Risk Factors For Peripheral Arterial Disease Research Articles

Epidemiology and Burden of Peripheral Artery Disease in People With Type 2 Diabetes: A Systematic Literature Review.

Type 2 diabetes (T2D) and lower-extremity peripheral artery disease (PAD) are growing global health problems associated with considerable cardiovascular (CV) and limb-related morbidity and mortality, poor quality of life and high healthcare resource use and costs. Diabetes is a well-known risk factor for PAD, and the occurrence of PAD in people with T2D further increases the risk of long-term complications. As the available evidence is primarily focused on the overall PAD population, we undertook a systematic review to describe the burden of comorbid PAD in people with T2D. The MEDLINE, Embase and Cochrane Library databases were searched for studies including people with T2D and comorbid PAD published from 2012 to November 2021, with no restriction on PAD definition, study design or country. Hand searching of conference proceedings, reference lists of included publications and relevant identified reviews and global burden of disease reports complemented the searches. We identified 86 eligible studies, mostly observational and conducted in Asia and Europe, presenting data on the epidemiology (n = 62) and on the clinical (n = 29), humanistic (n = 12) and economic burden (n = 12) of PAD in people with T2D. The most common definition of PAD relied on ankle-brachial index values ≤ 0.9 (alone or with other parameters). Incidence and prevalence varied substantially across studies; nonetheless, four large multinational randomised controlled trials found that 12.5%-22% of people with T2D had comorbid PAD. The presence of PAD in people with T2D was a major cause of lower-limb and CV complications and of all-cause and CV mortality. Overall, PAD was associated with poor quality of life, and with substantial healthcare resource use and costs. To our knowledge, this systematic review provides the most comprehensive overview of the evidence on the burden of PAD in people with T2D to date. In this population, there is an urgent unmet need for disease-modifying agents to improve outcomes.

Peripheral Arterial Disease prevalence and risk factors in the Eastern Caribbean Health Outcomes Research Network (ECHORN) cohort.

Peripheral arterial disease (PAD) indicates generalised atherosclerotic disease but is often asymptomatic. The prevalence and potential risk factors of PAD were studied in ECHORN cohort study participants. Representative samples of community-dwelling people ≥40 years of age residing in Barbados, Puerto Rico, Trinidad, and the USVI were recruited. The survey included questions on diabetes, hypertension, heart disease and smoking status. Body Mass Index, HbA1c, blood glucose and lipids were determined. Ankle brachial index (ABI) was evaluated in one leg. An oscillometric device measured arm and leg systolic BP simultaneously. ABI classifications were PAD ≤0.90, borderline 0.91 to 0.99, normal 1.00 to 1.40, and non-compressible >0.40. Multivariable logistic regression tested associations of potential risk factors with PAD. Of 2772 participants (mean age 57.3, 65.2% female), 35.8% were overweight, 38.1% obese, 32.4% had diabetes, 60% hypertension, and 15.4% reported heart. ABI prevalence (95% CI) by category was PAD 4.4% (3.6%, 5.1%), borderline 5.2% (4.4%, 6.1%), normal 87.0% (85.8%, 88.3%) and noncompressible 3.4% (2.7%, 4.0%). Female sex (OR 1.72, 95% CI 1.07 to 2.77), diabetes (OR 2.23, 95% CI 1.47 to 3.4), heart disease history (OR 1.74, 95% CI 1.07 to 2.83) and less than high school education vs having a university degree (OR 2.49, 95% CI 1.19 to 5.22) were independently associated with PAD. Testing one leg only would underestimate PAD prevalence. Increasing the ABI cutoff for identifying PAD to <1.0 when using oscillometric devices is suggested by some studies but would more than double the estimated prevalence. Guidelines need to address this issue. Female sex and lower educational attainment are important considerations when screening. While diabetes and a history of heart disease were confirmed as risk factors, the lack of association of increasing age and cigarette smoking with PAD was unexpected.

Peripheral Artery Disease among a High-Risk Asian Population with Ischaemic Stroke, Cardiovascular Disease, or Diabetes Mellitus.

