Prevalence Of Peripheral Arterial Disease Research Articles

Effect of nitrate administration on plasma nitric oxide levels in patients with peripheral arterial disease at Dr. Sardjito General Hospital, Yogyakarta

Peripheral arterial disease (PAD) is a disease involving reduction of blood flow to the inferior extremity associated with atherosclerotic lesions. In 2010, more than 200 million people with PAD were reported globally, including 54.8 million in Southeast Asia. The high prevalence of PAD causes its management become challenging for clinicians. Nitric oxide (NO) has a role in endothelial function that is associated with the appearance of symptoms in PAD patients. Exogenous nitrate is usually used as a primary vasodilator in the treatment of angina pectoris and Prinzmetal angina. However, information concerning the role of nitrate administration to improve symptomatic PAD patients is limited. This study aimed to evaluate the effectiveness of exogenous nitrates in increasing plasma NO levels and improving PAD patients. A prospective pre-post clinical trial involving PAD patients who were registered in the vascular registry at Dr. Sardjito General Hospital, Yogyakarta was conducted. Primary endpoint was the change in plasma NO levels after short term administration of nitroglycerin oral 2.5 mg once daily (4 h) and long term (7 d). Analysis of variance test with Bonferroni posttest was used for statistical hypothesis testing. Among 33 subjects who completed this study, no negative side effects, and only one hypotensive patient was reported at the first follow-up after 4 h of the nitroglycerin administration. Plasma NO levels increased in the post 4 h and in the post 7 d administration. However, no statistically significant was observed (p > 0.05). Administration of exogenous nitrates in patients with PAD increases the plasma NO levels, even though it is not statistically significant.

Prevalence and Risk Factors of Peripheral Arterial Disease in type 2 Diabets Mellitus in Yogyakarta, Indonesia

Aim:
 Diabetes mellitus increases the risk of peripheral artery disease (PAD) 2 times. PAD is diagnosed by ABI (Ankle Brachial Index). PAD increases mortality and morbidity of patient with Diabetes Mellitus (DM) Type 2. This study aims to determine the prevalence and risk factors of PAD in the population of type 2 diabetes mellitus (DM) in Yogyakarta, Indonesia.
 
 Methods:
 This study was a community-based descriptive and analytic observational study that examines the prevalence and risk factors of PAD in type 2 diabetes mellitus. Diagnosis of PAD was detected by ABI examination using VaSera VS-1500N. All patients with type 2 diabetes mellitus in Yogyakarta who meet the inclusion criteria will be enrolled in this study. The research subjects were taken in multi-stage, cluster-random sampling in Yogyakarta. The patient will undergo an interview of demographic data which were assessed by one assessor. Data from interviews and ABI examinations were analysed statistically.
 
 Results:
 Two hundred and fifty-six (256) patients with type 2 DM consisted of 188 patients (73.4%) women and 68 patients (26.6%) men. Prevalence of PAD diagnosed by abnormal ABI was found in 41 (16%) of 256 patients. Subjects with age more than 67 years old was significantly associated with PAD occurrence (P=0,001) in type 2 DM population.
 
 Conclusion:
 The prevalence of PAD was 16% of 256 type 2 DM patients. Age more than 67 years old was the strong risk factor of PAD in type 2 DM.
 
 Key words: Ankle Brachial Index, Peripheral Arterial Disease, Diabetes mellitus, Prevalence, Risk Factor

Association Between Metabolic Syndrome and Peripheral Arterial Disease in Elderly Patients with Type 2 Diabetes

