Risk Factors For Peripheral Arterial Disease Research Articles

Prevalence, Outcome, and Management of Risk Factors in Patients With Breast Cancer With Peripheral Arterial Disease: A Tertiary Cancer Center’s Experience

IntroductionThe risk factors of breast cancer overlap with those of peripheral arterial disease (PAD), with increasing prevalence. In addition, there is under-utilization of risk factor modification measures in patients with PAD. Materials and MethodsElectronic medical records of patients with breast cancer with International Classification of Diseases 9/10 codes for PAD spanning 10 years from June 1, 2009 to June 1, 2019 were reviewed. ResultsA total of 248 patients, 98% women, with a median age of 75 years and with a median follow-up of 76 months, were included. PAD risk factors were identified as smoking (44%), obesity (38%), hyperlipidemia (68%), hypertension (HTN) (74%), and diabetes (42%). Overall, survival was significantly impacted by smoking (P = .0301) and HTN (P = .0052). In a Cox proportion hazard ratio regression, HTN (overall death hazard ratio [HR], 3.1784; 95% CI, 1.0291-6.7490; P = .0070; cancer-related death HR, 2.6354; 95% confidence interval [CI], 1.0291-6.7490; P = .0434) and smoking (overall death HR, 1.7452; 95% CI 1.0707-2.8444; P = .0255; cancer-related death HR, 2.7432; 95% CI, 1.4190-5.3030; P = .0027) were predictors of overall death and cancer-related death. Of all patients, 48% were on statins and 54% were on antiplatelet therapies. Of the patients, 62% of current smokers were offered a smoking cessation program, 27% of obese patients were offered a nutrition consult, 42% of patients with diabetes had blood glucose controlled, and 54% of patients with HTN had blood pressure controlled. ConclusionSmoking and HTN are risk factors associated with decreased survival and predictive of overall death and cancer-related death. In this population, risk factor modification was under-utilized.

Microarray analysis of peripheral blood monocytes in patients with familial hypercholesterolemia and peripheral artery disease

Background and Aims: Monocyte infiltration to the arterial wall is one of the initial steps in atherosclerosis development. Atherosclerosis can cause peripheral artery disease (PAD). This is an inflammatory disease in which the blood supply to arteries is disturbed due to narrowing of the blood vessels. Familial hypercholesterolemia (FH) is a risk factor both for atherosclerosis and PAD. The aim of this study is detection of differentially expressed genes (DEG) in monocytes to reveal common pathological mechanisms involved in these diseases.

Vitamin D Deficiency May Not Be an Independent Risk Factor for Peripheral Arterial Disease in Middle-Aged and Elderly Patients with Type 2 Diabetes in China.

Background Vitamin D deficiency can lead to the increased severity and prevalence of metabolic disorders. However, the relationship between levels of 25-hydroxyvitamin D (25(OH)D) and peripheral arterial disease (PAD) is controversial. Therefore, the purpose of our study was to explore the relationship between 25(OH)D levels and PAD in middle-aged and elderly type 2 diabetes mellitus (T2DM) patients in China. Methods In this study, a total of 183 patients with T2DM were enrolled and categorized into groups with or without PAD. Clinical and biochemical parameters were assessed, and a Pearson analysis was used to identify a possible association between levels of 25(OH)D and glycated hemoglobin (HbA1c). Some biochemical parameters were also assessed in the T2DM patients with PAD according to vitamin D status. Interactions were also explored among HbA1c control, 25(OH)D levels, and PAD. The possible risk factors for PAD were measured by multivariable logistic regression analyses. Results Firstly, the parameters including age, HbA1c, and disease duration between T2DM and T2DM+PAD groups showed significantly different. In addition, the frequency of smoking in the group of T2DM patients was significantly less than that in the T2DM patients with the PAD group, while the frequency of well-controlled HbA1c in the patients with T2DM was significantly higher. There is a trend that the levels of 25(OH)D and HbA1c are correlated, but no interactions among vitamin D deficiency, HbA1c control, and PAD were found. However, HbA1c significantly differed between groups with vitamin D deficiency and insufficiency in the T2DM patients with PAD. According to the multivariate logistic regression analyses, the PAD risk factors of T2DM patients were family history of diabetes, smoking, age, disease duration, HbA1c, and LDL. Conclusions The findings demonstrate that the deficiency of vitamin D level is not related to PAD, but HbA1c may be linked to the presence of PAD in middle-aged and elderly patients with T2DM in China.