Background: Peripheral artery disease (PAD) affects more than 100 million people globally. Most PAD studies have been performed among predominantly White populations-less is known about other ethnicities. The aim of this cross-sectional study was to determine the prevalence and risk factors of PAD in a high-risk Asian population with ischaemic stroke (IS), myocardial infarction, unstable angina (CVD), or diabetes mellitus (DM). Methods: Patients admitted for IS, CVD, or DM were recruited. Data were collected on age, sex, body mass index (BMI), index condition (CVD, IS, DM), history of hypertension, DM, hypercholesterolaemia, cigarette smoking, and claudication. The Edinburgh Claudication Questionnaire was administered, the ankle brachial index (ABI) was determined, and PAD was diagnosed if ABI was ≤0.9. Results: Of the 450 subjects recruited, 150 were placed in each index disease group, the mean age was 61.9 ± 10.32 years, 43.1% were female, and the mean BMI was 23.9 ± 4.3. Hypertension was reported in 59.3%, DM in 63.6%, hypercholesterolaemia in 39.6%, and smoking in 42.9% of patients. The prevalence of PAD was 27.1%, 22.0% in IS, 29.3% in CAD, and 30.0% in DM. PAD was associated with increasing age (adjusted odds ratio (aOR) 1.04/year, 95% confidence interval [CI] 1.01-1.06; p < 0.001), reduced BMI (aOR 0.94, 95% CI 0.89-0.99; p = 0.026), DM (aOR 1.59, 95% CI 1.20-3.18; p = 0.007), and hypercholesterolaemia (aOR 1.82, 95% CI 1.17-2.28; p = 0.007). It was more frequent in non-lacunar versus lacunar acute IS, non-ST segment elevation versus ST-segment elevation acute myocardial infarction, and insulin-treated versus non-insulin-treated DM. Conclusions: Our study showed a high prevalence of PAD among high-risk Asian patients. This was associated with increasing age, DM, and hypercholesterolaemia and inversely associated with BMI. Different rates were found in sub-groups of IS, CVD, and DM. Systematic approaches were used to identify these high-risk individuals and to improve their outcomes.

Prevalence of Peripheral Arterial Disease and Principal Associated Risk Factors in Patients with Type 2 Diabetes Mellitus: The IDON-Peripheral Arterial Disease Study

The principal purpose of this study is to determine the prevalence of peripheral arterial disease (PAD), as well as the principal associated risk factors, in patients registered in the IDON-PAD database. PAD is a condition characterized by the narrowing or blockage of arteries in the body’s extremities due to plaque buildup, leading to reduced blood flow and tissue ischemia. While PAD primarily affects the lower extremities, it can lead to symptoms such as intermittent claudication and, in severe cases, ulcers and amputations. Risk factors for PAD are numerous and cumulative, including smoking, age over 50, type 2 diabetes mellitus, and hypertension. The prevalence of PAD increases with age, with rates ranging from 2.5% in those over 50 to 60% in those over 85, varying by ethnicity and study population. Diabetic patients face a higher risk of PAD-related complications and have lower success rates with revascularization procedures. The diagnosis of PAD traditionally relied on physical examination and symptoms, but the Ankle–Brachial Index is now a standard diagnostic tool due to its non-invasive nature and reliability. In Mexico, the prevalence of PAD is estimated at 10%, with significant risk factors being the duration of diabetes, hypertension, hypertriglyceridemia, and smoking. Notably, 70% of PAD cases are asymptomatic, emphasizing the importance of proactive screening. This study aimed to determine the prevalence of PAD and associated risk factors in diabetic patients aged 40 and above. The prevalence was found to be 11.2%, with high-risk waist circumference, elevated triglycerides, positive Edinburgh questionnaire, and weak pulses as significant predictors. The detection and management of PAD in diabetic patients require a comprehensive approach, including lifestyle modifications and regular screenings. Prevention strategies should focus on controlling risk factors, including obesity, hypertension, and dyslipidemia. In conclusion, PAD is a prevalent yet underdiagnosed condition in diabetic patients, necessitating proactive screening and comprehensive management to mitigate associated risks and improve patient outcomes. The principal limitation of this study is that, as it uses a cross-sectional methodology and is not an experimental study, although we can establish the prevalence of PAD as well as the associated risk factors, we cannot define causality or determine the hazard ratio for each of these factors. Special thanks to Dr. Leobardo Sauque Reyna and all participants for their contribution to this research.

Abstract 2025: Evolving Burden Of Peripheral Artery Disease Attributable To Smoking In 38 Oecd Countries From 1990-2019: Global, Regional, National Variations, Age Dynamics, And Implications For Global Health

Introduction and Background: Peripheral artery disease (PAD) ranks as the 11th leading cause of mortality and disability in countries within the Organization for Economic Cooperation and Development (OECD). Smoking is recognized as a leading risk factor for PAD, and its impact on the prevalence and outcomes of PAD has significant public health implications. Method: Using Global Burden of Disease framework, Deaths, disability adjusted life years (DALYs), years lived with disability (YLDs) due to stroke attributable to Smoking were analyzed by age, sex, year and location across the 38 OECD Countries from the last 3 decades. Results: From 1990 to 2019, the total number of deaths increased from 7,226 to 10,738, and Disability-Adjusted Life Years (DALYs) rose from 191,915 to 238,577. In 2019, the United States had the highest number of deaths (3,596) and DALYs (83,073). Hungary had the highest age-standardized mortality rate in 2019 (1.7 deaths per 100,000 person-years). The 80-84 age group had the most deaths (2,233), while the 70-74 age group had the highest DALYs (45,947) in 2019. Over the past three decades, males consistently had a higher burden, with an annual percentage change in deaths of 50% compared to 45% for females, and a 32% change in DALYs for males compared to 12% for females. Conclusion: The findings highlight the urgent need for public health efforts to address the increasing burden of peripheral artery disease (PAD), particularly focusing on smoking cessation and tailored interventions for high-risk groups. Clinicians should prioritize early detection and patient counseling to mitigate PAD risk factors, especially among males with a consistently higher burden.