BackgroundPeripheral artery disease (PAD) is a manifestation of atherosclerotic cardiovascular disease (ASCVD) and significantly increases the risk of myocardial infarction and stroke. As most patients with PAD are asymptomatic, this condition is largely neglected in clinical practice. Type 2 diabetes (T2DM) patients have higher prevalence of PAD. Therefore, early detection and intervention of diabetic PAD are very important. Metabolic syndrome (MetS) is a group of interrelated metabolic risk factors, a predictor of poor prognosis in elderly patients with ASCVD. Recently, many of the metabolic risk factors as well as the overall concept of MetS itself have sparked a great deal of debate regarding their precise roles in PAD.ObjectiveTo evaluate the relationship between metabolic syndrome (MetS) and peripheral arterial disease (PAD) in elderly patients with type 2 diabetes (T2DM).MethodsTwo hundred and eighty-one elderly T2DM patients admitted to Beijing Tongren Hospital from October 2016 to December 2017 were divided into PAD group (n=136) and non-PAD (NPAD) group (n=145). Their medical records, physical examination parameters and laboratory testing parameters were later recorded and analyzed by multivariate logistic regression analysis.ResultsNo significant difference was detected in general clinical data and laboratory testing parameters between the two groups (P>0.05). The incidence of MetS was significantly higher in PAD group than in NPAD group (88.2% vs 70.3%, P=0.001). Multivariate logistic regression analysis showed that the risk of PAD was 1.762-fold higher in MetS patients after adjustment for age, sex, history of smoking and alcohol consumption, WC, SBP, serum TC and HbA1c level, eGFR and duration of DM (95% CI: 1.205–6.330, P=0.016).ConclusionMetS closely correlates with PAD in elderly T2DM patients, though no significant difference has been detected in their metabolic indicators.

Joint statement from the European Atherosclerosis Society and European Society of Vascular Medicine focuses on patients with peripheral arterial disease

Joint statement from the European Atherosclerosis Society and European Society of Vascular Medicine focuses on patients with peripheral arterial disease

Periodontal disease measures and risk of incident peripheral artery disease: The Atherosclerosis Risk in Communities (ARIC) Study.

The association of periodontal disease with atherosclerotic cardiovascular diseases is well known, but not specifically with incident peripheral artery disease (PAD). Therefore, we studied the associations of periodontal disease with incident PAD in a population-based setting. Among 9,793 participants (aged 53-75 years) without prevalent PAD, self-reported history of periodontal disease was ascertained. Of these, 5,872 participants underwent full-mouth examinations from which periodontal status was defined using the US Centers for Disease Control and Prevention-American Academy of Periodontology (CDC-AAP) definition. We quantified the association of periodontal disease with incident PAD (defined by hospital admission diagnosis or procedures) using multivariable Cox regression models. During a median follow-up of 20.1 years, 360 participants (3.6%) developed PAD. In models accounting for potential confounders including diabetes and smoking pack-years, there was higher hazard of PAD in participants with self-reported tooth loss because of periodontal disease (hazard ratio:1.54 [95% CI:1.20-1.98]), history of periodontal disease treatment (1.37 [1.05-1.80]), and periodontal disease diagnosis (1.38 [1.09-1.74]), compared to their respective counterparts. The clinical measure of periodontal disease (n=5,872) was not significantly associated with incident PAD in the fully adjusted model (e.g., 1.53 [0.94-2.50] in CDC-AAP-defined severe periodontal disease versus no disease). We observed a modest association of self-reported periodontal disease, especially when resulting in tooth loss, with incident PAD in the general population. Nonetheless, a larger study with the clinical measure of periodontal disease is warranted.

Abstract 13049: Peripheral Artery Disease In Patients Undergoing Transcatheter Aortic Valve Replacement In Northern New England

Background: Transcatheter aortic valve replacement (TAVR) is now more common than surgical aortic valve replacement (SAVR) for severe aortic valve stenosis. In the general population, the prevalence of peripheral artery disease (PAD) in patients undergoing transfemoral TAVR is 25%, with higher risk of adverse outcomes including bleeding, readmission, myocardial infarction, and all-cause mortality. The objective of this study was to examine the prevalence of peripheral artery disease in patients undergoing TAVR at Dartmouth-Hitchcock Medical Center (DHMC). Methods: We performed a retrospective observational study of 569 patients undergoing TAVR between 1/1/2012-4/8/2020. PAD was defined as presence of aorto-iliac, femoral-popliteal, below-knee tibial, reno-vascular, mesenteric, cerebrovascular, aortic disease, or upper extremity arterial disease noted in the patient’s chart prior to TAVR. Results: Of 569 TAVR patients, 19% (n=109) had concomitant PAD. Of these, 70 patients (64%) were established with a vascular specialist and 54 (50%) had a prior intervention relating to their disease. Figure 1 characterizes the distribution and location of PAD among patients. Conclusion: In a Northern New England population, 1 in 5 patients undergoing TAVR had concomitant PAD. Cerebrovascular and peripheral vascular disease were most common. Understanding PAD epidemiology is of paramount importance with respect to vascular access and longitudinal management in a vulnerable aortic stenosis population.

