI: 1.50–16.04, respectively). Conclusions: The association between elevated ABI and poor survival is similar to that of low ABI. PAD appears to be an independent risk factor for mortality among patients with elevated ABI.

PAD as a Risk Factor for Mortality Among Patients with Elevated ABI – A Clinical Study

Objective This study aims to evaluate mortality across ankle–brachial index (ABI) values and to assess the association between elevated ABI, peripheral arterial disease (PAD) and mortality. Design This is a retrospective clinical study. Material and methods A total of 2159 patients referred with a suspicion of PAD had their ABI and toe brachial index (TBI) measured by photoplethysmography. ABI ≥1.3 was considered falsely elevated while TBI <0.60 was the diagnostic criterion for PAD among the subjects. The cohort was followed up for total and cardiovascular mortality until 30 June 2008, by record linkage with the National Causes-of-Death Register. Results The average follow-up time was 39 months. A total of 576 (26.7%) patients died during the follow-up. Mortality was highest in the elevated ABI group (35.7% for elevated ABI; 30.1% for low ABI and 16.0% for normal ABI, p < 0.001). There was a greater than twofold risk of total, and an increased but statistically non-significant risk of, cardiovascular mortality among patients with elevated ABI. Similar risk ratios were noted for the low ABI (≤0.9) group. More pronounced associations were observed at both ends of the scale when ABI was divided into sub-categories. The overall survival was significantly worse for the elevated ABI group than for both the normal and the low-ABI group ( p < 0.01 and p = 0.013, respectively). PAD was found to be independently associated with both total and cardiovascular mortality among those with elevated ABI (odds ratio (OR): 2.21; 95% confidence interval (CI): 1.01–4.85 and OR: 4.90; 95% CI: 1.50–16.04, respectively). Conclusions The association between elevated ABI and poor survival is similar to that of low ABI. PAD appears to be an independent risk factor for mortality among patients with elevated ABI.

Brachial-ankle pulse wave velocity and chronic kidney disease as a prognostic impact in hypertension

(hcPWV), heart-femoral PWV (hfPWV), femoral-ankle PWV (faPWV) using carotid and femoral sensor of form PWV/ABI. Therefore we examined prognostic impact of each regional PWV on stroke and cardiovascular disease (CVD) compared with baPWV in the cohort study of hypertensive patients. Methods: This study included 387 patients with essential hypertension (male/female Z 218/169, mean age 61.1 11.8, mean follow period 43months) whose baand regional PWV could be measured from October, 2000 to December, 2004. We set up stroke (n Z 20) and CVD (n Z 21) as a primary end point by the questionnaire. We classified the participants by the highest quartile of each PWV; high baPWV group, high hcPWV, high hfPWV and high faPWV; by the lowest quartile of ABI as low ABI group. Results: There was a significant correlation between baPWV and regional PWV; faPWV (r Z 0.560), hcPWV (r Z 0.253) and hfPWV (r Z 0.506). By Kaplan-Meier analysis, only high baPWV group showed the prognostic impact of stroke and CVD (p Z 0.0099) but not high faPWV (p Z 0.6982), high hcPWV (p Z 0.5740), high hfPWV (p Z 0.0773) and low ABI group (p Z 0.8008). Only low ABI group showed the prognostic impact on mortality (p Z 0.0223), high baPWV on stroke (p Z 0.0155) and high hcPWV on CVD (p Z 0.0382). Conclusion: As a further, larger, multicenter cohort study is needed, our study indicated that higher level of baPWV a might be a risk factor of stroke and CVD, but prognostic impact of regional PWV is not still unclear in hypertension.

