Marker Of Peripheral Arterial Disease Research Articles

P1411Lipoprotein(a) is a marker of peripheral artery disease in the absence of coronary heart disease

P1411Lipoprotein(a) is a marker of peripheral artery disease in the absence of coronary heart disease

Reduced high-density lipoprotein cholesterol: A valuable, independent prognostic marker in peripheral arterial disease

ObjectiveThe prognosis of patients with peripheral arterial disease (PAD) is characterized by an exceptionally high risk for myocardial infarction, ischemic stroke, and death; however, studies in search of new prognostic biomarkers in PAD are scarce. Even though low levels of high-density lipoprotein cholesterol (HDL-C) have been associated with higher risk of cardiovascular (CV) complications and death in different atherosclerotic diseases, recent epidemiologic studies have challenged its prognostic utility. The aim of this study was to test the predictive value of HDL-C as a risk factor for ischemic events or death in symptomatic PAD patients. MethodsClinical and demographic parameters of 254 symptomatic PAD patients were recorded. Amputation, ischemic coronary disease, cerebrovascular disease, and all-cause mortality were recorded during a mean follow-up of 2.7 years. ResultsMultivariate analyses showed that disease severity (critical limb ischemia) was significantly reduced in patients with normal HDL-C levels compared with the group with low HDL-C levels (multivariate analysis odds ratio, 0.09; 95% confidence interval [CI], 0.03-0.24). A decreased risk for mortality (hazard ratio, 0.46; 95% CI, 0.21-0.99) and major adverse CV events (hazard ratio, 0.38; 95% CI, 0.16-0.86) was also found in patients with normal vs reduced levels of HDL-C in both Cox proportional hazards models and Kaplan-Meier estimates, after adjustment for confounding factors. ConclusionsReduced HDL-C levels were significantly associated with higher risk for development of CV complications as well as with mortality in PAD patients. These findings highlight the usefulness of this simple test for early identification of PAD patients at high risk for development of major CV events.

Abstract 313: Differences in Galectin-3, a Biomarker of Fibrosis, Between Subjects With Peripheral Artery Disease and Controls

Introduction: Galectin-3 (G3) mediates vascular fibrosis. It can be detected in blood but it is unknown whether G3 is a marker of peripheral artery disease (PAD) or correlates with early atherosclerosis markers. Objectives/Aims: To determine if G3 plasma levels are different between subjects with PAD and controls without PAD. Secondary aim: To describe the relationship between G3 plasma levels and markers of early atherosclerosis (arterial elasticity, high-sensitivity C-reactive protein [HS-CRP], homeostatic model assessment [HOMA], and urinary albumin/creatinine ratio [UACR]) in a sample of subjects with PAD and controls. Methods: Consecutive subjects (n=60) were recruited in 2 groups: (1) a PAD group (n=31), with ankle/brachial index (ABI) <0.90, and (2) non-PAD controls (n=29) with ABI 1-1.4. G3 was measured by ELISA. Demographics, cardiovascular risk factors and markers of early atherosclerosis were compared between groups using t-tests, Chi-square tests and logistic regression and the association between G3 and markers of early atherosclerosis was investigated using linear regression analysis. Results: Compared to controls, participants with PAD were older (mean 68.6 vs. 61.8 years, p=0.02), had a higher percentage of men (68% vs. 38%, p=0.02), and had more smokers, diabetics, and subjects with hypertension and dyslipidemia (p<0.001 for all). G3 was higher in PAD (mean ± SD: 17.6±4.7 vs. 14.4±4.1 ng/mL, p<0.01). The odds ratio for G3 in the PAD group to be 1 ng/mL higher than the control group was 1.19, after adjusting by age (≥65 years) and gender, (95% CI 1.036-1.37, p=0.014). when HS-CRP was included in the model the association between PAD and G3 was not significant. HS-CRP (p=0.005) and HOMA (p=0.016) were positively associated with G3 in the adjusted model. Arterial elasticity (p=0.4) and UACR (p=0.09) were not associated with G3 in the adjusted model. Conclusion: After adjustment for age and gender, mean G3 levels were 22% higher in PAD participants compared to controls and G3 was positively associated with HS-CRP. Future studies are warranted to determine if G3 is an accurate prognostic biomarker or screening tool to detect PAD and atherosclerosis.