Abstract 14331: Findings of a Novel Barbershop-Based Peripheral Artery Disease Screening Program and Intervention for Black Men

Introduction: Peripheral artery disease (PAD) increases risk of cardiovascular events and limb events including amputations. Black race is a strong risk factor for PAD. Screening for PAD using the ankle-brachial index (ABI) can lead to early diagnosis and treatment. This is the first study to screen for PAD using the ABI in barbershops. Hypothesis: Barbershop-based screening and an educational intervention can detect PAD and increase PAD knowledge in a high-risk population. Methods: A screening pilot study was conducted at two barbershops in Cleveland from June-December 2020. Black male participants aged 40-89 completed an initial screening visit with automated ABI and a confirmatory visit with Doppler ABI. All were invited to watch an educational video on PAD and interviewed at 2-month follow-up. Automated blood pressure, health status, and knowledge about PAD were assessed at all visits. Results: 37 participants completed the initial screening, 31 (84%) completed the confirmatory testing visit, 29 (78%) completed the exit visit, and 27 (73%) watched the educational video. After screening with both automated and Doppler ABI, PAD was identified in 5/31 (16.1%) participants. PAD awareness was low, but among those who completed the study, 23 (82%) showed improved PAD awareness scores as well as improvement in their self-assessed knowledge of PAD ( p< 0.001). An association was found between good PAD awareness at baseline and education: compared to those with some college education, those who did not graduate high school scored lower on PAD awareness ( p = .022), as did those who only had a high school diploma or GED ( p = .049). Conclusions: In a pilot study, barbershop-based screening for PAD among Black men revealed a higher than expected PAD prevalence and low PAD awareness. ABI screening and an educational video increased PAD awareness. ABI screening and educational outreach in the barbershop may be effective tools to diagnose PAD and increase awareness among Black men.

The Association between Chronic Myeloid Leukemia and Heart Failure

IntroductionThe first and second leading causes of death in the United States are heart disease and cancer respectively. Chronic myeloid leukemia (CML) is a hematopoietic stem cell malignancy diagnosed at the mean age of 66. The rate of cardiovascular diseases in CML have been increased with the advent of therapies such as tyrosine kinase inhibitors (TKIs) as well as the improved survival rate with the treatments. Heart failure is one the most commonly identified cancer-therapy related cardiovascular adverse events. In this study, we are using national population cohort to study the association between CML and heart failure.MethodsWe conducted a retrospective analysis of 3 years of National inpatient sample (HCUP-NIS) from 2016 to 2018 data base. Patient older than 60 years old and with or without CML was selected using ICD-10 diagnosis code. Principal diagnosis of congestive heart failure and cardiogenic shock were included with the code. Discharge-level weight analysis was used to produce national estimate. Continuous variables were compared by t-test, while chi-square and Fisher's exact test for categorical variables. Finally, multivariate logistic regression was used to calculate odds ratio for inpatient mortality and multivariate linear regression for length of stay using STATA 17 statistical software.ResultsA total of 45,724,104 admissions met for inclusion criteria and 43,505 patients (0.095 %) have CML. Patients with CML are more likely to be of older age (75.2 v 74.9, p <0.002), male (55.2% v 46.8%, p < 0.0001) and white (79.7% v 76.0%, p < 0.0001). They are also associated with lower prevalence of diabetes (16.5% v 20.1%, p < 0.0001) and smoking (0.6% v 0.8%, p <0.0001) but higher prevalence of peripheral arterial diseases (13.7% v 11.6%, p <0.0001). During the study period, a total of 9,339,737 patients were admitted primarily due to CHF and 12,835 of patients (0.14%) have underlying CML. There was no statistical difference in deteriorating to cariogenic shock in CHF patients with and without CML (2.06% v 2.10%, p <0.805). After adjusting for age, sex, race, diabetes, Charlson comorbidity index, there was statistical significance in mortality (OR 1.18, CI 1.09 - 1.27, p < 0.0001) and longer length of stay by 0.28 day (p < 0.0001)DiscussionsThis study describes patient's demographic, in-patient mortality rate and length of stay in patients with CML and heart failure. A comorbid heart failure is associated with higher mortality rate and longer length of stay in hospital. Even though multiple societies have published several guidelines for baseline assessment of the cardiovascular risk factors, there is no standardized assessment tool for risk stratification and management of heart failure in CML patients. Moreover, presence of heart failure can be a limitation on treatments of CML and carry a poor prognosis. Our study emphasizes the importance of assessing cardiovascular diseases and optimizing the care before, during and after the treatment of CML. DisclosuresNo relevant conflicts of interest to declare.