Peripheral Arterial Disease in Diabetes and its Relation to Cardiovascular Risk Factors in Women

Objectives: Peripheral arterial disease (PAD) is characterized by occlusive disease in the abdominal aorta, iliac, and femoral arteries, leading to reduced blood flow and complications. Diabetes mellitus (DM) is known to contribute to the development and progression of PAD due to factors such as hyperglycemia, dyslipidemia, endothelial dysfunction, and inflammation. However, PAD may be underdiagnosed in women with DM, leading to adverse cardiovascular outcomes. The present study aimed to investigate the prevalence of PAD in women with type 2 DM (T2DM) and its relationship with cardiovascular risk factors. Materials and Methods: This hospital-based, cross-sectional, and observational study was conducted for a period of 3 months from June 10, 2023, to September 10, 2023, in the outpatient department of general medicine. After obtaining the approval from the Institutional Ethical Committee, the study was performed according to the Declarations of Helsinki and Good Clinical Practice requirements for human subject protection. Non-probability purposive sampling technique was used to enroll participants. Participants underwent face-to-face interviews and clinical examinations. Sociodemographic data, medical history, and pharmacotherapy details were collected. Laboratory investigations were conducted, including blood glucose, lipid profile, and glycosylated hemoglobin (HbA1C) tests. The ankle-brachial index (ABI) was measured. Results: The results showed that the majority of the participants were between 50 and 70 years of age, married, and had a high school education. Participants had an average body mass index (BMI) indicating overweight, and the average duration of diabetes was 6.571 years. Hypertension was the most prevalent comorbidity. Overweight, obesity I, and obesity II were present in 15.25% (n = 19), 33.6% (n = 42), and 8.8% (n = 11), respectively. Average values for HbA1C, fasting blood glucose (FBG), and postprandial blood glucose (PPBG) were within the diabetic range. ABI was normal in the right side, left side, and bilateral in 43.2%, 56%, and 14.4% of participants, respectively. ABI was borderline on the right side, left side, and bilateral in 40.8%, 36.8%, and 22.4% of participants, respectively. PAD was observed on the right side, left side, and bilateral in 16%, 7.2%, and 4% of participants, respectively. BMI, duration of DM, glycosylated hemoglobin, FBG, and PPBG showed significant negative correlations with ABI. Age, triglycerides, high-density lipoprotein, and low-density lipoprotein did not show any statistically significant correlation with ABI. Conclusion: The study highlighted the importance of screening for PAD in women with T2DM to improve cardiovascular outcomes. The findings shed light on the prevalence of risk factors for PAD and their association with the disease. These insights can contribute to the development of targeted interventions to reduce adverse clinical outcomes in this population.

Emerging trends in nationwide mortality, limb loss, and resource utilization for critical limb ischemia in young adults

Background/objectivesRecent trends indicate a rise in the incidence of critical limb ischemia (CLI) among younger adults. This study examines trends in CLI hospitalization and outcomes among young adults with peripheral arterial disease (PAD) in the United States. MethodsAdult hospitalizations (18–40 years) for PAD/CLI were analyzed from the 2016–2020 nationwide inpatient sample database using ICD-10 codes. Rates were reported per 1000 PAD or 100,000 cardiovascular disease admissions. Outcomes included trends in mortality, major amputations, revascularization, length of hospital stay (LOS), and hospital costs (THC). We used the Jonckheere–Terpstra tests for trend analysis and adjusted costs to the 2020 dollar using the consumer price index. ResultsApproximately 63,045 PAD and 20,455 CLI admissions were analyzed. The mean age of the CLI cohort was 32.7 ± 3 years. The majority (12,907; 63.1 %) were female and white (11,843; 57.9 %). Annual CLI rates showed an uptrend with 3265 hospitalizations (227 per 1000 PAD hospitalizations, 22.7 %) in 2016 to 4474 (252 per 1000 PAD hospitalizations, 25.2 %) in 2020 (Ptrend<0.001), along with an increase in PAD admissions from 14,405 (188 per 100,000, 0.19 %) in 2016 to 17,745 (232 per 100,000, 0.23 %%) in 2020 (Ptrend<0.0001). Annual in-hospital mortality increased from 570 (2.8 %) in 2016 to 803 (3.9 %) in 2020 (Ptrend = 0.001) while amputations increased from 1084 (33.2 %) in 2016 to 1995 (44.6 %) in 2020 (Ptrend<0.001). Mean LOS increased from 5.1 (SD 2.7) days in 2016 to 6.5 (SD 0.9) days in 2020 (Ptrend = 0.002). The mean THC for CLI increased from $50,873 to $69,262 in 2020 (Ptrend<0.001). The endovascular revascularization rates decreased from 11.5 % (525 cases) in 2016 to 10.7 % (635 cases) in 2020 (Ptrend = 0.025). Surgical revascularization rates also increased from 4.9 % (225 cases) in 2016 to 10.4 % (600 cases) in 2020 (Ptrend = 0.041). ConclusionHospitalization and outcomes for CLI worsened among young adults during the study period. There is an urgent need to enhance surveillance for risk factors of PAD in this age group.

