Low Ankle-brachial Index Research Articles

P1578LOW ANKLE BRACHIAL INDEX, AND HIGH SERUM ALBUMIN WAS INDEPENDENTLY ASSOCIATE WITH HIGHER OF ISCHAEMIC MODIFIED ALBUMIN IN CHRONIC HAEMODIALYSIS PATIENTS

Abstract Background and Aims Haemodialysis (HD) is one of the life-saving procedures which prolonged life of chronic kidney disease stage 5, however, the long-termed complications such as cardiovascular disease (CVD), immune and endothelial dysfunction are commonly occurred. The high incidence of CVD in haemodialysis patient associated with traditional and non-traditional risk factors. The novel non-traditional risk factors such as p-cresol, Advance Glycosylation End Products (AGEs), Ankle-Brachial Index (ABI), Cardio-Ankle Vascular Index (CAVI). The ischemic modified albumin (IMA) is the new marker for cardiovascular disease in various populations including haemodialysis. We aimed to explored the factors associate with higher IMA in chronic haemodialysis patients. Method Cross sectional study 196 chronic haemodialysis patients were collected blood sample for Ischemic modified albumin (IMA), measured Ankle-Brachial Index (ABI), Cardio-Ankle Vascular Index (CAVI), and skin autofluorescence advanced glycosylation end products (SAF). Results 53% were female, 21% were smoker, 57% were diabetes, 93% were hypertension, 33% were coronary artery disease, 12% on HDF. Mean Age were 69.2±13.2 year, ABI 1.1±0.15, CAVI 9.3±1.5, SAF 3.1±0.8 arbitrary unit, IMA 37.5±15.2 U/ml, and serum albumin 3.7±0.4 g/dl. In multivariate adjustment showed factors associate with higher IMA were low ABI (B co-efficiency -13.4, P=0.049) and high serum albumin (B co-efficiency 1.68, P=0.000002). Conclusion Lower ABI and high serum albumin associate with higher IMA. The finding underlines the association between the atherosclerosis, vascular endothelial function and cardiac injury in haemodialysis. These results should be confirmed and explored in larger and longer clinical trials. Figure Regression analysis of factors associate with IMA accumulation.

P0785POSITIVE CORRELATION OF SERUM RESISTIN LEVEL WITH PERIPHERAL ARTERY OCCLUSIVE DISEASE IN PATIENTS WITH CHRONIC KIDNEY DISEASE STAGE 3 TO 5

Abstract Background and Aims Resistin named for its ability to resist insulin action has an important link between obesity, insulin resistance and diabetes. Moreover, additional reports suggest that resistin has a pathogenic role in the development and progression of atherosclerosis and coronary artery disease. Chronic kidney disease (CKD) accelerates atherosclerosis via augmentation of inflammation and perturbation of lipid metabolism. Peripheral arterial occlusive disease (PAOD) is associated with an increased risk of death in CKD patients. The aim of this study was to evaluate the relationship between serum resistin level and PAOD by ankle-brachial index (ABI) in CKD patients. Method Fasting blood samples and baseline characteristics were obtained from 240 patients with CKD (stage 3-5). ABI values were measured using the automated oscillometric method (VaSera VS-1000). ABI values that were < 0.9 were included in the low ABI group. Concentrations of human serum resistin were determined using a commercially available enzyme immunoassay kit. Results Among the 240 CKD patients, 30 of them (12.5%) were in the low ABI group. Compared with patients in the control group, the patients in the low ABI group had higher prevalence of diabetes (p = 0.033), hypertension (p = 0.023), current smoking (p = 0.013), older age (p < 0.001), higher systolic blood pressure (p = 0.013), glucose (p = 0.022) level and resistin (p < 0.001) levels. In addition, the multivariable logistic regression analysis showed that serum resistin levels (Odds ratio [OR]: 1.140, 95% confidence interval [CI]: 1.054-1.234, p = 0.001) and age (OR: 1.102, 95% CI: 1.051-1.156, p < 0.001) were the independently associated with PAOD in CKD patients. The area under the receiver-operating characteristic (ROC) curve predicting PAOD by serum resistin level in CKD patients was 0.699 (95% CI: 0.636-0.756, p = 0.0001). Conclusion In this study, serum resistin level was found to be associated with PAOD in non-dialysis CKD stage 3-5 patients.