Hospital Mortality and Length of Stay for Patients with Myelodysplastic Syndrome Presenting with Acute ST-Elevation Myocardial Infarction (STEMI)

IntroductionIschemic heart disease remains the single largest cause of death worldwide. In the USA, 365,744 deaths were associated to coronary heart disease, and the mortality is highest in population older than 65 years old. Myelodysplastic syndromes (MDS) also mainly affect this group age and studies suggest an incidence as high as 75 cases per 100,000 aged >65 years. In the following abstract we analyze the mortality rate in patients with MDS and STEMI.MethodsWe conducted a retrospective analysis of 3 years of National inpatient sample (HCUP-NIS) data base from 2016 to 2018. Patients older than 60 years old and with or without MDS were selected using ICD-10 diagnosis code. Principal diagnosis of STEMI was included with the code. ICD-10 procedure code was used for left heart catheterization. Discharge-level weight analysis was used to produce a national estimate. Continuous variables were compared by t-test, while chi-square and Fisher's exact test were used for categorical variables. Finally, multivariate logistic regression was used to calculate odds ratio for inpatient mortality and multivariate linear regression for length of stay using STATA 17 statistical software.ResultsA total of 45,724,104 admissions met inclusion criteria, of those, 210,780 patients (0.46 %) have MDS. Patients with MDS are more likely to be of older age (78.7 v 74.8, p <0.00001), male (56.4% v 46.7%, p < 0.0001) and white (81.0% v 76.0%, p < 0.0001). They are also associated with lower prevalence of diabetes (16.2% v 20.1%, p < 0.003) and smoking (0.4% v 0.8%, p <0.0001) but higher prevalence of peripheral arterial diseases (12.7% v 11.6%, p <0.0001). During the study period, a total of 1,293,994 patients were admitted primarily due to STEMI, 3,270 of these patients (2.5%) had underlying MDS. Out of the 3,270, only 1,105 (33.8 %) underwent left heart catheterization. On the other hand, 735,610 patients without MDS (57.0%) underwent percutaneous coronary intervention. After adjusting for age, sex, race, diabetes, and Charlson comorbidity index, there was a statistical significant in mortality (OR 1.46, CI 1.08 - 1.98, p < 0.013) and longer length of stay by 0.59 day (p < 0.0001).DiscussionIn our study, MDS is associated with higher mortality and loner length of stay. Peripheral arterial diseases are found to be more prevalent in MDS even though other cardiovascular risk factors such as diabetes mellitus and smoking are less prevalent. It is consistent with prior study, by Jaiswal S et al, hypothesizing that MDS is an independence risk of atherosclerotic cardiovascular diseases. Interestingly, patients with MDS are less likely to undergo left heart catheterization which is the definitive intervention for diagnosis and treatment of ischemic heart diseases. We recommend our hematology society to identify and treat the cardiovascular risk factors in these patients. Further studies will be required to develop a standardized evaluation and management plans for MDS population. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Improving medical adherence and antithrombotic management for patients with chronic limb threatening ischaemia in Singapore