Association of plasma homocysteine with peripheral arterial disease in the hypertensive adults: A cross-sectional study.

Increased plasma homocysteine (Hcy) has been identified as one of the important risk factors for cardiovascular disease. However, the association between plasma Hcy and peripheral artery disease (PAD) is still controversial. This study aimed to investigate the association between plasma Hcy and PAD and the potential modifier factors in Chinese hypertensive adults. A total of 25300 hypertensive patients aged 18years or older were included in the analysis in this cross-sectional study. The outcome was PAD, which defined as an ankle-brachial index ≤0.90 in either limb. Multiple logistic regression was used to analyze the relationship between plasma Hcy and PAD. The median plasma Hcy was 14.00 (interquartile range: 11.60-17.80)μmol/L. There was a significant positive association between plasma Hcy and PAD (per SD increment; OR: 1.13; 95% CI: 1.06-1.19). Patients in the upper plasma Hcy tertile (≥16.16μmol/L) were associated with a 53% increased risk of PAD compared with patients in the lower tertile (<12.33μmol/L) after adjustment for multiple potential confounders. Subgroup analyses showed the association between Hcy and PAD was robust among various strata. Among Chinese adults with hypertension, plasma Hcy is an independent risk factor for PAD. This finding may improve the risk stratification of PAD.

Association between red cell distribution width-and-albumin ratio and the risk of peripheral artery disease in patients with diabetes.

The aim of this study is to explore the association between red blood cell distribution width-to-albumin ratio (RAR) and the risk of peripheral artery disease (PAD) in patients with diabetes. This cross-sectional study extracted the data of 1,125 participants with diabetes from the National Health and Nutrition Examination Survey database. A weighted univariable logistic regression model was used to explore variables associated with PAD. With PAD as the outcome variable, a weighted logistic regression model was established. The odds ratio (OR) and 95% confidence interval (CI) were effect size. After adjusting for covariates, the risk of PAD in patients with diabetes was observed in those with higher RAR (OR = 1.83; 95% CI: 1.06-3.15). In addition, RAR ≥3.25 was related to increased risk of PAD in patients with diabetes (OR = 2.04; 95% CI: 1.05-3.95). In people with diabetes aged ≥65, RAR was a risk factor for PAD with an OR value of 2.67 (95% CI: 1.30-5.46). RAR≥3.25 was associated with increased risk of PAD (OR = 3.06; 95% CI: 1.15-8.11) relative to RAR <2.80. In people with diabetes who smoked, the risk of PAD was elevated in those with RAR ≥3.25 (OR = 2.85; 95% CI: 1.28-6.32). As for patients with cardiovascular disease, the risk of PAD was elevated as the increase of RAR (OR = 2.31; 95% CI: 1.05-5.10). RAR ≥3.25 was correlated with increased risk of PAD (OR = 3.75; 95% CI: 1.42-9.87). The area under the curve of RAR for the risk of PAD in patients with diabetes was 0.631 (95% CI: 0.588-0.675). A higher RAR was related to increased risk of PAD in patients with diabetes. The findings might offer a reference for the management of PAD in patients with diabetes.

A high burden of diabetes and ankle brachial index abnormalities exists in Mexican Americans in South Texas