Association between an elevated inter-arm systolic blood pressure difference, the ankle–brachial index, and mortality in patients with diabetes mellitus

ObjectivesTo estimate the prevalence of an inter-arm blood pressure difference greater than 10mmHg in patients with type 2 diabetes, and the association of this measurement with the presence of a low ankle–brachial index and mortality at 5-year follow-up. MethodA validated blood pressure measurement protocol was used. The blood pressure was calculated for each arm to obtain mean systolic differences. Peripheral arterial disease was confirmed by an ankle–arm index less than 0.9. The medical history of the patient was reviewed in the computerized clinical notes after 5 years of follow-up. ResultsThe study included 139 patients with a mean age of 70.1 years (49% male), and a mean duration of diabetes mellitus of 10.8 years. A total of 50 (36%) patients had an inter-arm systolic blood pressure difference greater than 10mmHg. Patients with an inter-arm systolic blood pressure greater than 10mmHg had lower ankle–arm index (0.91±0.30 vs. 1.04±0.28, P=0.005), and higher mortality rates from all causes (48.0% vs. 28.9%; hazard ratio 1.64; 95% confidence interval: 1.06–2.53; P=0.03), compared with those with lower inter-arm systolic blood pressure difference. ConclusionA high proportion of patients with type 2 diabetes have an elevated systolic blood pressure difference between arms. A significant relationship was found between elevated inter-arm systolic blood pressure difference, lower ankle–brachial index and greater all-cause mortality.

Association of Circulating Hepatocyte Growth Factor and Risk of Incident Peripheral Artery Disease: The Multi-Ethnic Study of Atherosclerosis.

Higher levels of hepatocyte growth factor (HGF) have been associated with the presence of peripheral arterial disease (PAD), but prospective associations are unknown. We examined the association of circulating HGF levels with incident PAD. Between 2000 and 2002, HGF was measured in 6742 Multi-Ethnic Study of Atherosclerosis participants without PAD. Incident clinical PAD, adjudicated on the basis of a positive history for the presence of disease-related symptoms or treatment, was ascertained through 2015. Incident low ankle-brachial index (ABI), defined as an ABI < 0.9 and a decline of ≥ 0.15, was assessed among 5736 individuals who had an ABI > 0.9 at baseline and ≥1 follow-up ABI measurement 3 to 10 years later. There were 116 clinical PAD and 197 low ABI events that occurred over a median follow-up of 14 and 9 years, respectively. After adjustment for demographic and clinical variables, a standard deviation increment of HGF (303 ng/L) was associated with an increased risk of clinical PAD (hazard ratio: 1.21; 95% confidence interval [CI]: 1.05-1.39) but not a low ABI (rate ratio: 1.03; 95% CI: 0.85-1.25). In conclusion, higher HGF levels were modestly associated with an increased risk of developing clinical PAD.

Prognostic Value of Abnormal Ankle-Brachial Index in Patients With Coronary Artery Disease: A Meta-Analysis.

The prognostic value of the ankle-brachial index (ABI) in patients with coronary artery disease (CAD) remains undefined. This meta-analysis sought to investigate the association of abnormal ABI and adverse outcomes in patients with CAD. PubMed, Embase, China National Knowledge Infrastructure, VIP, and Wanfang databases were comprehensively searched for studies published from inception to September 10, 2019. All observational studies investigating the association of abnormal baseline ABI and risk of major adverse cardiovascular events (MACE) or all-cause mortality were selected. Normal ABI is usually defined as between 0.9 and 1.4. The prognostic values were summarized by pooling risk ratio (RR) with 95% confidence intervals (CIs) for abnormal versus normal ABI category. Nine (9384 patients with CAD) studies were included. Abnormal ABI was independently associated with MACE (RR: 2.46; 95% CI: 2.02-2.99) and all-cause mortality (RR: 1.74; 95% CI: 1.32-2.30). Subgroup analysis showed that the pooled RR for MACE was 2.34 (95% CI: 1.73-3.16) for an abnormal low ABI. Abnormal ABI predicts MACE and all-cause mortality in patients with CAD, even after adjusting conventional confounding factors. However, the prognostic value of abnormal ABI is mainly dominated by a low ABI rather than a high ABI.