The role of inflammation in cardiovascular diseases: the predictive value of neutrophil-lymphocyte ratio as a marker in peripheral arterial disease.

Peripheral arterial disease (PAD) is an important manifestation of atherosclerosis, with increasing prevalence worldwide. A growing body of evidence shows that the systemic inflammatory response is closely related to the development, progression, and prognosis of atherosclerosis. In the last decade, several studies have suggested the role of measured inflammatory biomarkers as predictors of severity and prognosis in PAD in an effort to stratify the risk of these patients, to improve treatment selection, and to predict the results after interventions. A simple inflammatory marker, more available than any other, is the neutrophil–lymphocyte ratio (NLR), which can be easily obtained in clinical practice, based on the absolute count of neutrophils and lymphocytes from the differential leukocytes count. Many researchers evaluated vigorously the NLR as a potential prognostic biomarker predicting pathological and survival outcomes in patients with atherosclerosis. In this work, we aim to present the role of NLR as a prognostic marker in patients with PAD through a thorough review of the literature.

Abstract MP08: Higher Diet Quality is Associated with Lower Odds of Inflammation and Peripheral Artery Disease in the Hispanic Community Health Study/Study of Latinos

Introduction: C-reactive protein (CRP; a marker of inflammation) and the ankle-brachial index (ABI; a marker of peripheral artery disease (PAD)) are considered emerging risk factors for cardiovascular disease (CVD) in addition to traditional cardiometabolic markers. Results on the association of a healthy diet and these emerging risk factors have been inconsistent, and few studies have been conducted on Hispanics/Latinos, who present high prevalence of cardiometabolic risk factors. Hypothesis: We hypothesized that higher diet quality as measured with the Alternate Healthy Eating Index (AHEI; range 0-110: lowest to highest quality) would be associated with lower odds of having high-risk levels of CRP and of ABI, independently from cardiometabolic risk factors. Methods: Baseline data were analyzed from US-Hispanics/Latinos aged 18-74y without previously-diagnosed CVD participating in the population-based Hispanic Community Health Study/Study of Latinos cohort. There were 14,623 participants with complete CRP data, and 7,892 with ABI data (measured only for those aged ≥45y). Food and nutrients components of AHEI were assessed from two 24-hour recalls. High-risk CRP was defined as >3.0 mg/L, and high-risk ABI was defined as <0.90 or >1.40, with further categorization into PAD (<0.90) and arterial stiffness (>1.40). Results: Nearly 35% of Hispanics/Latinos had high-risk CRP levels and 6.3% had high-risk ABI (4.2% had PAD and 2.1% had arterial stiffness). After adjusting for demographic, socioeconomic, and lifestyle factors, as well as cardiometabolic risk factors (diabetes, hypertension, obesity, or dyslipidemia), the odds (95% confidence interval) of having high-risk ABI were 36% (5, 43%) lower for each 10-unit increase in AHEI (p=0.020). The association remained significant for PAD alone, albeit attenuated (p=0.046), but not for arterial stiffness (p=0.210). Each 10-unit increase in AHEI was associated with 21% (10, 31%) lower odds of high-risk CRP(p=0.0003) after similar adjustments. There were no significant interactions between AHEI and sex, background, smoking, or cardiometabolic risk factors for the associations with ABI. The association of AHEI with high-risk CRP was stronger for those with diabetes (0.68 (0.52, 0.89) vs. 0.82 (0.71, 0.94) without diabetes; p-interaction=0.0002) and with obesity (0.70 (0.58, 0.85) vs. 0.86 (0.73, 1.01) without obesity; p-interaction=0.0001). Conclusions: A higher diet quality is associated with lower inflammation and PAD among Hispanics/Latinos, independently from traditional cardiometabolic risk factors. Promoting a healthy overall diet may benefit with further lowering CVD-risk related to emerging factors in a population that already presents high prevalence of cardiometabolic markers.