Indoxyl Sulfate and Incident Peripheral Artery Disease in Hemodialysis Patients.

Peripheral artery disease (PAD) is highly prevalent among patients with chronic kidney disease (CKD) and portends a very poor prognosis. Indoxyl sulfate has been shown to induce atherothrombosis and impaired neovascularization in uremic mice. However, there is no clinical evidence regarding the role of indoxyl sulfate in PAD associated with CKD. We examined associations between indoxyl sulfate and incident symptomatic lower extremity PAD events as well as major adverse cardiovascular events (MACE) and all-cause mortality using Cox proportional hazards models in a prospective cohort of 200 hemodialysis patients free of PAD at baseline. Patients were considered as having PAD if they developed PAD symptoms confirmed by an ankle-brachial index with waveforms, duplex ultrasound or angiography, and/or major adverse limb events including revascularization and amputation. During a median follow-up of 6.5 years, 37 patients (18.5%) experienced incident symptomatic PAD. MACE occurred in 52 patients, and a total of 85 patients died. After adjusting for traditional risk factors for PAD, including age, current smoking, diabetes, and cardiovascular disease, indoxyl sulfate was significantly associated with the risk of PAD (hazard ratio (HR), 1.19 for every 10-μg/mL increase in indoxyl sulfate; 95% confidence interval (CI), 1.05–1.35). However, indoxyl sulfate was not associated with risk of MACE (HR, 1.00; 95% CI, 0.90–1.12) or death from any cause (HR, 0.98; 95% CI, 0.90–1.07). Indoxyl sulfate was associated with incident symptomatic PAD but not with MACE or all-cause mortality, suggesting that indoxyl sulfate toxicity may be unique to PAD among hemodialysis patients.

Hubungan Indeks Massa Tubuh (IMT) dengan Ankle Brachial Index (ABI) pada Pasien Diabetes Mellitus Tipe 2 Etnis Jawa

Diabetes mellitus (DM) often give a macrovascular complication such as Peripheral arterial disease (PAD). Ankle-brachial index (ABI) is a sensitive and specific examination for PAD. Obesity can be a risk factor of PAD. Obesity can be classified by the BMI (Body Mass Index) classification. The purpose of this research is to analyze the relationship of BMI with ABI in Type 2 DM (T2DM) patients of Javanese ethnicity. This study was an observational analytic research with case-control design and used a purposive sampling technique. There were 40 case samples and 40 control samples. Data analysis used the Independent T-test and Chi-square test. There was a significant differences on age (p=0,000), METs (p-value=0,003), and ABI (p-value=0,002) between the two groups. In the DM group was found that most abnormal ABIs were found in the higher BMI, even though there was no significant correlation by the statistic (p-value=0,255). BMI contributed less to the ABI value of Javanese ethnic T2DM patients.

Peripheral artery disease in outpatients with a recent history of acute coronary syndrome or at high atherothrombotic risk.