Re-evaluating the safety and effectiveness of the 0.9 ankle-brachial index threshold in penetrating lower extremity trauma

ObjectiveCurrent guidelines recommend additional imaging when the ankle-brachial index (ABI) is ≤0.9 after extremity trauma; however, the accuracy of this 0.9 threshold compared with other values has not been evaluated. The primary aim of this study was to compare the safety and effectiveness of various ABI thresholds in predicting lower extremity vascular injuries after penetrating trauma. We hypothesized that a lower ABI threshold can be used safely to avoid unnecessary imaging. MethodsA retrospective cohort study was performed at a single level I trauma center from January 2015 to December 2017. All patients who presented with penetrating lower extremity trauma and who underwent computed tomography angiography (CTA) were reviewed. Patients taken directly to the operating room without first undergoing CTA or those without documented ABIs were excluded. Demographic information, clinical features of presentation, interventions performed, and outcomes were recorded. P values were obtained using the Kolmogorov-Smirnov test, and a receiver operating characteristic curve was created to compare various ABI thresholds. ResultsA total of 47 patients (81% male), with a mean age of 29 years (range, 14-59 years), met inclusion criteria. Of the 17 limbs (36%) with a vascular abnormality seen on CTA, 6 (35%) required an intervention. The distribution of ABIs in injured limbs requiring revascularization was significantly lower (P = .006) than in those that did not require intervention. An ABI threshold of 0.7 is most accurate, with the highest combined sensitivity (83%) and specificity (91%) for detecting vascular injuries requiring revascularization. In addition, the negative predictive value was no different between a threshold of 0.7 (98%) and a threshold of 0.9 (97%), with both thresholds missing one vascular injury (pseudoaneurysm) requiring repair. ConclusionsThe ABI remains reliable in distinguishing between limbs with and limbs without vascular injury requiring revascularization after penetrating lower extremity trauma. A lower threshold can safely be used without compromising the negative predictive value of a screening ABI. Applying a threshold of 0.7 to our cohort would have avoided 51% (24) of the CTA studies performed without missing additional vascular injuries requiring repair.

Increased blood pressure variability during the subacute phase in patients with ischemic stroke presenting with a low ankle-brachial index.

This study aimed to evaluate the associations of blood pressure (BP) variability in patients with ischemic stroke during the subacute phase using ambulatory blood pressure monitoring and the ankle-brachial index (ABI). We retrospectively examined 831 consecutive patients (women 44.8%, mean age 76 ± 12 years) with acute ischemic stroke who underwent 24-h ambulatory blood pressure monitoring during the subacute phase of stroke (median 9 days from onset) and an ABI examination. BP variability was evaluated by assessing the standard deviation and coefficient of variation of systolic BP and diastolic BP. A low ABI was defined as an ABI <0.9. Of the 831 patients, 201 (24.2%) had a low ABI. Older age, lower body mass index, diabetes mellitus, chronic kidney disease, atrial fibrillation and a higher National Institutes of Health Stroke Scale score at admission were independently associated with a low ABI. The patients with a low ABI had a higher mean 24-h diastolic BP, higher standard deviation of both BP measurements (systolic BP and diastolic BP) and a higher coefficient of variation in both BP measurements than those with a higher ABI. According to the multivariable linear regression analysis, a low ABI was independently associated with increased BP variability (a high standard deviation or coefficient of variation of both BP measurements) after adjusting for baseline confounders. A low ABI was associated with increased BP variability during the subacute ischemic phase. Geriatr Gerontol Int 2020; 20: 448-454.

Associations between ankle-brachial index, diabetes, and sleep apnea in the Hispanic community health study/study of Latinos (HCHS/SOL) database

BackgroundSleep apnea and diabetes mellitus (DM) negatively impact cardiovascular health. One important indicator of cardiovascular health is the Ankle-Brachial Index (ABI). Either low ABI or high ABI are signs of peripheral vascular impairment. Impaired vascular health and DM, together, might provoke sleep apnea; however, information regarding these relationships is limited. Therefore, this study aimed to investigate the association between ABI, DM status, and severity of obstructive sleep apnea in people of Hispanic/Latino descent who are diverse in culture, environmental exposures, nativity, socioeconomic status, and disease burden.MethodsA cross sectional analysis from a multi-center epidemiologic study, Hispanic Community Health Study/Study of Latinos, was utilized and included 3779 participants (mean age 55.32 ± 7.67, females 57.9%). The sample was divided into 4 groups based on the American Diabetes Association diagnostic guidelines (no DM or DM), and the ABI status (normal and abnormal). Multiple linear regression analysis was used to determine the association of the four groups and other independent variables with severity of sleep apnea measured by apnea-hypopnea index. Kruskal-Wallis H test was used for comparisons between groups for the apnea-hypopnea index. The significant level was set at 0.01.ResultsThere were significant differences between groups in the mean of apnea-hypopnea index (P < 0.001; no DM + normal ABI = 5.42 ± 9.66, no DM + abnormal ABI = 7.11 ± 11.63, DM + normal ABI = 10.99 ± 15.16, DM + abnormal ABI = 12.81 ± 17.80). Linear regression showed that DM and abnormal ABI were significantly associated with severe sleep apnea (β = 3.25, P = 0.001) after controlling for age, sex, BMI, income, education, alcohol use, cigarette use, hypertension or related medication, stroke and statin use.ConclusionThese findings suggest that people with DM and abnormal ABI were more likely to have high apnea-hypopnea index compared to the other groups. We observed gradual increasing in the severity of sleep apnea from low abnormality groups to high abnormality groups for Hispanic/Latino. Further work should elucidate the association of DM, abnormal ABI and sleep apnea with longer term outcomes, and replicate this work in different populations.