Onychodystrophy: A possible marker for peripheral artery disease

Peripheral artery disease (PAD) is quite common, particularly among the elderly. In advanced phases, it has an important impact in the quality of life, so it is recommended to identify this disease on early stages. Onychodystrophy is a deformity of the nail plate of any origin. Up to 50% are caused by fungal infection, the rest is mainly secondary to inflammatory processes. Nail inspection is a very accessible task, and valuation of PAD with the ankle-brachial index (ABI) is a noninvasive affordable technique. One hundred two self-reported healthy participants were recruited, and the ABI was obtained, as well as inspection of the toenails in search of onychodystrophy. Sixty-seven patients had abnormal ABI measurements. Of these, 39 were diagnosed as having onychodystrophy. These results are statistically significant to support the fact that onychodystrophy may be an early marker of asymptomatic PAD, allowing prompt intervention to ameliorate or stop disease progression.

Relationship of Inflammatory Biomarkers with Severity of Peripheral Arterial Disease.

Objective. The pentraxin family, including high-sensitivity C-reactive protein (hs-CRP), serum amyloid P (SAP), and pentraxin 3 (PTX3), has been identified as playing a key role in inflammatory reactions such as in atherosclerosis and cardiovascular disease. In this study, we examined the relationship between peripheral arterial disease (PAD) and serum levels of pentraxins. Methods. This study was undertaken via a retrospective review of PAD patients with surgical intervention for lesions of the common femoral artery. We evaluated the preoperative patient conditions, hemodynamic status, such as ankle brachial index (ABI), and clinical ischemic conditions according to Rutherford classification. Preoperatively, we collected blood samples for determining the serum levels of hs-CRP, SAP, and PTX3. Results. Twelve PAD patients with common femoral arterial lesions were treated and examined. The hemodynamic severity of PAD was not negatively correlated with hs-CRP, SAP, or PTX3. The clinical severity evaluated by Rutherford classification was significantly positively correlated with the serum level of PTX3 (p = 0.019). Conclusion. We demonstrated that PTX3 might be a better marker of PAD than hs-CRP and SAP. Furthermore, PTX3 might be a prognostic marker to evaluate the severity of PAD.

Abstract 19013: Longitudinal Changes in Ankle and Brachial Pressures in a Community Dwelling Population: Results From the Baltimore Longitudinal Study of Aging

Reduction in ankle-brachial index (ABI) is a marker of peripheral arterial disease (PAD) and is attributed to flow limiting lesions. It is unclear whether the major changes in blood pressure with aging affect ankle and brachial pressures differently and result in changes in ABI with advancing age. We studies 719 participants (2176 observations) from the Baltimore Longitudinal Study of Aging who were free of clinical cardiovascular (CV) disease at baseline. Ankle and brachial systolic blood pressures (SBP) and their index (ABI) were measured in both sides using oscillometric device (Colin VP2000) and averages of both sides were calculated. Linear mixed effects models were used with age expressed as Entry-Age and Follow up Time (Time) to test for non-linear longitudinal changes in these parameters. About 15% of the sample had diabetes at baseline, 3.5% were current and 38% were former smokers. Adjusting for diabetes, smoking status and anti-hypertensive medications, men had greater ABI than women (B= 0.02, P=<0.001) with no statistically significant differences in trajectories. ABI changed with aging with statistically significant Entry-age X Time terms (P<0.01). Model predicted values (Figure 1) shows a longitudinal decline in ABI after the age of 65. In men, this decline was a result of a longitudinal decline in ankle SBP vs plateauing brachial SBP. In women, the decline in ABI was a result of a greater increase in brachial SBP compared to ankle SBP. In conclusion, aging is independently associated with a decline in ABI in a healthy population free of clinical C disease. There were gender different in the pressure profiles yielding this reduction in ABI. A pathological reduction in ABI could represent an exaggerated age-associated hemodynamic alterations and not exclusively due to flow limiting lesions. Further studies are needed to understand the underlying alterations in arterial properties and the clinical significance of this subclinical reduction in ABI.