The frequency and implications of peripheral artery disease (PAD) in some risk groups are not entirely characterized in Latin America. We studied PAD prevalence, risk factors, and six-month outcomes in stable outpatients with a history of a recent acute coronary syndrome (ACS), or at high coronary risk. We recruited 830 outpatients in 43 Mexican sites (median age: 64.8 years; 57.8% men). Inclusion criteria were age >18 years, and ACS within 30 days, or age <55 years plus ≥2 major vascular risk factors, or age ≥55 years plus ≥1 vascular risk factors. Patients received standardized assessments at baseline and six-month follow-up for medical history, ankle-brachial index (ABI), and the Edinburgh Claudication Questionnaire (ECQ). ABI <0.8 was found in 10.5%, <0.9 in 22.5%, >1.3 in 4.8%, and >1.4 in 3.6%, without differences according to sex or selection criteria. Positive ECQ was found in 7.6%. ABI <0.9 was directly associated with age, diabetes, ACS, and chronic kidney disease, but inversely associated with BMI >27. The six-month case-fatality and atherothrombotic events rates were 1.6% and 3.6%, respectively. In patients with ABI <0.9 and ABI <0.8, the six-month case-fatality rates were 2.5% (p = 0.27) and 5.4% (p = 0.03), respectively. In a Cox proportional-hazards model, baseline factors associated with death were age ≥65, ABI <0.8, and ACS. Subclinical PAD is more common than symptomatic claudication in high-risk coronary outpatients. Low ABI is associated with reduced short-term survival in patients with recent ACS or at high coronary risk.

P1593THE ASSOCIATION BETWEEN THE ANCLE-BRACHIAL INDEX AND MARKERS OF INFLAMATION IN CHRONIC HEMODIALYSIS PATIENTS

Abstract Background and Aims Among hemodialysis patients, peripheral arterial disease (PAD) represents an important health care burden and has been associated with high mortality. The ancle-brachial index (ABI), is a reliable and noninvasive method used to asses PAD. The aim of this study was to evaluate the prevalence of PAD in patients undergoing chronic hemodialysis and the association with inflammation and malnutrition using serum C-reactive protein (CRP) and serum albumin as biomarkers. Method The study was conducted at different hemodialysis centers in patients receiving hemodialysis three times a week. We excluded patients with atrial fibrillation or who had been recently hospitalized. The ABI has been used as a diagnostic tool for PAD and measured before a hemodialysis session. A value of ABI less than 0.9 was considered abnormal. To better estimate the impact of malnutrition and inflammation we used the serum albumin, blood lipids values and serum C-reactive protein values defined by calculating the mean of the last three measurements. Results A total of 261 ESRD patients on maintenance hemodialysis were enrolled in the study. Mean age was 56.0 (±12) years, 58% were males, and 17.6% were diabetics. Mean time on hemodialysis was 5.9 (±6.7) years, with 24% of patients on dialysis for less than 3 years. Among our patients we found that the prevalence of PAD was 23.4%, of whom 58.1% were men. We found that age, diabetes, duration of hemodialysis, low serum albumin levels and high serum triglyceride levels were risk factors for PAD in hemodialysis patients. The multivariate analysis of our study has shown that a lower level of albumin and higher level of CRP were significantly associated with an ABI less than 0.9 (odds ratio, 4.54; 95% confidence interval, P = 0.017) after adjusting for demographic, clinical, biochemical and medication data. We did not find significant differences in serum calcium, phosphate or PTH levels between patients with PAD and those without it. Conclusion In conclusion, the present study showed high prevalence of PAD in patients on hemodialysis. The prevalence was higher in diabetics. Low albumin levels and C-reactive levels were independent risk factors of PAD. We found that early diagnosis and treatment of PAD could help to improve the quality of life of hemodialysed patients and postpone arterial complications in this group of patients.

Apolipoprotein E Gene Polymorphism, Glycated Hemoglobin, and Peripheral Arterial Disease Risk in Chinese Type 2 Diabetic Patients.

Background The apolipoprotein E (ApoE) gene polymorphism has been found to influence plasma lipid concentration, and its correlation with peripheral arterial disease (PAD) has been investigated. However, it is unclear whether ApoE is associated with PAD in Chinese type 2 diabetes mellitus (T2DM) patients. Therefore, our study is aimed at investigating the relationship between the ApoE gene polymorphism and PAD in Chinese T2DM patients. Methods A total of 192 T2DM patients were divided into two groups: T2DM and T2DM with PAD. The clinical and biochemical parameters were obtained. Polymerase chain reaction was used to identify the genotypes of ApoE. The multivariable logistic regression analysis was used to identify the possible risk factor for PAD. Results There were no significant differences in the genotype and allele frequencies of ApoE between the T2DM and T2DM with PAD groups. However, the T2DM with PAD group tended to have more ε4/ε4/Conclusions These results demonstrated that there was no evidence of a relationship between ApoE and PAD.