Dear Editor, Chronic limb threatening ischaemia (CLTI) represents the most advanced stage of peripheral artery disease (PAD), which, if left untreated, can progress to ulceration, gangrene, sepsis, major lower extremity amputation (LEA) and premature death. The prevalence of PAD ranges from 3% to 10% in the general population, increasing to 15–20% in people aged ≥70

RETRACTED: Predictive Factors of Surgical Complications in the First Year Following Kidney Transplantation

In the recent years, an increased use of marginal donors and grafts and a growing prevalence of peripheral arterial disease in the recipients have been observed. Meanwhile, the open surgical technique for kidney transplantation has not changed. The aim of this study is to analyze all surgical complications occurring in the first year after kidney transplant and to determine potential predictive risk factors. Data of the 399 patients who underwent kidney transplant in our University Hospital between January 2006 and December 2015 were retrospectively reviewed. The primary endpoint was the overall rate of vascular, parietal and urological complications at 1 year following kidney transplantation. The secondary outcomes were graft and patient' survival rates, and the identification of predictive factors of the surgical complications. 24% of patients developed 134 complications. Vascular complication represented 39% of all complications and resulted in 9 graft losses. Parietal and urological complications represented 46-15% of all complications, respectively, No parietal or urological complications were associated with graft loss. 5 patients died during the 1st year, none of these cases was associated with graft loss. The graft survival rate reached 96% at 1 year, including patients still alive. The occurrence of surgical complication was associated with reduced graft survival at 1 year. Using a multivariate analysis, 4 predictive factors were identified: age, deceased donor, operative time and dyslipidemia. Surgical complications after kidney transplantation remained frequent and age, deceased kidney donors, and operative time were identified as risk factors. As vascular complications were a major cause of early graft loss, efforts should aim to reduce their occurrence to increase graft survival.

Dose-Response Relationship Between Physical Activity and the Incidence of Peripheral Artery Disease in General Population: Insights From the National Health and Nutrition Examination Survey 1999-2004.

Purpose: A low ABI, ≦0.9, indicates peripheral artery disease (PAD) and physical activity (PA) represents an important non-surgical treatment for patients with PAD. However, as for the general population, the associations between PA, PAD, and their mutual dependence are not well-defined. Here we aimed to determine whether there is a dose–response relationship between PA and incidence of PAD in the general population using restricted cubic spline (RCS).Patients and methods: This study analyzed 1,370 adults aged ≧40 years who had participated in the National Health and Nutrition Examination Survey (NHANES) during 1999–2004. The ABI of the participants were measured by trained technicians, and PAD was defined as ABI ≦0.9. PA was obtained with a standard questionnaire, and metabolic equivalents (MET) were used to quantify the PA level. Logistic regression was used to assess the association between PA and incidence of PAD, and the dose–response relationship was analyzed with RCS.Results: PAD was present in 6.2% of the participants: 5.6% of males and 6.9% of females. After adjusting for potential confounders, compared with the first quartile (Q1) of MET, the odds ratios (ORs) of PAD for those with Q2, Q3, and Q4 of MET were 0.688 [95% confidence interval (CI) = 0.684–0.692], 0.463 (95% CI = 0.460–0.466), 0.816 (95% CI = 0.812–0.821), respectively (all p < 0.0001). The RCS regression showed that physical activity was related to the incidence of PAD in a non-linear manner (p for non-linearity < 0.0001). For females, the prevalence of PAD decreased as physical activity increased, reaching the minimum for activity at ~5,800 MET-min month−1 (OR = 0.425, 95% CI = 0.424–0.426), and for males, no plateau was found in this study.Conclusion: The prevalence of PAD is inversely associated with PA, and vigorous activities might help decrease PAD risk for general population. The prevalence of PAD reaches the minimum at ~5,800 MET-min month−1, representing a recommended PA value.