Endothelial progenitor cells as a biological marker of peripheral artery disease.

The role of endothelial progenitor cells (EPCs) in peripheral artery disease (PAD) remains unclear. We hypothesized that EPC mobilization and function play a central role in the development of endothelial dysfunction and directly influence the degree of atherosclerotic burden in peripheral artery vessels. The number of circulating EPCs, defined as CD34(+)/KDR(+) cells, were assessed by flow cytometry in 91 subjects classified according to a predefined sample size of 31 non-diabetic PAD patients, 30 diabetic PAD patients, and 30 healthy volunteers. Both PAD groups had undergone endovascular treatment in the past. As a functional parameter, EPC colony-forming units were determined ex vivo. Apart from a broad laboratory analysis, a series of clinical measures using the ankle-brachial index (ABI), flow-mediated dilatation (FMD) and carotid intima-media thickness (cIMT) were investigated. A significant reduction of EPC counts and proliferation indices in both PAD groups compared to healthy subjects were observed. Low EPC number and pathological findings in the clinical assessment were strongly correlated to the group allocation. Multivariate statistical analysis revealed these findings to be independent predictors of disease appearance. Linear regression analysis showed the ABI to be a predictor of circulating EPC number (p=0.02). Moreover, the functionality of EPCs was correlated by linear regression (p=0.017) to cIMT. The influence of diabetes mellitus on EPCs in our study has to be considered marginal in already disease-affected patients. This study demonstrated that EPCs could predict the prevalence and severity of symptomatic PAD, with ABI as the determinant of the state of EPC populations in disease-affected groups.

Serum Thyrotropin Concentrations Are Not Associated with the Ankle-Brachial Index: Results from Three Population-Based Studies

Background: There is only limited data on the potential association between thyroid dysfunction and peripheral arterial disease (PAD). Objective: The aim of our study was to investigate the potential association of thyroid function, as defined by serum concentrations of the clinically used primary thyroid function marker thyrotropin [i.e. thyroid-stimulating hormone (TSH)] and 3,5-diiodothyronine (3,5-T₂), with the ankle-brachial index (ABI) as a marker of PAD. Methods: We used data from 5,818 individuals from three cross-sectional population-based studies conducted in Northeast (SHIP-2 and SHIP-TREND) and Central Germany (CARLA). Measurement of serum TSH concentrations was conducted in one central laboratory for all three studies. In a randomly selected subpopulation of 750 individuals of SHIP-TREND, serum 3,5-T₂ concentrations were measured with a recently developed immunoassay. ABI was measured either by a hand-held Doppler ultrasound using the Huntleigh Dopplex D900 or palpatorily by the OMRON HEM-705CP device. Results: Serum TSH concentrations were not significantly associated with ABI values in any of the three studies. Likewise, groups of individuals with a TSH <0.3 mIU/l or with a TSH ≥3.0 mIU/l had no significantly different ABI values in comparison with individuals with a TSH in the reference range. Analyses regarding TSH within the reference range or serum 3,5-T₂ concentrations did not reveal consistent significant associations with the ABI. No sex-specific associations were detected. Conclusions: The results of our study do not substantiate evidence for an association between thyroid function and PAD, but further studies are needed to investigate the associations of overt forms of thyroid dysfunction with PAD.