Vitamin D serum levels and peripheral arterial disease among southern Brazilian adults.

To investigate the association between low serum vitamin D levels and peripheral arterial disease (PAD). A cross-sectional study with a consecutive sample of 133 individuals from Caxias do Sul, Brasil. We considered PAD patients those with an ankle-brachial index (ABI) ≤ 0.90 or with arterial revascularization. Vitamin D serum level was categorized as sufficient (≥30 ng/mL), insufficient (>20 to 29 ng/mL), and deficient (<20 ng/mL). Prevalence ratios (RP) were calculated through Poisson regression. The prevalence of PAD was 50.7% (95% CI 42-59). After adjustment for potential PAD risk factors, RP were 1.08 (95% CI 0.66-1.76) for insufficient serum level and 1.57 (95% CI 0.96-2.57) for deficient vitamin D serum level; (p for trend = 0.020). Vitamin D serum levels showed an inverse and significant dose-response relationship with PAD.

Sedentary time and peripheral artery disease: The Hispanic Community Health Study/Study of Latinos

Experimental evidence suggests that sedentary time (ST) may contribute to cardiovascular disease by eliciting detrimental hemodynamic changes in the lower limbs. However, little is known about objectively measured ST and lower extremity peripheral artery disease (PAD). We included 7,609 Hispanic/Latinos (ages 45-74) from the Hispanic Community Health Study/Study of Latinos. PAD was measured using the ankle brachial index (≤0.9). ST was measured using accelerometry. We used multivariable logistic regression to assess associations of quartiles of ST and PAD, and then used the same logistic models with restricted cubic splines to investigate continuous nonlinear associations of ST and PAD. Models were sequentially adjusted for traditional PAD risk factors, leg pain, and moderate- to vigorous-intensity physical activity (MVPA). Median ST was 12.2 h/d, and 5.4% of individuals had PAD. In fully adjusted restricted cubic splines models accounting for traditional PAD risk factors, leg pain, and MVPA, ST had a significant overall (P = .048) and nonlinear (P = .024) association with PAD. A threshold effect was seen such that time spent above median ST was associated with higher odds of PAD. That is, compared to median ST, 1, 2, and 3 hours above median ST were associated with a PAD odds ratio of 1.16 (95% CI = 1.02-1.31), 1.44 (1.06-1.94), and 1.80 (1.11-2.90), respectively. Among Hispanic/Latino adults, ST was associated with higher odds of PAD, independent of leg pain, MVPA, and traditional PAD risk factors. Notably, we observed a threshold effect such that these associations were only observed at the highest levels of ST.

Prevalence and Risk Factors of Peripheral Arterial Disease in Patients with Lumbar Spinal Stenosis and Intermittent Claudication: CT Angiography Study.

BackgroundIt can be difficult to differentiate between vascular and neurogenic intermittent claudication. The exact diagnosis often cannot be made on clinical evidence and ultimately requires imaging. Perioperative screening for peripheral arterial disease (PAD) in lumbar spinal stenosis (LSS) patients is important because untreated PAD increases the risk of severe vascular events. The aims of this study were to study the prevalence of PAD in LSS patients with symptoms of intermittent claudication, and to study the independent risk factors for PAD. We specified the cases where it was necessary to perform computed tomography angiography (CTA) as a preoperative screening tool in surgery for spinal stenosis.MethodsThis study involved a retrospective analysis of 186 consecutive subjects with radiographic evidence of LSS and symptoms of intermittent claudication, who underwent 3D CTA of the lower extremities at our institution during a three-year period. More than 50% luminal narrowing on CT angiograms was determined to be clinically significant and placed in the PAD group.ResultsThirty-two subjects were diagnosed with PAD and referred to the general vascular team in our hospital, where they received treatment for PAD. In the non-PAD group (154 subjects), 117 underwent definitive surgery for spinal stenosis such as posterior lumbar interbody fusion and a further 37 underwent conservative treatment. Only hypertension, diabetes, and men gender were found to be statistically significant predictors of PAD.ConclusionThe current study showed that man gender, diabetes and hypertension were the greatest risk factors for PAD. We conclude that man patients with diabetes and/or hypertension should be put under serious consideration for routine CTA examination when under evaluation for LSS and intermittent claudication.