Ankle Brachial Index as Predictor of Coronary Artery Lesion Severity in Patients with Suspected Stable Coronary Artery Disease

Background: Atherosclerosis is a general process and can occur in coronary, peripheral, and aortic arteries. Traditional risk factors for atherosclerosis are gender, age, hypertension, diabetes, smoking, dyslipidemia, and family history. Atherosclerosis in the coronary arteries will develop into coronary artery disease (CAD). Angiography examination is the gold standard in CAD diagnosis. Lower extremity artery disease (LEAD) is part of peripheral artery disease (PAD) due to atherosclerosis and can be diagnosed using the ankle brachial index (ABI). The aim of this study was to predict the severity of coronary artery lesions in patients with suspected SCAD population with ABI.Method: This was a analytical observational study using cross sectional research design. Data was taken consecutively from affordable populations at the polyclinic of RSUP Dr. Sardjito for 2 periods in May 2017-August 2017 and August 2018-October 2018. Examination of ABI was performed before patients underwent angiography and ABI was divided into low ABI (≤0.90) and normal ABI (0.91-1.40). SS measurements based on video angiography were divided into severe (SS&gt; 22) and not severe (SS ≤22).Data were presented in categorical form and analyzed using SPSS 23. Confounding factors were then analyzed by bivariate test. If there was a confounding factor with a value of p &lt;0.25, it was followed by a multivariate test.Result: There were 35 subjects with low ABI and 71 subjects with severe lesions of 104 patients. The hypothesis test showed ABI increased the incidence of coronary lesion severity with PR 1.52 (1.21-1.93 with 95% CI) with a p value of 0.002. Bivariate tests show no confounding factors that increase the incidence of coronary lesion severity. Hypertension and dyslipidemia have a value of p &lt;0.25 so multivariate analysis is performed. The results of multivariate analysis were only that ABI increase the incidence of coronary lesion severity (p= 0.004).Conclusion: A low ABI value will increase the incidence of coronary atherosclerosis lesion by 1.52 times in patients with suspected SCAD

Predictive value of the combination of brachial-ankle pulse wave velocity and ankle-brachial index for cardiovascular outcomes in patients with acute myocardial infarction.

Although ankle-brachial index and brachial-ankle pulse wave velocity measurement are well-established modalities for assessing peripheral artery disease and arterial stiffness and predicting cardiovascular events, it is unclear which one is more important or if a combination of the two is more effective for determining prognosis among patients with acute myocardial infarction. Patients with acute myocardial infarction (n = 889) were stratified into four groups according to a brachial-ankle pulse wave velocity (cut-off value: 1684 cm/s) and ankle-brachial index (cut-off value: 0.98): group I (high ankle-brachial index and low brachial-ankle pulse wave velocity, n = 389), group II (high ankle-brachial index and high brachial-ankle pulse wave velocity, n = 281), group III (low ankle-brachial index and low brachial-ankle pulse wave velocity, n = 103), group IV (low ankle-brachial index and high brachial-ankle pulse wave velocity, n = 116). The mean follow-up duration was 348 days. Major adverse cardiovascular events or cardiac death occurred in 64 (7.2%) and 26 patients (2.9%), respectively. In multivariable analysis, group III and IV had a significant high hazard ratio for major adverse cardiovascular events (5.93, 5.43) and cardiac death (13.51, 19.06). Additionally, ankle-brachial index had a higher hazard ratio than brachial-ankle pulse wave velocity for major adverse cardiovascular events (3.38 vs. 1.40) and cardiac death (6.21 vs. 2.40). When comparing receiver operating characteristic curves of the combined models of risk factors, brachial-ankle pulse wave velocity, and ankle-brachial index, pulse wave velocity plus ankle-brachial index or pulse wave velocity plus ankle-brachial index plus risk factors were significantly more predictive of major adverse cardiovascular events than risk factors. Our findings indicate that ankle-brachial index is a strong independent prognostic factor and adding a brachial-ankle pulse wave velocity measurement to ankle-brachial index increases the prognostic power for cardiac events in patients with acute myocardial infarction, while ankle-brachial index and pulse wave velocity showed additive value to risk factors.