The Ankle-Brachial Index Is Related to Left Ventricular Ejection Fraction in Bonnet Macaques

Low ankle-brachial index (ABI) is a marker of peripheral arterial disease associated with higher cardiovascular risk. ABI has been found to be influenced by left ventricular ejection fraction (LVEF), but this relation is confounded by atherosclerosis. Objectives: Since nonhuman primates have a low incidence of atherosclerosis, we sought to evaluate the effect of LVEF on ABI in 24 healthy female bonnet macaques (age 83 ± 21 months). Methods: LVEF was determined by echocardiography during anesthesia with ketamine. ABI was determined using automatic blood pressure cuff. Results: Mean LVEF was 73 ± 6%. Mean ABI was 1.03 (range 0.78-1.17) with similar right and left lower limb values (p = 0.78). On univariate analysis, mean ABI was significantly correlated with LVEF (r = 0.58, p = 0.003) but not with age, crown-rump length or weight. Mean LVEF increased in a stepwise manner from lowest to highest ABI tertile (68 ± 6 vs. 73 ± 4 vs. 77 ± 5%, p = 0.008). On ordinal regression and forced multivariate linear analyses, ABI status was independently related to LVEF. Conclusions: ABI is influenced by left ventricular systolic function but not age, height, weight or mass index in bonnet macaques. Left ventricular systolic function should be accounted for when considering ABI measurements.

High-sensitivity cardiac troponin T in patients with intermittent claudication and its relation with cardiovascular events and all-cause mortality – The CAVASIC Study

Background. Serum concentrations of high-sensitivity cardiac troponin T (hs-cTnT) are elevated in various diseases. The role of this marker in peripheral arterial disease (PAD) has not been fully investigated. Methods. Hs-cTnT was measured in the CAVASIC Study, a male cohort of 235 patients diagnosed with intermittent claudication and 249 age- and diabetes-matched controls. Patients with symptomatic PAD were prospectively followed for a median time of 7 years. The association of hs-cTnT with PAD, cardiovascular disease (CVD) at baseline as well as incident CVD and all-cause mortality during follow-up was analyzed. Results. Detectable hs-cTnT was associated with an 84% higher probability for symptomatic PAD at baseline: OR = 1.84, 95%CI 1.05–3.21, p = 0.03. Inclusion of ln-NT-proBNP or prevalent CVD abolished this association (both OR = 1.22, p = 0.52). However, detectable hs-cTnT was associated with prevalent CVD (n = 69) in PAD patients independent from ln-NT-proBNP: OR = 3.42, p = 0.001. In the adjusted Cox regression analysis detectable (HR = 2.15, p = 0.05) and especially hs-cTnT ≥14 ng/L (HR = 5.06, p < 0.001) were predictive for all-cause mortality (n = 39) independent from ln-NT-proBNP. Furthermore, hs-cTnT ≥14 ng/L was significantly associated with incident CVD (n = 66): HR = 3.15, 95%CI 1.26–7.89, p = 0.01. Conclusions. This study in male patients with intermittent claudication and age- and diabetes-matched controls revealed hs-cTnT to be associated with PAD and prevalent CVD. The latter association was even significant after considering NT-proBNP. Prospectively, in PAD patients hs-cTnT was predictive for incident cardiovascular diseases and all-cause mortality. Thus, hs-cTnT could be a surrogate marker for cardiomyocyte damage also in symptomatic PAD patients.

Predictive Factors for Low Ankle Brachial Index in Patients with Systemic Lupus Erythematosus

To the Editor: The paper by Erdozain, et al 1 described a cross-sectional study of 216 patients with systemic lupus erythematosus. Ankle brachial index (ABI) was used as a surrogate marker for peripheral arterial disease (PAD). The number of patients with ABI under 0.9 was 46 (21.3%). In their multiple logistic regression analysis, age became a significant factor for low ABI. … Address correspondence to Dr. T. Kawada, Department of Hygiene and Public Health, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-Ku, Tokyo 113-8602, Japan. E-mail: kawada{at}nms.ac.jp

Abstract W P142: Can Peripheral Arterial Disease Markers Predict the Outcome of Non-cardioembolic Stroke Patients?