Risk factors for peripheral arterial disease in elderly patients with Type-2 diabetes mellitus: A clinical study.

Objectives:To determine risk factors for peripheral arterial disease (PAD) in elderly patients with Type-2 diabetes mellitus.Methods:The elderly patients with Type-2 diabetes treated in the Central Hospital of Cangzhou were enrolled and divided into PAD group and non-PAD group between October 2016 and November 2019, The data of the patients including age, gender, body mass index, blood pressure, hemoglobin A1c, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol, total cholesterol, triglyceride, white cell count, lymphocyte count, high-sensitivity C-reactive protein, uric acid as well as living habits and complications of Type-2 diabetes mellitus were recorded to determine the risk factors for PAD.Results:One thousand four hundred seventy six (1476) patients were enrolled, in which 465 patients were included in group of PAD, and 1011 in non-PAD group. The univariate analysis revealed that the two groups significantly differed in age (p=0.003), course of T2DM (p=0.001), hypertension (p=0.006), smoking habits (p<0.001), hyperuricemia (p<0.01), high-sensitivity C-reactive protein (p<0.01), white cell count (p<0.001), lymphocyte count (p<0.001) and diabetic neuropathy (p<0.001). In the multivariate analysis, age (OR: 1.56, 95% CI: 1.21-1.89), smoking habit (OR: 1.37, 95% CI: 1.19-1.68), hypertension (OR: 1.44, 95% CI: 1.15-1.98), diabetic neuropathy (OR: 3.55, 95% CI: 2.14-4.29), high-sensitivity C-reactive protein (OR: 1.74, 95% CI: 1.39-2.61) and hyperuricemia (OR: 2.71, 95% CI: 1.66-3.87) were significant risk factors for PAD.Conclusions:Age, smoking habit, hypertension, diabetic neuropathy, high-sensitivity C-reactive protein and hyperuricemia were independent risk factors for peripheral arterial disease in elderly patients with Type-2 diabetes mellitus.

The Unusual Improvement of Intermittent Claudication Distance in Patient with Peripheral Arterial Disease Utilizing “2/3 Claudication Distance” Protocol of Exercise Training

Peripheral arterial disease (PAD) affects 12% - 20% of the population over 65 years. PAD is a component of systemic atherosclerosis and is associated with increased rate of all-cause mortality and cardiovascular events, compared with those without PAD. The strongest risk factors for PAD are older age and cigarette smoking. PAD accelerates functional decline leading to physical disability. Many randomized clinical trials demonstrated that treadmill walking training increases pain-free and maximal walking distances in patients with PAD. Exercise intervention is strongly recommended for patients with PAD and symptoms of intermittent claudication (IC). The need to provide an exercise training program to patients with peripheral arterial disease is essential, as almost half of these patients will eventually develop coronary artery disease. There are many existing treadmill walking protocols for patients with PAD. Most of these are based on claudication severity. We present a case of significant improvement of pain-free distance and maximum treadmill walking distance in a patient with PAD after 12 weeks of walking training program utilizing the “2/3 claudication distance” formula.