Ethnic differences exist in the United States in the interrelated problems of diabetes (DM), peripheral arterial disease (PAD), and leg amputations. The purpose of this study was to determine the prevalence and risk factor associations for subclinical PAD in a population sample of Mexican Americans using the ankle brachial (ABI) index.The ABI-High (higher of the two ankle pressures/highest brachial pressure) and ABI-Low (lower of the two ankle pressures/highest brachial pressure) were calculated to define PAD. Toe brachial index (TBI) was also calculated. 746 participants were included with an age of 53.4 ± 0.9 years, 28.3 % had diabetes mellitus (DM), 12.6 % were smokers, and 51.2 % had hypertension (HTN). Using ABI-High ≤ 0.9, the prevalence of PAD was 2.7 %. This rose to 12.7 % when an ABI-Low ≤ 0.9 was used; 4.0 % of the population had an ABI-High > 1.4. The prevalence of TBI < 0.7 was 3.9 %. DM was a significant risk factor for ABI-High ≤ 0.9 and ABI-High > 1.4, and TBI < 0.7. Increased age, HTN, smoking was associated with ABI-High ≤ 0.9, while being male was associated with ABI-High > 1.4. Increased age, smoking, and lower education were all associated with abnormal TBI.Despite relatively younger mean age than other studied Hispanic cohorts, the present population has a high burden of ABI abnormalities. DM was a consistent risk factor for PAD. These abnormalities indicate an important underlying substrate of vascular and metabolic disease that may predispose this population to the development of symptomatic PAD and incident amputations.

Correlation between serum 25-hydroxyvitamin D level and peripheral arterial disease in patients with type 2 diabetes mellitus: a single-center retrospective study.

To investigate the association between serum 25-hydroxyvitamin D (25(OH)D) level and peripheral arterial disease (PAD) in patients with type 2 diabetes mellitus (T2DM). This retrospective study analyzed data from 752 T2DM patients treated at Shaoyang Central Hospital between September 2020 and September 2023. Patients were divided into two groups: those with T2DM alone and those with T2DM and PAD. We compared demographic data, biochemical indices, and ankle-brachial index (ABI) values. Pearson correlation and multivariate logistic regression with a forward likelihood ratio method assessed the relationship and risk factors. The predictive value of serum 25(OH)D levels for PAD was evaluated using receiver operating characteristic (ROC) analysis. The T2DM+PAD group was older and had a longer duration of diabetes compared to the T2DM group. This group also had lower BMI, diastolic blood pressure, and ABI values, but higher levels of low-density lipoprotein cholesterol (LDL-C) and total cholesterol (TC) (all P<0.05). Serum 25(OH)D levels were significantly lower in the T2DM+PAD group (P<0.05). ABI negatively correlated with age, diabetes duration, LDL-C, and TC, and positively with BMI and 25(OH)D levels (all P<0.05). Older age, lower BMI, higher LDL-C, and lower 25(OH)D levels were independent risk factors for PAD (ORs: 1.060, 0.781, 1.083, and 0.959, respectively; all P<0.05). The risk of PAD was significantly higher in the 25(OH)D deficiency group (P<0.05). The AUC for serum 25(OH)D in predicting PAD occurrence was 0.629. Lower serum 25(OH)D levels are associated with higher risk of PAD in patients with T2DM. Early identification and management of 25(OH)D deficiency may be crucial for preventing PAD in this population.

Prevalence of and Risk Factors for Peripheral Artery Disease in Rural South Africa: A Cross-Sectional Analysis of the HAALSI Cohort.

The burden of peripheral artery disease (PAD) is increasing in low- and middle-income countries. Existing literature from sub-Saharan Africa is limited and lacks population-representative estimates. We estimated the burden and risk factor profile of PAD for a rural South African population. We used data from 1883 participants from a rural, low-incomecohort of South African adults aged 40 to 69 years with available ankle-brachial index measurements. We defined clinical PAD as ankle-brachial index ≤0.90 or >1.40, and borderline PAD as ankle-brachial index >0.90 and ≤1.00. We compared the distribution of sociodemographic variables, biomarkers, and comorbidities across PAD classifications. To identify associated factors, we calculated unadjusted and age-sex-adjusted prevalence ratios (PRs) with log-binomial models. Overall, 6.6% (95% CI, 5.6-7.7) of the sample met the diagnostic criteria for clinical PAD, while 44.7% (95% CI, 42.4-47.0) met the diagnostic criteria for borderline PAD. Age (PR: 1.9 [95% CI, 1.2-3.1] for ages 50-59 years compared with 40-49 years; PR: 2.5 [95% CI, 1.5-4.0] for ages 60-69 years compared with 40-49 years); diagnosed hypertension (PR: 1.53 [95% CI, 1.08-2.17]); and C-reactive protein (PR: 1.08 [95% CI, 1.03-1.12]) were associated with increased prevalence of clinical PAD. All other examined factors were not significantly associated with clinical PAD. We found high PAD prevalence for younger age groups compared with previous research and a lack of statistical evidence for the influence of traditional risk factors for this rural, low-income population. Future research should focus on identifying the underlying risk factors for PAD in this setting. South African policymakers and clinicians should consider expanded screening for early PAD detection in rural areas.