Introduction: In acute stroke patients, ankle-brachial index (ABI)&gt;0.9 is a clear predictor of increased stroke recurrence risk. However, it has not been defined whether clinical markers of peripheral arterial disease could predict the outcome of non-cardioembolic stroke. Hypothesis: We assessed the hypothesis that clinical markers (e.g. ABI and pulse wave velocity [PWV]) of peripheral arterial disease could predict the outcome of non-cardioembolic stroke. Methods: In our Brain Attack Center, 5432 acute ischemic stroke patients were admitted in January 2007 to December 2012. Among them, 686 lacunar or atherothrombotic stroke (TOAST criteria) patients (248 female and 438 male, median age 70.0 (range 35 to 96)) who admitted within 7 days after their onset and evaluated ABI and PWV during hospitalization were retrospectively examined in this study. Baseline characteristics and NIHSS scores at admission were noted, and modified Rankin scale (mRS) scores 3 months after stroke were evaluated. The patients were categorized into normal (≥0.9) and decreased (&lt;0.9) ABI groups, and into good-outcome (mRS score, 0,1) and poor-outcome (mRS score, 2_6) groups. Results: ABI was decreased in 28 (5.7%) of 496 good-outcome patients and 22 (11.6%) of 190 poor-outcome patients (p=0.008). PWV was increased in the patients with poor-outcome (2116.6±477.5 cm/s) compared with the patients with good-outcome (1934.9±415.6 cm/s, p&lt;0.001). The patients were categorized into low- or high-PWV with a cutoff (2163 cm/s) determined from a receiver operating characteristics curve against the patients’ outcome. The poor-outcome of patients were predicted with high-age (≥75years), NIHSS score at admission, low-ABI, and high-PWV, independently (overall Χ 2 =86.7, R 2 =0.107, n=686, p&lt;0.001; low-ABI: odds ratio 2.13 [95% confidence interval 1.12 to 4.01], p=0.022; high-PWV: odds ratio 2.36 [95% confidence interval 1.61 to 3.45]). Conclusion: Our results showed that the poor-outcome of patients were predicted with ABI and PWV even after controlling age and NIHSS score. It is important to evaluate clinical markers (ABI and PWV) of peripheral arterial disease in the non-cardioembolic stroke patients.

The association of relative telomere length with symptomatic peripheral arterial disease: Results from the CAVASIC study

Background and objectivesShort telomere length has been described to be associated with biological aging including atherosclerosis phenotypes. However, information in patients with symptomatic peripheral arterial disease (PAD) is sparse. We therefore aimed to investigate whether inter-individual differences in relative telomere length (RTL) are associated with symptomatic PAD. DesignWe measured RTL by a quantitative PCR method in the CAVASIC Study, a cohort of 241 male Caucasian patients diagnosed with intermittent claudication and 249 age- and diabetes-matched controls. ResultsWe observed significantly shorter mean RTL in patients than in controls (1.24 ± 0.19 vs. 1.32 ± 0.23, p < 0.001). Each shortening of RTL by one standard deviation significantly increased the odds for PAD by 44%: age-adjusted OR = 1.44 (95%CI 1.19–1.75, p < 0.001). This association remained significant after additional adjustment for log-C-reactive protein, glomerular filtration rate, HDL cholesterol, current smoking and log N-terminal pro-B-type natriuretic peptide (NT-proBNP). Excluding patients with prevalent cardiovascular disease revealed very similar results. When we compared the model fit of the various adjustment models including cardiac risk factors and/or NT-proBNP the addition of RTL significantly improved discrimination between patients and controls. ConclusionThis study in a male cohort of patients with intermittent claudication and age- and diabetes-matched controls indicates a significant association of shorter relative telomere length with PAD. Our results reinforce RTL as a marker for PAD that reflects the influence of genetic and environmental risk factors. Moreover, the association remains significant after excluding patients and controls free from prevalent cardiovascular disease.