Levels of ankle–brachial index and the risk of diabetes mellitus complications

ObjectiveWe sought to compare the association of categorized ankle–brachial index (ABI) with mortality and complications of diabetes in persons with no symptoms of peripheral arterial disease (PAD) and in primary...

High Serum Adipocyte Fatty Acid-Binding Protein Is Associated With Peripheral Artery Disease in Peritoneal Dialysis Patients

BACKGROUND: Peripheral arterial disease (PAD) is a vascular disorder wherein peripheral ischemia is caused by arterial obstruction and results in increased events of cardiovascular disease (CVD). Peritoneal dialysis (PD) is an independent predictor of subclinical PAD and the subsequent mortality in patients with end-stage renal disease. Adipocyte fatty acid-binding protein (A-FABP) is a potential biomarker for CVD risk, especially in patients with overt atherosclerosis. This study was conducted to determine the relationship between PAD and fasting serum levels of A-FABP in patients undergoing PD. METHODS: Fasting blood samples were obtained from 66 PD patients. A-FABP levels were measured using a commercially available enzyme immunoassay kit. Ankle-brachial index (ABI) values were measured using the automated oscillometric method. Serum left or right ABI values of ＜ 0.9 were included in the low ABI group. RESULTS: There were 14 patients (21.2%) in the low ABI group. Compared with patients in the control group, those in the low ABI group had a higher prevalence of diabetes (P = 0.045) and higher serum C-reactive protein (P ＜ 0.001) and A-FABP (P ＜ 0.001) levels but lower weekly Kt/V (P = 0.014) and lower normalized protein equivalent of nitrogen appearance (P = 0.034) values. Multivariate logistic regression analysis of the factors that were significantly associated with PAD revealed that A-FABP (odds ratio, 1.038; 95% confidence interval [CI], 1.004-1.074; P = 0.030) was an independent predictor of PAD in PD patients. The area under the curve plotted to estimate the optimal level of A-FABP predicting PAD in PD patients by the receiver operating characteristic curve analysis was 0.757 (95% CI, 0.636-0.854; P = 0.0004). CONCLUSION: This study demonstrated that a higher serum A-FABP level is an independent predictor of PAD in patients undergoing PD.

Diet is associated with ankle-brachial index, inflammation, and ambulation in patients with intermittent claudication

ObjectiveThe aims of this investigation were to determine whether the daily dietary intake of nutrients by patients with peripheral artery disease (PAD) and intermittent claudication (IC) met recommended levels for adults older than 50 years and to determine whether meeting recommended levels of nutrients was associated with ankle-brachial index (ABI), inflammation, and ambulation of patients with PAD and IC. MethodsA total of 48 patients were assessed on their dietary intake of 20 nutrients during a 3-day period. Patients were further characterized on demographic variables, comorbid conditions, cardiovascular risk factors, ABI, 6-minute walk distance (6MWD), and high-sensitivity C-reactive protein (hsCRP) concentration. ResultsFew patients met the daily recommended intakes for calcium (4%), fiber (6%), vitamin E (6%), trans fatty acids (13%), vitamin A (15%), total sugars (19%), potassium (23%), sodium (29%), saturated fat (29%), and vitamin C (31%), and none of the patients met the daily recommended intake of vitamin D (0%). Overall, patients met few of the 20 dietary recommendations as the median score was seven recommendations. Only 17 of 48 patients met more than seven of the recommendations. For the ABI regression model adjusted for age, sex, race, smoking, hypertension, dyslipidemia, body mass index, and percentage body fat, the only significant predictor was total sugars (P < .001); patients who did not meet the recommendation had lower ABI values. For the hsCRP-adjusted regression model, the strongest significant predictor was omega-3 polyunsaturated fatty acids (P = .001), indicating that those who did not meet the recommendation had higher hsCRP values. Finally, for the 6MWD-adjusted regression model, folate (P = .011) and dietary score index (P = .014) were significant predictors; those who did not meet the recommendation for folate and those who met 5 or fewer of the 20 recommendations had shorter 6MWD. ConclusionsPatients with PAD and IC consume a low-nutrient-dense diet that is deficient in many vitamins, calcium, fruits, and vegetables and contains too much added sugar, saturated and trans fats, and processed foods. In addition, more severe PAD, greater inflammation, and ambulatory dysfunction are independently associated with aspects of a low-nutrient-dense diet, such as too much intake of added sugars, low intake of omega-3 polyunsaturated fatty acids and folate, and meeting the recommended intakes of only five or fewer nutrients.