Association between physical activity level and ankle-branchial index in patients with risk factors of peripheral arterial disease

Introduction: Peripheral arterial disease (PAD) causes a three-fold increase in risk of mortality and major cardiovascular events. PAD is typically diagnosed with ankle-branchial index (ABI) ≤0.90. World Health Organization recommends to address behavioural risk factors to prevent further burden of cardiovascular diseases. Purpose: The aim of this study was to examine correlation between physical activity level and ABI among patients with risk factors of PAD and ABI in normal range or ABI indicating some or moderate arterial disease. Methods: 71 patients who were over 65 years old and had minimum of two additional PAD risk factors were recruited. Physical activity level was measured by International Physical Activity Questionnaire, walking ability was assessed by 6-minute Walking Test (6MWT). Results: Mean ABI was in normal range (1.08, SD 0.15). Mean Body Mass Index of the group indicated obesity (30.6, SD 5.5 kg/m2). Among modifiable PAD risk factors, hypertension and dyslipidaemia were the most prevalent. Most of the participants (62%) were moderately active. Mean total physical activity was 5310.2 MET-min per week. The average person has been sitting for around 5 hours per day. The mean result of 6MWT was 432.2 meters (SD 103.4). Following correlations were observed: between total physical activity level and ABI (r=0.17), between walking ability and ABI (r=0.39), sitting time and ABI (r=-0.32). Conclusions: older people with PAD risk factors could benefit from everyday walking and housework. Incorporating walking while transportation can exert PAD prevention effect. Sitting time should be avoided. These recommendations apply not only for patients with some or moderate PAD, but also for older individuals with normal range ABI, but with PAD risk factors.

A Prospective Cohort Study of Substitutions of Poultry, Red Meat or Lean Fish with Fatty Fish and the Risk of Incident Peripheral Arterial Disease in Men

Introduction - The evidence regarding potential associations between intake of fish, poultry, red meat and the risk of peripheral arterial disease (PAD) is limited. Analysis and interpretation of dietary data are difficult. First, most foods are eaten together with foods characteristic for the dish and secondly, increased consumption of one food type is typically accompanied by a lower intake of other food types. To account for this we used the substitution approach in which we compare individuals with different food patterns corresponding to replacing one food item with another. The aims of this study were to examine associations for substitutions of poultry, red meat and lean fish with fatty fish and the risk of PAD. We hypothesised that a higher intake of fatty fish and a concomitant lower intake of other meat products was associated with a lower risk of PAD. Methods - We conducted a prospective cohort study based on data from the Diet, Cancer and Health cohort initiated in 1993 to 1997. At baseline, middle-aged men filled in a lifestyle questionnaire and a validated 192-item semi-quantitative food frequency questionnaire about their usual diet the year before. During follow-up, we identified participants with validated diagnoses of peripheral arterial disease with ankle-brachial index below 90% or toe-brachial index below 70%. Data were analysed using multivariable Cox regression models. Substitutions of 150 g/week of either poultry, processed red meat, unprocessed red meat or lean fish with 150 g/week of fatty fish were explored. Results - After relevant exclusions and follow-up for a median of 13.6 years, 546 eligible PAD cases were identified in the cohort of 25,725 men. In multivariable analyses including adjustment for established lifestyle risk factors for PAD, the HR of replacing poultry with fatty fish was 0.93 (95% CI 0.77-1.11), while the HRs of incident PAD after replacing either unprocessed or processed red meat with fatty fish were 0.88 (95% CI 0.76-1.03) and 0.85 (95% CI 0.73-1.00), respectively. When substituting lean fish with fatty fish the HR of PAD was 0.89 (95% CI 0.72-1.11). The associations were all in the same direction, however not statistically significant.Table 1Substitution between 150 g per week of different meat and the risk of peripheral arterial diseaseSubstitution between food groups per 150 g/weekHR∗95% CIHR∗∗95% CIFatty fish instead of poultry1.00(0.83-1.21)0.93(0.77-1.11)Fatty fish instead of unprocessed red meat0.85(0.73-0.99)0.88(0.76-1.03)Fatty fish instead of processed red meat0.76(0.65-0.89)0.85(0.73-1.00)Fatty fish instead of lean fish0.85(0.69-1.06)0.89(0.72-1.11)*Model 1A: Crude analysis adjusted for age and energy intake.**Model 1B: As model 1A with additional adjustment for traditional risk factors including educational level, BMI, waist circumference, physical activity, alcohol intake and smoking. Open table in a new tab *Model 1A: Crude analysis adjusted for age and energy intake. **Model 1B: As model 1A with additional adjustment for traditional risk factors including educational level, BMI, waist circumference, physical activity, alcohol intake and smoking. Conclusion - This study suggested that substituting meat products and lean fish with fatty fish might be associated with a lower risk of incident PAD, however not statistically significant.