Four-Limb Blood Pressure as Predictors of Mortality in Elderly Chinese

The predictive value of blood pressure (BP) for cardiovascular morbidity and mortality diminishes in the elderly, which may be confounded and compensated by the BP differences across the 4 limbs, markers of peripheral arterial disease. In a prospective elderly (≥60 years) Chinese study, we performed simultaneous 4-limb BP measurement using an oscillometric device in the supine position, and calculated BP differences between the 4 limbs. At baseline, the mean age of the 3133 participants (1383 men) was 69 years. During 4 years (median) of follow-up, all-cause and cardiovascular deaths occurred in 203 and 93 subjects, respectively. In multiple regression analyses, arm BPs on the higher arm side of systolic BP did not predict mortality (P≥0.06) except for a negative association between mean arterial pressure and total mortality (P=0.04). However, in adjusted analyses, the hazard ratios associated with a 1-SD decrease in ankle-brachial BP index or increase in interarm or interankle BP difference were 1.15 to 1.23 for total mortality (P≤0.01) and 1.17 to 1.24 for cardiovascular mortality (P≤0.04). In categorical analyses, similar results were observed for a decreased ankle-brachial index (≤0.90, ≤0.95, or ≤1.00) or increased interarm or interankle difference (≥15 mm Hg or ≥10 mm Hg). In conclusion, in the elderly, above and beyond arm BP level and together with ankle-brachial index, the interarm and interankle BP differences improve prediction of mortality. Simultaneous 4-limb BP measurement has become feasible with current technology and might be useful in cardiovascular prevention.

Plasma pentraxin 3 may be a better marker of peripheral artery disease in hemodialysis patients than C-reactive protein

Pentraxin 3 (PTX3) is a novel inflammatory cytokine produced in atherosclerotic plaque. We hypothesized that this marker may be a better predictor of peripheral artery disease (PAD) than C-reactive protein (CRP) in hemodialysis (HD) patients. The ankle-brachial index (ABI) was measured in HD patients. PTX3 levels in 116 HD patients and 30 healthy blood donors were measured by ELISA. A total of 116 HD patients (age: 56.44 ± 14.08 years) were enrolled; 21 (18%) patients had PAD. PTX3 was significantly higher in PAD versus non-PAD patients (5.55 ± 2.63 vs 2.32 ± 1.29 ng/mL; p < 0.001). In a univariate analysis, ABI correlated significantly with age, blood glucose and triglycerides, and plasma PTX3 (r = -0.548, p < 0.001) and high-sensitivity (hs)CRP (r = -0.495, p < 0.001). Using ROC curve analysis for PAD, PTX3 (cut-off value 4.06 ng/mL, AUC 0.901, p < 0.0001) showed a significantly better positive predictive value than hsCRP (cut-off value 3.33 mg/L, AUC 0.640, p < 0.05). Logistic regression analysis further confirmed that PTX3 (OR = 9.755, p = 0.001) was an independent predictor of PAD. In conclusion, we demonstrated that PTX3 may be a better marker of PAD than hsCRP, and independently correlated with PAD in HD patients.

Abstract P080: Associations of Poor Sleep Quality and Quantity and Subclinical Atherosclerosis in Older Age - The Chicago Healthy Aging Study (CHAS)