Risk factors for peripheral artery disease and diabetic peripheral neuropathy among patients with type 2 diabetes

AimsTo investigate the prevalence of peripheral artery disease (PAD) and diabetic peripheral neuropathy (DPN) and the associated risk factors among Chinese patients with type 2 diabetes mellitus. MethodsA cross-sectional study was conducted using data between November 1, 2018, and December 31, 2022. PAD was defined as ABI ≤ 0.9. DPN diagnosis involved specialized physician assessments using questionnaires and vibration perception threshold tests. Logistic regression analysis was used to identify related factors. We also evaluated the association between the clustering of risk factors and disease incidence. ResultsThe study population comprised 13,315 patients (mean age: 63.3 years). 4.9 % of the patients had PAD and 43.9 % had DPN. Multivariate regression analysis revealed advanced age, smoking, hypertension, coronary heart disease, dyslipidemia, elevated HbA1c, and uric acid levels as independent risk factors for PAD. For DPN, independent risk factors included advanced age, female gender, hypertension, coronary heart disease, elevated total cholesterol, triglycerides, lipoprotein(a), fasting plasma glucose, HbA1c, alkaline phosphatase, cystatin C, albumin-to-creatinine ratio, and elevated homocysteine levels, whereas apolipoprotein A was a protective factor. The clustering of risk factors was prevalent and associated with higher disease risk. ConclusionsOur study contributed to identifying high-risk individuals and improving lower limb health among diabetic individuals.

Exploring Understanding of Peripheral Artery Disease among Patients at High-Risk in Saudi Arabia: Results from an Interview-Based Study.

The level of awareness of peripheral artery disease (PAD) in Saudi Arabia, especially among populations at high risk, is not currently well known. Therefore, our objective was to assess the existing level of awareness among patients who are at high risk of PAD, as well as their comprehension of the disease. An interview-based cross-sectional study included 1035 participants with risk factors for PAD and collected data on demographics and knowledge domains related to PAD. The statistical analysis was performed using t-tests and ANOVA. Overall, participants exhibited poor knowledge, with a mean score of 5.7 out of 26. The highest scores were observed in the risk factor and preventive measure domains, with means of 1.8 out of 7 and 1.8 out of 6, respectively. The factors associated with higher knowledge scores included older age, male gender, higher education, healthcare profession, interviews in vascular settings, previous awareness of PAD, and prior cardio-cerebrovascular interventions. This study underscores the inadequate knowledge of PAD among high-risk individuals. Targeted educational initiatives are essential to bridge this knowledge gap, potentially reducing the burden of PAD-related complications and improving patient outcomes. Efforts should focus on raising awareness about PAD, particularly among high-risk populations.

Abstract 17363: Loss of Skeletal Muscle Bmal1 Impairs Limb Perfusion and Muscle Regeneration in a Mouse Model of Peripheral Arterial Disease

Introduction: Peripheral arterial disease (PAD) is a growing pathologic condition worldwide and leads to severe myopathy. Traditional risk factors for PAD, including diabetes, smoking, and advanced age, are associated with disrupted circadian clock function. However, the contribution of circadian disruption to PAD remains poorly understood. Hypothesis: This study aims to investigate the role of skeletal muscle clock in the severity of PAD. Methods: We performed femoral artery ligation (FAL) surgery in male adult-life inducible skeletal muscle-specific Bmal1 knockout ( Bmal1 musc ) (n = 6) and control mice (n = 5). We measured limb perfusion with laser doppler imaging weekly and assessed post-surgical angiogenesis with CD31/αSMA co-immunostaining and muscle recovery with hematoxylin and eosin (H&amp;E) staining and Laminin immunohistochemistry at 30 days post-surgery. We also performed RNA-sequencing, qPCR, and Western blotting assays to characterize the differentially expressed genes in both ligated and non-ligated hindlimb muscles. Results: Adult-life deletion of skeletal muscle Bmal1 reduced reperfusion recovery, with an average rate of only 50% by 22 days post-surgery in Bmal1 musc mice compared to approximately 80% in control mice. HIF1α target genes including the pro-angiogenic factor Vegfα were significantly downregulated in Bmal1 musc mice. Conversely, genes enriched in the anti-angiogenic TGF-β signaling pathways were up-regulated in Bmal1 musc mice. Myostatin, a myokine that inhibits muscle growth, was downregulated in Bmal1 musc muscles. H&amp;E staining and Laminin immunohistochemistry revealed significantly less but enlarged newly formed myofibers in the tibialis anterior muscle in Bmal1 musc mice. Conclusions: Skeletal muscle BMAL1 plays a critical role in determining the severity of ischemic muscle injury in a mouse model of PAD. Circadian dysfunction impairs hindlimb ischemia reperfusion, decreases the number of newly formed myofibers, and promotes the formation of enlarged regenerating myofibers, which is however previously reported to be associated with compromised muscle force production. Restore muscle circadian function could be a promising strategy to ameliorate myopathic severity in PAD patients.

Risk Factors for and Risk of Peripheral Artery Disease in Swedish Individuals With Type 2 Diabetes: A Nationwide Register-Based Study.

