Lower Peripheral Arterial Disease Prevalence Research Articles

CHANGES IN CLINICAL PROFILE OF REFRACTORY HYPERTENSIVES AFTER THE INTRODUCTION OF SPIRONOLACTONE

Objective: To characterize prevalence and clinical profile of patients with RfHTN among a historical cohort of patients with RHTN in 2 moments: before and after the introduction of spironolactone. Design and method: A cross-sectional analysis was performed during the pre-spironolactone period (before 2005) with 1,048 participants with RHTN (72.3% women, average age: 61.2 ± 11.3 years). All of them were submitted to a standard protocol including clinical and laboratory tests, 24-hour ABPM, echocardiogram, and pulse wave velocity. In a second analysis, refractory patients were evaluated after the introduction of spironolactone (post-spironolactone period – after 2005). The statistical analysis included bivariate comparisons between patients with RHTN and those with RfHTN, as well as logistic regressions to assess independent correlations of RfHTN pre- and post-spironolactone. Results: In the initial cross-sectional analysis (pre-spironolactone), RfHTN prevalence was 14%. Age < 60 years, smoking, obesity and left ventricular hypertrophy (LVH) were independently correlated with RfHTN. After the introduction of spironolactone, prevalence increased to 17.6%. It was observed that refractory patients using spironolactone presented less aortic stiffness, lower prevalence of LVH, cerebrovascular disease and peripheral arterial disease (PAD), what might indicate a reduced cardiovascular risk despite the lack of blood pressure control. Refractory patients have also presented higher magnitude of white-coat effect, reflecting an exacerbated sympathetic activity. Age < 60 years and lower prevalence of PAD were correlated with RfHTN in the post-spironolactone period. Conclusions: The use of spironolactone seems to reduce cardiovascular risk despite the lack of blood pressure control.

Low Prevalence of Peripheral Arterial Disease in Type 2 Diabetes Patients in North India

Introduction: Peripheral Arterial Disease (PAD) is a major macrovascular complication of type 2 diabetes (T2D). Though data is limited, studies have indicated a lower prevalence of PAD in Indian diabetes patients as compared to western population. Present study assessed prevalence of PAD in T2D patients in Delhi, North India. Methodology: This study is a retrospective analysis of patient records of T2D patients. A total of 1000 patient were screened, 195 patients were excluded due to incomplete data and 8patients were included in the study. Diagnosis of PAD was based on ankle brachial index (ABI) measurement. An ABI value of <0.9 indicated diagnosis of PAD, 0.9 to 1.3 was taken as normal, and ABI>1.3 as indicator of non-compressible arteries. Results: Study population consisted of 470 male and 335 female T2D patients (n=805), group 22 to 83 years. PAD (ABI <0.9) was present in 12 patients (1.49%), 9males (75% of PAD) and 3 females (25% of PAD). Diabetes patients with PAD had a higher mean age (57.±10.96 vs. 50.97 ±10.03years) a longer duration of diabetes (12.67 ±7.9 vs. 8.±8.06years, p=0.02) and significantly lower BMI (24.92kg/m2±2.42 vs. 29.55±5.87 kg/m2, p=0.0066) as compared to nondiabetic patients. More patients with PAD had hypertension (58.33% vs. 47.79%, p=0.96) and coronary artery disease (16.67% vs. 7.44%, p=0.908) which, however, were not statistically significant. PAD patients had significantly higher levels of total cholesterol (198.75±66.39 vs. 162.23±44.71mg/dl, p=0.0055) and LDL cholesterol (120.66±40.48mg/dl, p=0.039). No difference was seen in triglyceride levels (165.67±70.92mg/dl vs. 165.4±110.14,p=0.99) and A1c levels (8.97±3.vs. 9.08±2.54%, p=0.87) in two groups. Conclusion: Our study shows that prevalence of PAD in T2D patients in Delhi, North India, is much lower than that reported in western population (∼20%) and from south India (6.3%). Prevalence of PAD was higher in patients with higher age, longer duration of diabetes, lower BMI, and higher total and LDL cholesterol. Disclosure B.M. Makkar: None. J.K. Sharma: None. S. Jaggi: None. K. Soota: None. V. Gupta: None. G. Khurana: None.

Ethnic differences in the prevalence of peripheral arterial disease: a systematic review and meta-analysis

ABSTRACTBackground: Previous studies have demonstrated higher rates of peripheral arterial disease (PAD) in blacks and lower in Asians compared to whites. The aim of this study is to undertake a comprehensive review of literature on ethnic differences in the epidemiology of PAD.Methods: A systemic review and meta-analysis included studies reporting PAD prevalence in general or diabetic populations, and comparing PAD prevalence in ethnic groups.Results: Mean prevalence of PAD in general population for whites, blacks and Asians was 3.5%, 6.7% and 3.7% respectively. Meta-analysis demonstrated higher prevalence of PAD in blacks (p < 0.001) and lower amongst Asians (p < 0.001), compared to whites. In diabetic population, the mean prevalence of PAD for whites, blacks, east Asians and south Asians was 17%, 25.3%, 13.5% and 7.6% respectively. In diabetic population, south Asians had a lower PAD prevalence (p < 0.001) compared to whites; there was no significant difference between blacks and whites. Overall females have higher PAD rates, in general (3.8% vs 3.2%; p < 0.001) and in diabetic population (13.7% vs 10%; p < 0.001).Conclusion: Blacks are vulnerable to PAD, in contrast to Asians who have lower prevalence of PAD when compared to whites. Further research is needed in order to identify the factors that generate this difference.