Background: Previous studies have demonstrated a link between both sleep quantity and quality and an increased risk of CVD, stroke, and diabetes. However only a few population-based studies have information on the association of sleep quantity and quality and subclinical atherosclerosis as measured by coronary artery calcium (CAC) and ankle brachial index (ABI) -- a marker for peripheral arterial disease. Methods: CHAS data were used to investigate cross-sectional associations of short sleep duration and poor sleep quality assessed by the Pittsburgh Sleep Quality Index (PSQI) (see Table Footnote for definition of poor sleep quality and quantity) and prevalence of having CAC (score &gt; 0) or low ABI (&lt;0.99). CAC, assessed by multi-detector computed tomography, was quantified by the Agatston’s method. ABI was calculated as the ratio of Doppler recorded systolic pressures in the lower and upper extremities (ABI &gt;1.4 was excluded). Results: The study sample consists of 1,005 men and 390 women ages 65-84 (mean age 71) in 2007-10; 9% were African American. There are no differences in CAC prevalence among participants with or without short sleep duration (11.2% vs. 11.0%). For low ABI, these figures are 20% and10.8%, respectively. With multiple adjustments (see Table Footnote), there are no significant associations of short sleep duration or poor sleep total score with prevalent CAC. However, participants with short sleep duration are more likely to have low ABI, i.e., the odds (95% confidence interval) of having ABI &lt;0.99 with sleep duration of &lt;6hrs was almost two fold (1.02-3.13) compared to others (see Table). Conclusion: In older age, shorter sleep duration is associated with peripheral vascular disease. Sleep may represent a modifiable risk factor for CVD.

Correlation between plasma lipoprotein-associated phospholipase A2 and peripheral arterial disease

Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a recently identified and potentially useful plasma biomarker for cardiovascular diseases. However, its role in peripheral arterial disease (PAD) remains unclear. The objective of this study was to assess the independent association of Lp-PLA2 and other inflammatory markers with the reduced ankle-brachial blood pressure index (ABI), a marker of PAD. We performed a cross-sectional study in 982 individuals aged ≥40 years who were recruited from the First Affiliated Hospital of Zhengzhou University. PAD was defined as an ABI <0.9 in at least one leg. The individuals were further divided into two groups, 145 with PAD and 837 without PAD. Following adjustment for traditional cardiovascular risk factors, the odds ratios of PAD when comparing the highest to the lowest quartiles were 3.24 (95% CI, 1.68–3.94) for Lp-PLA2, 2.14 (95% CI, 1.07–3.11) for homocysteine, 1.93 (95% CI, 1.02–4.01) for fibrinogen, 2.26 (95% CI, 1.32–5.74) for apolipoprotein B and 1.3 (95% CI, 0.75–2.49) for high-sensitivity C-reactive protein (hsCRP). When Lp-PLA2 and inflammatory markers were simultaneously included in the full model, the corresponding odds ratios were 1.81 (95% CI, 1.14–3.68) for Lp-PLA2, 1.15 (95% CI, 0.49–2.69) for homocysteine, 1.21 (95% CI, 0.88–5.57) for fibrinogen, 0.98 (95% CI, 0.51–3.85) for apolipoprotein B and 1.23 (95% CI, 1.12–3.51) for hsCRP. Lp-PLA2 levels were significantly and independently associated with PAD following adjustment for other inflammatory markers. These findings reflect the potential role of circulating Lp-PLA2 as a marker of atherosclerosis.

LOX-1 is a novel marker for peripheral artery disease in patients with type 2 diabetes

ObjectiveThe aim of this study was to investigate whether serum soluble lectin-like oxidized low-density lipoprotein receptor-1 (sLOX-1), which mediates initiation and progression of atherosclerosis in endothelial cells, could be a novel marker for peripheral artery disease (PAD) in patients with type 2 diabetes. MethodsWe evaluated relationships of serum sLOX-1 to ankle–brachial index (ABI) and examined the association of serum sLOX-1 with PAD in 410 patients with type 2 diabetes. ResultsSerum sLOX-1 was inversely correlated with ABI (r=−0.197, P<0.0001). Stepwise regression analysis demonstrated that serum sLOX-1 (β=−0.168, F=5.571, P<0.05) was independently associated with ABI, and multiple logistic regression analysis demonstrated that serum sLOX-1 (16.254 (1.237–213.651), P=0.0339) was independently associated with PAD. ConclusionsSerum sLOX-1 is associated with ABI and it could be a novel marker for PAD in patients with type 2 diabetes.