Association between an elevated inter-arm systolic blood pressure difference, the ankle–brachial index, and mortality in patients with diabetes mellitus

ObjectivesTo estimate the prevalence of an inter-arm blood pressure difference greater than 10mmHg in patients with type 2 diabetes, and the association of this measurement with the presence of a low ankle–brachial index and mortality at 5-year follow-up. MethodA validated blood pressure measurement protocol was used. The blood pressure was calculated for each arm to obtain mean systolic differences. Peripheral arterial disease was confirmed by an ankle–arm index less than 0.9. The medical history of the patient was reviewed in the computerized clinical notes after 5 years of follow-up. ResultsThe study included 139 patients with a mean age of 70.1 years (49% male), and a mean duration of diabetes mellitus of 10.8 years. A total of 50 (36%) patients had an inter-arm systolic blood pressure difference greater than 10mmHg. Patients with an inter-arm systolic blood pressure greater than 10mmHg had lower ankle–arm index (0.91±0.30 vs. 1.04±0.28, P=0.005), and higher mortality rates from all causes (48.0% vs. 28.9%; hazard ratio 1.64; 95% confidence interval: 1.06–2.53; P=0.03), compared with those with lower inter-arm systolic blood pressure difference. ConclusionA high proportion of patients with type 2 diabetes have an elevated systolic blood pressure difference between arms. A significant relationship was found between elevated inter-arm systolic blood pressure difference, lower ankle–brachial index and greater all-cause mortality.

Inter-arm difference of systolic blood pressure measured by automated double-cuff device is associated with arterial stiffness in patients with hypertension.

Inter-arm differences of SBP ≧5 mmHg have been associated with all-cause and cardiovascular mortalities in hypertensive subjects. Inter-arm differences of SBP appears to be mediated by arterial stiffness. We hypothesized inter-arm differences of SBP ≧5 mmHg may be related to higher pulse pressure/stroke volume index, a surrogate marker of arterial stiffness. To obtain inter-arm differences of SBP (the absolute difference of right and left arm) and ankle-brachial index, bilateral blood pressures were measured simultaneously at the four limbs using an automated oscillometric device in patients with treated hypertension (n = 234) and in normotensive subjects (n = 40). Pulse pressure was calculated as SBP-DBP. Stroke volume was obtained by time-velocity integral method using echocardiography. Left ventricular mass and relative wall thickness were calculated by the conventional methods. All hypertensive patients were medically treated and had average blood pressure levels of 135/85 mmHg. Inter-arm differences of SBP ≧5 mmHg was detected in 26.5% of hypertensive patients. Hypertensive patients with inter-arm differences of SBP ≧5 mmHg had higher pulse pressure/stroke volume index, lower ankle-brachial index, higher BMI, and higher relative wall thickness, higher prevalence of female than those with inter-arm differences of SBP <5 mmHg. Multiple linear regression analysis confirmed inter-arm differences of SBP ≧5 mmHg was associated with higher pulse pressure/stroke volume index, higher relative wall thickness, and lower ankle-brachial index. Inter-arm difference of SBP measured by automated double-cuff device was related to large artery stiffness in patients with hypertension.