High Sensitivity Troponin and Risk of Incident Peripheral Arterial Disease in Chronic Kidney Disease (from the Chronic Renal Insufficiency Cohort [CRIC] Study)

Patients with chronic kidney disease (CKD) are at increased risk for peripheral arterial disease (PAD). A novel biomarker to accurately and reliably predict new onset PAD in high risk patients is needed. High sensitivity troponin (HsTP) is a new assay which allows detection of very low troponin levels with high precision. We sought to explore the association between HsTP and risk of PAD in CKD. The Chronic Renal Insufficiency Cohort (CRIC) is a prospective cohort of 3,939 individuals with mild to moderate CKD using age related criteria for glomerular filtration rate. High sensitivity troponin T was measured at study enrollment. Patients with previous history of PAD or coronary artery disease were excluded. Patients were followed for new-onset adjudicated PAD, and the association between HsTP and incident PAD was examined. A total of 2,909 participants free of PAD and coronary artery disease at enrollment were included in this analysis. Over a mean follow up 7.4 years [interquartile ranges 5.8 to 8.5] years, 79 (2.7%) patients developed PAD. The 3-, 6-, and 9-year incidence of PAD was 1.00%, 2.03%, and 2.72%, respectively. At 9 years, the cumulative rates of PAD increased with HsTP (Quartile 1: 0.3%, Quartile 2: 2.4%, Quartile 3: 3.7%, Quartile 4: 10.7%; p<0.001). After adjusting for clinical risk factors of PAD, patients in the third quartile (Hazards ratio 5.89, 95% confidence interval: 1.31 to 26.47, p = 0.021) and fourth quartile of HsTP (Hazards ratio 10.24, 95% confidence interval 2.23 to 47.08, p = 0.003) had higher risk of PAD compared with lowest quartile of HsTP. HsTP had good discrimination of PAD at 3 years (area under the curve [AUC] 0.76), 6 years (AUC 0.79) and 9 years (AUC 0.80). Addition of HsTP to Framingham risk score improved model discrimination of PAD. In conclusion, in patients with mild-moderate CKD, HsTP levels are associated with and predictive of risk of incident PAD. This association remains significant despite adjustment for traditional PAD risk factors and chronic kidney disease.

Impact of diabetes mellitus on 5-year clinical outcomes following successful endovascular revascularization for peripheral artery disease.

Endovascular therapy is a viable treatment option for symptomatic peripheral artery disease (PAD). Diabetes mellitus is a major risk factor for PAD. We evaluated the long-term impact of diabetes mellitus in patients with PAD who underwent endovascular therapy. In this prospective registry of 765 patients who underwent endovascular therapy for symptomatic PAD, 560 had diabetes and 205 did not have diabetes. Propensity score matching (PSM) analysis was performed to adjust for any potential confounders. The primary endpoints were 5-year major adverse cardiac and cerebrovascular events (MACE) and major adverse limb events (MALE). After PSM analysis, baseline clinical and limb characteristics were similar in patients with diabetes and in patients without diabetes. Patients with diabetes had a higher rate of major hematoma (> 4 cm) (9.9% vs 3.3%, p = 0.038). At 5-year clinical follow-up, patients with diabetes and patients without diabetes had similar rates of MACE (20.7% vs 20.7%, log rank p = 0.989) and MALE (19.8% vs 24.5%, log rank p = 0.312), as well as the individual endpoints. In subgroup analysis adjusted by PSM, female patients with diabetes had a higher risk of MALE (hazard ratio 0.31, 95% CI 0.13-0.69, p = 0.004). Although there was a higher rate of major hematoma, patients with diabetes who underwent endovascular therapy had similar 5-year cardiac and vascular outcomes compared with patients without diabetes. Bleeding avoidance strategies, including optimal antiplatelet and antithrombotic therapy, and meticulous vascular access techniques, are needed in patients with diabetes to reduce the risk of bleeding and its deleterious impact on morbidity and mortality.