To investigate to what extent having control of peripheral artery disease (PAD) risk factors is associated with the risk of incident PAD in individuals with type 2 diabetes. A total of 148,096 individuals with type 2 diabetes in the Swedish National Diabetes Register between 2005 and 2009 were included and matched with 320,066 control subjects on the basis of age, sex, and county. A few control subjects who developed type 2 diabetes after recruitment, during wash-in (<0.2%), were not censored but instead matched with two new control subjects. Individuals with type 2 diabetes were evaluated according to the number of PAD risk factors beyond recommended guideline levels at baseline, including LDL cholesterol, blood pressure, smoking, glycated hemoglobin, and estimated glomerular filtration rate. Incident PAD events were ascertained from 2006 to 2019. A graded association was observed between the number of PAD risk factors not at target and incident PAD in individuals with type 2 diabetes. The adjusted hazard ratio for PAD was 1.41 (95% CI 1.23-1.63) for those with type 2 diabetes with all PAD risk factors within target compared with control subjects matched for sex, age, and county but not risk factor status, in contrast with 9.28 (95% CI 3.62-23.79) for those with all five PAD risk factors not at target. A graded association was observed between increasing number of PAD risk factors not at target and incident PAD in individuals with type 2 diabetes.

Prevalence, clinical profile, and risk factors of peripheral artery disease in an Iraqi cohort of chronic kidney disease.

Peripheral artery disease (PAD) is prevalent in patients with chronic kidney disease (CKD) and is associated with substantial morbidity, mortality, and a lower quality of life. This study aimed to determine the prevalence of PAD, clinical profile, and related risk factors among patients with CKD in Iraq (a low-to middle-income country). A cross sectional study comprised 175 CKD patients, of them 60% were male, their mean age was 56 ± 12.5 years, attending Nephrology unit, Hawler Teaching Hospital, Erbil, Iraq between march 2022 and November 2022. Data on demographic and baseline characteristics were collected. Laboratory tests were performed. All participants underwent a detailed history and clinical examination. Vascular lesions in the lower limbs were assessed using the ankle-brachial index. PAD was diagnosed based on an ankle-brachial index value ˂ 0.9, relevant symptoms, and clinical findings. Forty-nine patients (28%) had PAD, and only 17 (34.7%) were symptomatic. PAD was significantly associated with older age (P = .008), male sex (P = .039), diabetes (P = .012), and hypertension (P = .023). In addition, PAD prevalence was significantly higher in patients with prior coronary artery disease (P < .001), advanced CKD stages (P .032), low estimated glomerular filtration rate (P .03), albuminuria (P .002), elevated glycated hemoglobin (P .04), and high sensitive C-reactive protein (P < .001). No significant association was detected between PAD and body mass index, smoking, CKD duration, cerebrovascular disease, dyslipidemia, albumin, creatinine, hemoglobin, total PTH, and phosphate. Peripheral artery disease was prevalent in patients with CKD in Iraq, and the most affected patients were asymptomatic. Older age, male sex, hypertension, diabetes, prior coronary artery disease, advanced CKD stages, albuminuria, higher glycated hemoglobin level, and increased high-sensitivity C-reactive protein level were identified as risk factors. Early detection of occult PAD might enhance efforts toward proper prevention and treatment.

Risk factors for at-risk foot and peripheral artery disease among the population with diabetes: A multicommunity-based cross-sectional study

AimsThis study aimed to investigate the prevalence, characteristics, and influence factors of the at-risk foot with diabetes mellitus (DM). MethodsThis study included 3030 DM patients from the at-risk foot screening program of Shanghai in China between March 21 and April 30 in 2021. Data were collected from the questionnaire survey, physical examination, and fasting blood sample. ResultsThe prevalence of at-risk foot was 27.8% among DM patients. After adjusted, the risk of higher at-risk grade increased with age and urinary albumin creatinine ratio (OR = 1.04, 95%CI = 1.02–1.06; OR = 1.001, 95%CI = 1.000–1.002, respectively), whereas decreased with estimated glomerular filtration rate (eGFR) (OR = 0.991, 95%CI = 0.984–0.998). The incidence of peripheral artery disease (PAD) was 11.1% in all people with DM, and age, pulse rate, and low-density lipoprotein were independent risk factors for PAD. In contrast, high-density lipoprotein, eGFR, and lymphocyte-to-monocyte ratio were independent protective factors for PAD. Glycated hemoglobin HbA1c was not an independent risk factor for increased risk grade or more severe PAD. ConclusionsThe at-risk foot accounted for a high percentage among DM patients. Advanced age and renal dysfunction are independent risk factors for the at-risk foot. Glycemic control does not reduce the risk grade of at-risk foot and the incidence of PAD.

Admixture mapping of peripheral artery disease in a Dominican population reveals a putative risk locus on 2q35.