The monocyte/high-density lipoprotein ratio predicts coronary artery disease in heart failure

Abstract Background The monocyte/high density lipoprotein ratio (MHR) is a combined inflammatory marker implicated in atherosclerosis. MHR predicts cerebrovascular disease (CVD) and chronic kidney disease (CKD); it correlates with coronary artery disease (CAD) severity and has been shown to be a prognostic predictor in patients with myocardial infarction. The role of MHR in chronic heart failure (HF) is largely unknown. Purpose Assess the ability of MHR to predict CAD in patients with HF Methods We conducted a retrospective cohort study in ambulatory patients with HF with left ventricular systolic dysfunction (LVSD) that were followed in our HF clinic from January/2012 to May/2018. We selected all the patients that had performed a diagnostic/therapeutic coronary angiography. Patients with missing data concerning monocyte counts or high-density lipoprotein levels were excluded. The endpoint under analysis was the presence of CAD on coronary angiography. A ROC curve was used to study the ability of MHR to predict CAD. The association of MHR with CAD was assessed by a logistic-regression analysis. A multivariate model was built accounting for age, sex, comorbidities [hypertension, diabetes, peripheral artery disease (PAD), CVD, CKD and inflammatory/auto-immune disease], low-density lipoprotein value, haemoglobin, brain-type natriuretic peptide (BNP), severe LVSD and segmental contractility defects in the echocardiogram. MHR was analysed both as continuous and categorical variable; the cut-off of 16 was chosen based on the ROC curve. Results We studied 295 chronic HF patients with LSVD who underwent coronary angiography. Mean age was 67±12 years, 70.8% men and 55.9% with CAD. Patients with CAD were older (69 against 64 years), had significantly higher MHR (19±9 vs. 16±7), higher prevalence of hypertension, diabetes, PAD and CVD, and worse renal function. The area under the curve for the association between MHR and CAD was 0.68 (0.62–0.74), p&amp;lt;0.001. The best MHR cut-off for CAD prediction was 16 - sensitivity: 66.7%, specificity: 65.4%, positive predictive value: 71.0% and negative predictive value: 60.8%. This association was independent of potential confounders. Patients with MHR≥16 had a multivariate-adjusted OR of having CAD of 5.41 (95% CI: 2.40–12.20), p&amp;lt;0.001 when compared to those with lower MHR. When MHR was analysed as a continuous variable the association remained significant. Conclusions The MHR is an independent predictor of CAD in chronic HF. Patients with MHR ≥16 have a 71% probability of presenting CAD and a more than 5-fold higher risk compared with those with lower MHR. It is sometimes difficult to ascertain ischemic disease/aetiology in HF patients, particularly in the elderly, frail and/or with advanced CKD. This simple, inexpensive and harmless marker can help clinicians identify patients most likely to have CAD and decide treatment in accordance. Funding Acknowledgement Type of funding sources: None.

PREVALENCE OF PERIPHERAL ARTERIAL DISEASE AMONG HEMODIALYSIS PATIENTS

Background: Peripheral arterial disease (PAD) is common in patients with end-stage renal disease on hemodialysis, but is frequently underdiagnosed. The risk factors for PAD are well known within the general population, but they differ somewhat in hemodialysis patients. This study aimed to determine the prevalence of PAD and its risk factors in patients on hemodialysis. Objective: To assess the prevalence of peripheral arterial disease in end stage renal disease patients on hemodialysis. Patients and Methods: This was across-sectional study carried out at Hemodialysis Unit of Al-Hussein University Hospital over a period of six month; from September 2019 to April 2020, and conducted on 80 hemodialysis patients. Demographic data and clinical information were recorded. Laboratory data including CBC, calcium, phosphate, total cholesterol, triglyceride, high-density lipoprotein, and iron profile were evaluated. The ankle-brachial index was measured in all patients. PAD was diagnosed if ankle-brachial index 0.9. Results: As regard description of demographic data, the mean age of all studied patients was 45.3 ± 8.8 years with minimum age of 24 years and maximum age of 62 years. There were 43 males (53.8%) and 37 females (46.3%). Thirty-five patients (43.7%) were diabetic, and 48 patients (60%) were hypertensive. According to laboratory profile, the mean of WBCs, Hb, platelets, serum calcium, PO4, and iPTH were 6.5 x10³/ul, 10.4 g/dl, 228.2 x10³/ul, 8.3 mg/dl, 9.4 mg/dl and 477.2 ug/ml respectively. Regarding lipid profile, the mean of total cholesterol, HDL and triglyceride were 214.7 mg/dL, 41.9 mg/dL,and 172.2 mg/dL, respectively. Regarding to iron profile, the mean of iron serum, ferritin and TIBC were 62.7 mg/dl, 603.3 ng/ml and 236.7 mg/dl, respectively. According to ABI, there were 22 patients (27.5%) ≤ 0.9, while there were 58 patients (72.5%) > 0.9. The prevalence of peripheral arterial disease among HD patients was 27.5%. Conclusions: High prevalence of peripheral arterial disease in CKD patients on hemodialysis and Ankle –brachial index was clearly more sensitive than physical examination in detecting of peripheral arterial disease in CKD patients on hemodialysis.