Body mass index and peripheral artery disease

Background and aimsAn independent association of body mass index (BMI) with atherosclerotic cardiovascular disease is somewhat controversial and may differ by vascular bed. Sex-specific risk factors for atherosclerosis may further modify these associations. Obesity and peripheral artery disease (PAD) are both more prevalent in women. We sought to determine the association between PAD and BMI using a very large population-based study. MethodsSelf-referred individuals at >20,000 US sites completed medical questionnaires including height and weight, and were evaluated by screening ankle brachial indices (ABI) for PAD (ABI<0.9). ResultsAmong 3,250,350 individuals, the mean age was 63.1 ± 10.5 years and 65.5% were women. The mean BMI was 27.7 ± 5.8 kg/m2. 27.8% of participants were obese (BMI ≥30 kg/m2) – 27.6% females, 28.1% males. Overweight individuals (BMI 25–29.9 kg/m2) exhibited the lowest prevalence of PAD. There was a J-shaped association of BMI with prevalent PAD. After adjustment for age and cardiovascular risk factors, underweight was associated with similarly increased odds of PAD (1.72 vs. 1.39, women and men, respectively). The association of obesity with PAD was predominant in women, with only a slight association of increasing BMI with PAD in men (OR = 2.98 vs. 1.37 for BMI ≥40 kg/m2). ConclusionsOur study suggests that increasing BMI is a robust independent risk factor for PAD only in women. This observation requires validation, but highlights the need for further research on sex-specific risk and mechanisms of atherosclerosis.

Peripheral Arterial Disease Prevention in Women: Awareness and Action.

Peripheral Arterial Disease Prevention in Women: Awareness and Action.

Hypertriglyceridemia is associated with an increased risk of peripheral arterial revascularization in high-risk statin-treated patients: A large administrative retrospective analysis.

BackgroundPeripheral artery disease (PAD) is common, and although it is associated with cardiovascular (CV) morbidity, mortality, reduced quality of life, and increased health care burden, PAD data are relatively scarce. Elevated triglycerides (TG) are associated with and are a risk factor for PAD.HypothesisLarge administrative retrospective data may provide further insight into the relationship between hypertriglyceridemia and peripheral arterial revascularization in high‐risk statin‐treated patients.MethodsThis retrospective administrative claims analysis of the Optum Research Database included statin‐treated patients aged ≥45 years with diabetes and/or atherosclerotic CV disease enrolled in 2010 and followed for ≥6 months. Patients with TG ≥150 mg/dL were propensity score‐matched to a comparator cohort with TG <150 mg/dL and high‐density lipoprotein cholesterol >40 mg/dL (n = 23 181 in each cohort). A sub‐analysis was conducted in patients with TG 200‐499 mg/dL and a matched comparator cohort (n = 10 990). Clustered P‐values were calculated using a Cox proportional hazard model with cohort as the independent variable (α, 0.05).ResultsMultivariate analysis showed a 37% higher rate of peripheral arterial revascularization in the elevated‐TG cohort vs the comparator cohort (hazard ratio [HR] 1.370, 95% confidence interval [CI] 1.263‐1.486; P < .001). Results in the high‐TG sub‐cohort were similar, with a 49% higher rate of revascularization vs the comparator cohort (HR 1.489; 95% CI, 1.348‐1.644; P < .001).ConclusionsThis large administrative retrospective analysis of high‐risk statin‐treated patients showed that elevated TG (≥150 mg/dL) and high TG (200‐499 mg/dL) were significant predictors of peripheral arterial revascularization; this warrants further study.