Abdominal aortic calcification (AAC) and ankle-brachial index (ABI) predict health care costs and utilization in older men, independent of prevalent clinical cardiovascular disease and each other

Background and aimsAbdominal aortic calcification (AAC) and low ankle-brachial index (ABI) are markers of multisite atherosclerosis. We sought to estimate their associations in older men with health care costs and utilization adjusted for each other, and after accounting for CVD risk factors and prevalent CVD diagnoses. MethodsThis was an observational cohort study of 2393 community-dwelling men (mean age 73.6 years) enrolled in the Osteoporotic Fractures in Men (MrOS) study and U.S. Medicare Fee for Service (FFS). AAC was scored on baseline lateral lumbar spine X-rays using a 24-point scale. ABI was measured as the lowest ratio of arm to right or left ankle blood pressure. Health care costs, hospital stays, and SNF stays were identified from Medicare FFS claims over 36 months following the baseline visit. ResultsMen with AAC score ≥9 (n = 519 [21.7% of analytic cohort]) had higher annualized total health care costs of $1473 (95% C.I. 293, 2654, 2017 U S. dollars) compared to those with AAC score 0–1, after multivariable adjustment. Men with ABI <0.90 (n = 154 [6.4% of analytic cohort]) had higher annualized total health care costs of $2705 (95% CI 634, 4776) compared to men with normal ABI (≥0.9 and < 1.4), after multivariable adjustment. ConclusionsHigh levels of AAC and low ABI in older men are associated with higher subsequent health care costs, after accounting for clinical CVD risk factors, prevalent CVD diagnoses, and each other. Further investigations of whether preventing progression of peripheral vascular disease and calcification reduces subsequent health care costs are warranted.

Association between selected immune markers and low ankle-brachial index in virologically suppressed HIV-infected patients on antiretroviral therapy in Nigeria

ENWEndNote BIBJabRef, Mendeley RISPapers, Reference Manager, RefWorks, Zotero AMA Elochukwu Agu C, Uchendu I, Okwuosa C, Achukwu P. Association between selected immune markers and low ankle-brachial index in virologically suppressed HIV-infected patients on antiretroviral therapy in Nigeria. HIV & AIDS Review. International Journal of HIV-Related Problems. 2020;19(4):227-236. doi:10.5114/hivar.2020.101502. APA Elochukwu Agu, C., Uchendu, I., Okwuosa, C., & Achukwu, P. (2020). Association between selected immune markers and low ankle-brachial index in virologically suppressed HIV-infected patients on antiretroviral therapy in Nigeria. HIV & AIDS Review. International Journal of HIV-Related Problems, 19(4), 227-236. https://doi.org/10.5114/hivar.2020.101502 Chicago Elochukwu Agu, Chidozie, Ikenna Kinsgley Uchendu, Chukwugozie Nwachukwu Okwuosa, and Peter Uwadiegwu Achukwu. 2020. "Association between selected immune markers and low ankle-brachial index in virologically suppressed HIV-infected patients on antiretroviral therapy in Nigeria". HIV & AIDS Review. International Journal of HIV-Related Problems 19 (4): 227-236. doi:10.5114/hivar.2020.101502. Harvard Elochukwu Agu, C., Uchendu, I., Okwuosa, C., and Achukwu, P. (2020). Association between selected immune markers and low ankle-brachial index in virologically suppressed HIV-infected patients on antiretroviral therapy in Nigeria. HIV & AIDS Review. International Journal of HIV-Related Problems, 19(4), pp.227-236. https://doi.org/10.5114/hivar.2020.101502 MLA Elochukwu Agu, Chidozie et al. "Association between selected immune markers and low ankle-brachial index in virologically suppressed HIV-infected patients on antiretroviral therapy in Nigeria." HIV & AIDS Review. International Journal of HIV-Related Problems, vol. 19, no. 4, 2020, pp. 227-236. doi:10.5114/hivar.2020.101502. Vancouver Elochukwu Agu C, Uchendu I, Okwuosa C, Achukwu P. Association between selected immune markers and low ankle-brachial index in virologically suppressed HIV-infected patients on antiretroviral therapy in Nigeria. HIV & AIDS Review. International Journal of HIV-Related Problems. 2020;19(4):227-236. doi:10.5114/hivar.2020.101502.

Clinico-Etiological Evaluation of Chronic Leg Ulcer in a Tertiary Care Center of Eastern India.