Peripheral artery disease (PAD) is a form of atherosclerotic cardiovascular disease, affecting ∼8 million Americans, and is known to have racial and ethnic disparities. PAD has been reported to have a significantly higher prevalence in African Americans (AAs) compared to non-Hispanic European Americans (EAs). Hispanic/Latinos (HLs) have been reported to have lower or similar rates of PAD compared to EAs, despite having a paradoxically high burden of PAD risk factors; however, recent work suggests prevalence may differ between sub-groups. Here, we examined a large cohort of diverse adults in the BioMe biobank in New York City. We observed the prevalence of PAD at 1.7% in EAs vs. 8.5% and 9.4% in AAs and HLs, respectively, and among HL sub-groups, the prevalence was found at 11.4% and 11.5% in Puerto Rican and Dominican populations, respectively. Follow-up analysis that adjusted for common risk factors demonstrated that Dominicans had the highest increased risk for PAD relative to EAs [OR = 3.15 (95% CI 2.33-4.25), p < 6.44 × 10-14]. To investigate whether genetic factors may explain this increased risk, we performed admixture mapping by testing the association between local ancestry and PAD in Dominican BioMe participants (N = 1,813) separately from European, African, and Native American (NAT) continental ancestry tracts. The top association with PAD was an NAT ancestry tract at chromosome 2q35 [OR = 1.96 (SE = 0.16), p < 2.75 × 10-05) with 22.6% vs. 12.9% PAD prevalence in heterozygous NAT tract carriers versus non-carriers, respectively. Fine-mapping at this locus implicated tag SNP rs78529201 located within a long intergenic non-coding RNA (lincRNA) LINC00607, a gene expression regulator of key genes related to thrombosis and extracellular remodeling of endothelial cells, suggesting a putative link of the 2q35 locus to PAD etiology. Efforts to reproduce the signal in other Hispanic cohorts were unsuccessful. In summary, we showed how leveraging health system data helped understand nuances of PAD risk across HL sub-groups and admixture mapping approaches elucidated a putative risk locus in a Dominican population.

A Pilot Program to Educate High-School Students Regarding Vascular Disease: The Western New York Model

Public education and awareness are critical to addressing issues related to vascular health and disease. However, to date, little work has been done at the community level with regard to outreach to at-risk populations and to address these knowledge gaps. We describe an intervention to educate high-school students regarding vascular disease with aims to improve community knowledge and to also promote further inquiry into the field of vascular surgery. An educational initiative was commenced in three public high schools. A team of vascular surgeons, vascular residents/fellows, medical students, and vascular lab technicians provided in-class education sessions for the length of a class period (approximately 50 minutes). During each session, there was an interactive presentation on risk factors, presentation, and treatment of peripheral arterial disease, stroke, and abdominal aortic aneurysms. This was followed by hands-on stations where students were introduced to endovascular tools and 3D-printed aortic models, as well as a station where students performed ultrasound examinations of their own carotid arteries and abdominal aortas, and ankle brachial indexes were performed. Before and after each session, substantive quizzes regarding vascular disease were administered, and results of the quizzes were tracked. A total of 155 students completed pre-educational session quizzes, and 132 students completed postsession quizzes (Table). Five questions were included on the pre- and postsession quizzes: peripheral arterial disease risk factors (question 1), smoking-related risks (question 2), abdominal aortic aneurysm symptoms (question 3), stroke symptoms (question 4), and smoking pathophysiology (question 5). An improvement was seen in the aggregate number of correct responses for each question (Table). There was also an increase in the total number of students who scored four correct: 7 (4.5%) presession to 20 (15.2%) postsession, and those who scored five correct: 0 (0%) presession to 11 (8.3%) postsession. Targeted programs aimed at high-school students by vascular surgeons, trainees, and staff can provide a sustainable model for public education and awareness of vascular disease that increases knowledge and may also spur interest in vascular surgery. Further work is needed to determine if these interventions can increase knowledge not only in students in the community at large but also in populations at risk surrounding these schools.TablePre- and posteducational session quiz resultsPresession correct responses, No. (%)Postsession correct responses, No. (%)Question 1: risk for developing PAD106 (68.4)101 (76.5)Question2: smoking-related risks59 (38.1)59 (44.7)Question3: most common AAA symptom12 (7.7)45 (34.1)Question 4: signs of stroke33 (21.3)44 (33.3)Question 5: smoking pathophysiology75 (48.4)75 (56.8)Total N = 155Total N = 132Total no. of correct responses 018 (11.6)9 (6.8) 144 (28.4)31 (23.5) 248 (31.0)32 (24.2) 338 (24.5)29 (22.0) 47 (4.5)20 (15.2) 50 (0)11 (8.3)AAA, Abdominal aortic aneurysm; PAD, peripheral arterial disease. Open table in a new tab