Evaluation of peripheral arterial disease in type 2 diabetic patients using computed tomography angiography

Background: Peripheral artery disease (PAD) in patients with Type 2 diabetes mellitus (T2DM) has broad characteristics and various complications. Aim: The purpose of this study is to evaluate PAD in T2DM and their association with age, gender, and the duration of T2DM. Materials and Methods: This study is a prospective cross-sectional one conducted at the radiology department in Royal Care International Hospital, Khartoum, Sudan, over 3 years. A total of one hundred and ten patients, 69 males and 41 females, were examined using MDCT. A binary logistic regression test was applied to identify independent predictors of PAD. Results: PAD in T2DM is found to be 50.91% atherosclerosis, 43.64% plaques, 29.09% stenosis, and 14.55% thrombosis (mean age 65.84 ± 9.57 years; mean duration of T2DM 29.37 ± 6.7 years). The prevalence of PAD was common in patients over 60-year-old. Atherosclerosis is significantly higher in males than females (59.4% vs. 36.6%, 95% confidence interval = 1.092–5.600, P = 0.03%). Plaques and stenosis of lower-extremity arteries were higher in males than females 44.9% vs. 41.5% and 29.0% vs. 29.3%) respectively. The incidence of thrombosis was higher in femoral arteries than lower distal arteries, and the prevalence was higher in females than males (22% vs. 10.1%, odds ratio = 2.228), respectively. Conclusion: Atherosclerosis, plaques, stenosis, and thrombosis were the most common PAD findings in patients affected with T2DM. Age, gender, and duration of diabetes, relatively risk factors associated with PAD. Thrombosis is more prevalent in the femoral artery than lower distal arteries.

Prevalence of Peripheral Arterial Disease and Associated Vascular Risk Factors in 65-Years-Old People of Northern Barcelona.

Objective: To determine the prevalence and risk factors associated with peripheral arterial disease (PAD) in Northern Barcelona at 65 years of age. Methods: A single-center, cross-sectional study, including males and females 65 years of age, health care cardholders of Barcelona Nord. PAD was defined as an ankle–brachial index (ABI) < 0.9. Attending subjects were evaluated for a history of common cardiovascular risk factors. A REGICOR score was obtained, as well as a physical examination and anthropometric measurements. Results: From November 2017 to December 2018, 1174 subjects were included: 479 (40.8%) female and 695 (59.2%) male. Overall prevalence of PAD was 6.2% (95% CI: 4.8–7.6%), being 7.9% (95% CI: 5.9–9.9%) in males and 3.8% (95% CI: 2.1–5.5%) in females. An independent strong association was seen in male smokers and diabetes, with ORs pf 7.2 (95% CI: 2.8–18.6) and 1.8 (95% CI: 1.0–3.3), respectively, and in female smokers and hypertension, with ORs of 5.2 (95% CI: 1.6–17.3) and 3.3 (95% CI: 1.2–9.0). Male subjects presented with higher REGICOR scores (p < 0.001). Conclusion: Higher-risk groups are seen in male subjects with a history of smoking and diabetes and female smokers and arterial hypertension, becoming important subgroups for our primary healthcare centers and should be considered for ABI screening programs.