Background:A chronic leg ulcer (CLU) is a significant public health problem. It has various etiologies. Racial, familial, occupational, and social factors may also have an impact on the prevalence of different causes of leg ulcers. Though there are western data on the epidemiology of leg ulcer, similar data are largely unavailable from our part of the world.Aims:We undertook a study in a tertiary care center in eastern India to determine the clinical and etiological pattern of patients with CLU.Materials and Methods:Hundred consecutive patients presenting with CLU, fulfilling the criteria, were included after informed consent. Patients were subjected to proper history taking, clinical examination, routine blood test, and pus for culture and sensitivity test (where needed) along with Ankle Brachial Index (ABI).Results:Among the 100 patients, venous ulcer (34%) was predominant followed by arterial ulcer (14%), mixed arterial and venous ulcer (11%). History of smoking (56%) and obesity (BMI >25) (32%) were the common risk factors in leg ulcer patients. Fifty nine percent of the total CLU were infected and out of this, 86.4% showed growth of microorganisms. Staphylococcus aureus (39%) was the most commonly isolated organism, followed by Pseudomonas aeruginosa (15%). Eleven (24.44%) clinically diagnosed venous ulcer patients showed significantly lower ABI (<0.9) and were diagnosed as mixed ulcer (a venous ulcer with a peripheral arterial disease).Conclusion:Venous ulcer and mixed ulcer are the most common type of CLU.

Association of Ankle-Brachial and Toe-Brachial Indexes With Mortality in Patients With CKD

Rationale & ObjectiveA low ankle-brachial index (ABI) is used to diagnose peripheral artery disease (PAD) but may be normal or elevated in patients with medial arterial calcification and stiff vessels, as is common in chronic kidney disease (CKD). The toe-brachial index (TBI) has been recommended because it is not influenced by medial arterial calcification, but alone the TBI does not capture risk associated with medial arterial calcification. We hypothesized that the difference between ABI and TBI (ABI − TBI) would capture both PAD and medial arterial calcification and thus better identify mortality risk from PAD, particularly in those with CKD.Study DesignProspective cohort study.Setting & Participants471 patients with clinical suspicion for PAD referred for vascular testing.ExposuresABI, TBI, and ABI − TBI.OutcomeAll-cause mortality.Analytical ApproachCox proportional hazards models evaluating the association of ABI − TBI with mortality over 7 years.ResultsMean age was 68 years, 89% were men, 35% had diabetes, 64% had CKD, and mean estimated glomerular filtration rate was 55 mL/min/1.73 m2. Median ABI was 0.96 (interquartile range [IQR], 0.73-1.08), median TBI was 0.62 (IQR, 0.46-0.81), and median ABI − TBI was 0.23 (IQR, 0.14-0.39). Higher ABI − TBI values were associated with increased risk in mortality only among participants with ABI values ≥ 0.9 (P = 0.03). Among participants with CKD and ABI values ≥ 0.9, participants with ABI − TBI values higher than the median had greater (HR, 1.79; 95% CI, 1.18-2.72) risk for mortality (P = 0.005). This was attenuated after age adjustment (HR, 1.41; 95% CI, 0.91-2.20) but did not change after further adjustment for confounders.LimitationsMainly male cohort derived from a vascular laboratory; lack of limb outcomes and data for albuminuria.ConclusionsA high ABI − TBI value may be associated with higher risk for mortality in persons with CKD and a normal ABI. Age affects this association, and further studies evaluating ABI − TBI in larger populations are required.

Serum osteoprotegerin level is positively associated with peripheral artery disease in patients with peritoneal dialysis

Osteoprotegerin (OPG) is a potential biomarker of cardiovascular disease complications and severity. Peripheral arterial disease (PAD) is associated with an increased risk of death in patients on peritoneal dialysis (PD). Therefore, this study aimed to evaluate the relationship between serum OPG levels and PAD by measuring the ankle-brachial index (ABI) of patients on PD. A commercial enzyme-linked immunosorbent assay kit was used to measure OPG values. Left or right ABI values of <0.9 were categorized as the low ABI group. Among 70 patients on PD, 13 (18.6%) were categorized in the low ABI group. Patients in the low ABI group had higher prevalence of diabetes mellitus (p = .044) and higher serum C-reactive protein (CRP) (p < .001) and OPG levels (p < .001) but lower creatinine (p = .013) and peritoneal Kt/V (p = .048) levels than those in the normal ABI group. Results of multivariable logistic regression analysis revealed that OPG [adjusted odds ratio (aOR) 1.027, 95% confidence interval (CI) 1.010–1.045, p = .002] and CRP (aOR 1.102, 95% CI 1.006–1.207, p = .037) levels were independent predictors of PAD in patients on PD. OPG can also be used to predict PAD development with the area under the receiver operating characteristic curve of 0.823 (95% CI: 0.714–0.904, p < .001) in patients on PD. Therefore, serum OPG and CRP levels can be considered as risk factors for PAD development in patients on PD.