The relationship of ankle brachial index to all-cause and cardiovascular disease mortality in Chinese male patients with hypertension

To evaluate the risk factors for peripheral arterial disease (PAD) and the relationship of low ankle brachial index (ABI) to all-cause and cardiovascular disease (CVD) mortality in Chinese male patients with hypertension. The data of 1606 male participants with hypertension from the eight hospitals in Beijing and Shanghai were analyzed. ABI was ascertained at baseline by measuring the systolic pressures on bilateral brachial and tibial arteries. ABI < or = 0.9 was used as the diagnostic criteria for PAD identification. The follow-up survey was conducted from November 2005 to January 2006. Of 1606 male participants with hypertension at baseline, 406 (25.3% ) were in low-ABI group and 1200 (74.7%) were in normal-ABI group. Older age, TC, history of diabetes, history of smoking and 2-grade hypertension were associated with low ABI in male patients with hypertension. During the (12.87 +/- 2.94) months follow-up, there were 153 deaths. Of which, 62 were attributable to CVD. Low ABI was associated with adjusted all-cause and CVD mortality risk of 1.728 (1.223-2.441) and 2.388 (1.409-4.046) respectively in Cox regression models. Rate of survival for the low-ABI group was significantly worse than for the normal-ABI group. The risk of all-cause and CVD mortality was increased with the decline of ABI. Low ABI is independently associated with the high risks of all-cause and CVD mortality in Chinese male patients with hypertension. The utility of ABI as a tool for predicting mortality in the patients with hypertension should be popularized.

Risk factors of peripheral arterial disease and relationship between low ankle brachial index and mortality from all-cause and cardiovascular disease in Chinese patients with hypertension.

The aim of this study was to evaluate the risk factors of peripheral arterial disease (PAD) and the relationship between ankle brachial index (ABI) and mortality from all-cause and cardiovascular disease (CVD) in Chinese patients with hypertension. The ABI cohort Study was designed to investigate risk factors of PAD and the relationship between ABI and mortality from all-cause and CVD in Chinese patients. ABI was identified at baseline by measuring systolic pressure at bilateral brachial and tibial arteries. Mortality surveillance was completed from November 2005 to January 2006. Among 3047 participants with hypertension at baseline, 839 (27.5%) were in the low-ABI group. Older age, female gender, higher serum level of triglycerides, lower serum level of high-density lipoprotein, a history of diabetes and a history of smoking were associated with low ABI. During the 13-month follow-up, there were 252 deaths, of which 100 died of CVD. Low ABI was associated with mortality from all-cause and CVD, whose adjusted relative risk was 1.619 (95% confidence interval 1.190-2.203) and 2.454 (1.531-3.933), respectively, in Cox regression models. The survival rate was significantly lower in the low-ABI group than in the normal-ABI group. This study demonstrated that low ABI was independently associated with a high risk of all-cause and CVD mortality in Chinese patients with hypertension. ABI should be promoted as an ideal tool to predict mortality in diabetic patients.

Risk Factors of Peripheral Arterial Disease and Relationship Between Low Ankle - Brachial Index and Mortality From All-Cause and Cardiovascular Disease in Chinese Patients With Type 2 Diabetes

The aim of the present study was to evaluate the risk factors for peripheral arterial disease and the relationship between the ankle - brachial index (ABI) and mortality from all-cause and cardiovascular disease (CVD) in Chinese patients with type 2 diabetes mellitus (DM). ABI was identified at baseline by measuring systolic pressure in the bilateral brachial and tibial arteries. Mortality surveillance was completed from November 2004 to January 2006. Among 1,647 participants with type 2 DM at baseline, 531 (32.2%) were in the low-ABI group. Older age, female gender, higher serum level of total cholesterol, longer duration of DM and a history of smoking were associated with low ABI. During the 13-month follow-up, there were 132 deaths, of which 47 were from CVD. Low ABI was associated with mortality from all-cause and CVD, the adjusted relative risk of which was 1.851 (95% confidence interval 1.280-2.676) and 3.211 (1.703-6.053), respectively, in Cox regression models. The survival rate was significantly lower in the low-ABI group than in the normal-ABI group. Low ABI was independently associated with a high risk of all-cause and CVD mortality in Chinese patients with type 2 DM. ABI should be promoted as an ideal tool for predicting mortality in diabetic patients.