A Missense Variant in the IL-6 Receptor and Protection From Peripheral Artery Disease

A Missense Variant in the IL-6 Receptor and Protection From Peripheral Artery Disease

The Interaction Between Self-Reported Sleep Duration and Physical Activity on Peripheral Artery Disease in Chinese Adults: A Cross-Sectional Analysis in the Tianning Cohort Study

PurposeSleep duration was associated with large artery atherosclerosis, but its association with atherosclerosis in lower extremity arteries was not well studied. Together with sleep, physical activity constitutes main component of our daily life and influences sleep. Here, we aimed to examine the independent and joint associations of sleep duration and physical activity with peripheral artery disease (PAD) in Chinese adults.Patients and MethodsIn Tianning cohort, night-time sleep duration and physical activity were assessed by the Pittsburgh Sleep Quality Index and the Global Physical Activity Questionnaire, respectively, for 5130 participants (51.0±15.6 years, 58.7% female). PAD was defined as ankle-brachial index (ABI) <0.9. General linear, and logistic regression models were used to assess the associations of sleep duration and physical activity with PAD. The biological interaction between sleep duration and physical activity on PAD was examined using additive model.ResultsCompared to participants sleeping 6–8.9 h, those sleeping ≥9 h had a 0.02 lower ABI (β=−0.02, P=0.007) and 38% higher odds of PAD (OR=1.38, P=0.035). Compared to physically active participants sleeping 6–8.9 h, among ≥9 h group, physically inactive individuals had significantly increased odds of PAD (OR=2.40, P<0.001), whereas physically active individuals did not (OR=1.15, P=0.472). On additive scale, attributable proportion due to interaction (0.40, 95% CI: 0.07, 0.73) indicated a significant interaction between sleep duration and physical activity on PAD.ConclusionBeing physically active may attenuate the detrimental association between prolonged sleep duration and PAD. Moreover, we found a significant interaction between prolonged sleep duration and physical inactivity in the prevalence of PAD.

The Association Between Socioeconomic Factors and Peripheral Artery Disease Prevalence in the Chronic Renal Insufficiency Cohort

The association of socioeconomic factors with peripheral artery disease (PAD) has not been as well characterized as with other cardiovascular conditions. We sought to define how annual income, education level, black race, and gender are associated with PAD prevalence in a well-defined diverse set of adults with chronic kidney disease (CKD).

Risk stratification and mortality prediction in octo- and nonagenarians with peripheral artery disease: a retrospective analysis

ObjectivesAmong changes in demographics, aging is the most relevant cardiovascular risk factor. The prevalence of peripheral artery disease (PAD) is high in elderly patients and is associated with a worse prognosis. Despite optimal treatments, mortality in the high-risk population of octo- and nonagenarians with PAD remains excessive, and predictive factors need to be identified. The objective of this study was to investigate predictors of mortality in octo- and nonagenarians with PAD.MethodsCases of treated octo- and nonagenarians, including the clinical characteristics and markers of myocardial injury and heart failure, were studied retrospectively with respect to all-cause mortality. Hazard ratios [HR] were calculated and survival was analyzed by Kaplan-Meyer curves and receiver operating characteristic curved were assessed for troponin-ultra and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and chronic limb-threatening ischemia (CLTI).ResultsA total of 123 octo- and nonagenarians admitted for PAD were eligible. The troponin level was the major predictor of all-cause mortality (HR: 4.6, 95% confidence interval [CI]: 1.4–15.3), followed by the NT-proBNP level (HR: 3.9, 95% CI 1.8–8.8) and CLTI (HR: 3.1, 95% CI 1.6–5.9). Multivariate regression revealed that each increment of 1 standard deviation in log troponin and log NT-proBNP was associated with a 2.7-fold (95% CI 1.8–4.1) and a 1.9-fold (95% CI 1.2–2.9) increased risk of all-cause death. Receiver operating characteristic curve analysis using a combination of all predictors yielded an improved area under the curve of 0.888. In a control group of an equal number of younger individuals, only NT-proBNP (HR: 4.2, 95% CI 1.2–14.1) and CLTI (HR: 6.1, 95% CI 1.6–23.4) were predictive of mortality.ConclusionOur study demonstrates that cardiovascular biomarkers and CLTI are the primary predictors of increased mortality in elderly PAD patients. Further risk stratification through biomarkers in this high-risk population of octo- and nonagenarians with PAD is necessary.