Risk Of PAD Research Articles

Abstract 126: Genome Wide Association Study in the Million Veteran Program Identifies a Novel Role for Thrombosis in the Pathogenesis of Peripheral Artery Disease

Introduction: PAD is a leading cause of cardiovascular morbidity and mortality. Previously published GWAS have been limited by small sample sizes and have only identified 3 genome-wide significant (P<5x10 -8 ) risk loci to date. Hypothesis: DNA sequence variants affecting multiple biological pathways are associated with PAD risk. Methods: Using electronic health record data, we identified individuals with and without clinical PAD from the 353,323 Million Veteran Program (MVP) participants genotyped on a customized Affymetrix Biobank array. We tested 32 million genotyped and imputed DNA variants for association with clinical PAD separately in participants of European (EUR), African (AFR), and Hispanic (HIS) ancestry using logistic regression models controlling for age, sex and population structure, and then performed trans-ethnic meta-analysis. The results were replicated with data from the UK Biobank. Results: We identified 31,307 individuals (24,009 EUR, 5,373 AFR, 1,925 HIS) with, and 211,753 individuals without, PAD. Following meta-analysis and replication, there were 19 genome-wide significant risk loci associated with PAD. We replicated a known association at 9p21 (P=4.3 x10 -39 ), and identified several novel loci associated with PAD that were previously known to be associated with atherosclerosis ( LPA , HDAC9 ), diabetes ( TCF7L2 ), lipid levels ( LPL , CELSR2 ), and tobacco use ( CHRNA3 ). We also identified a novel association with PAD for the Factor V Leiden (FVL) mutation (OR 1.20, P=1.6x10 -12 ), which remained significant after controlling for venous thromboembolism (OR 1.10, P=8.7x10 -4 ). Sensitivity analysis demonstrated FVL is associated with increasing risk estimates for PAD severity (claudication OR 1.19, P=0.0012; rest pain OR 1.41, P=0.004; tissue loss OR 1.57, P=7x10 -9 ). Conclusions: Using the MVP, we assembled the largest reported cohort of individuals with clinical PAD and genetic data worldwide. Our data replicate known causal risk factors and identify a novel association for FVL and its putative role for thrombosis in the development of clinical PAD.

Abstract 204: Diabetes Influence Infragenicular Arterial Segment Phospholipid Profiles

Diabetes patient have higher risk of PAD. Our group previously demonstrated that CEA plaque lipidomics are altered by diabetes. It remains unknown whether similar alterations also occur in infra-inguinal PAD. Between 2015 to 2017, patients undergoing major lower extremity amputation were recruited into a vascular surgery tissue biobank. At the time of amputation, infra-inguinal arterial segment with maximally (Max) and minimally (Min) disease were harvested. lipids were extracted using a modified Bligh-Dyer technique and evaluated by Electrospray-ionization tandem mass spectrometry. The relative proportions of all major phospholipid species (including phosphatidylcholine, PC; ceramide, Cer; phosphatidylethanolamine, PE; phosphatidylinositol, PI; and phsophatidylserine, PS) were derived. Paired one-sample sighed rank test was used to evaluate the differences between Max and Min diseased arterial segments, and Wilcoxon two-sample test was used between diabetic and non-diabetic group. 14 diabetic (DM) and 7 non-diabetic(NDM) patients were enrolled with well-matched demographics. Analysis of the major phospholipid families, there were no differences between DM and NDM in Max segments. However in Min segments there were differences (58% lower PI in DM patients, P<0.03). Further sub-group analysis was performed at max and min in DM and NDM separately and found differences in PCs, aPCs, PEs, pPEs, Cers. The most highly differentially expressed lipids included PC 40:3(76%, P=0.01), PC 40:5(60%,P=0.04 ), aPC38:3 (83%, P=0.01), aPC38:2(79%, P=0.04) ,and these have been shown previously to be important in arachidonic acid mediated inflammation. Max and Min diseased segments from infra-ingunial arterial segments from diabetic and non-diabetic patients demonstrate significantly different lipid contents. These findings highlight the profound biochemical differences in plaque phospholipid biology in the diabetes and provide a platform for future exploration in diseased oriented treatment strategies.

Microvascular and Macrovascular Disease and Risk for Major Peripheral Arterial Disease in Patients With Type 2 Diabetes.

Peripheral arterial disease (PAD) is a common manifestation of atherosclerosis in type 2 diabetes, but the relationship between other vascular diseases and PAD has been poorly investigated. We examined the impact of previous microvascular and macrovascular disease on the risk of major PAD in patients with type 2 diabetes. We analyzed 10,624 patients with type 2 diabetes free from baseline major PAD in the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) clinical trial. The primary composite outcome was major PAD defined as PAD-induced death, peripheral revascularization, lower-limb amputation, or chronic ulceration. The secondary end points were the PAD components considered separately. Major PAD occurred in 620 (5.8%) participants during 5 years of follow-up. Baseline microvascular and macrovascular disease were both associated with subsequent risk of major PAD after adjustment for age, sex, region of origin, and randomized treatments. However, only microvascular disease remained significantly associated with PAD after further adjustment for established risk factors. The highest risk was observed in participants with a history of macroalbuminuria (hazard ratio 1.91 [95% CI 1.38-2.64], P < 0.0001) and retinal photocoagulation therapy (1.60 [1.11-2.32], P = 0.01). Baseline microvascular disease was also associated with a higher risk of chronic lower-limb ulceration (2.07 [1.56-2.75], P < 0.0001) and amputation (1.59 [1.15-2.22], P = 0.006), whereas baseline macrovascular disease was associated with a higher rate of angioplasty procedures (1.75 [1.13-2.73], P = 0.01). Microvascular disease, particularly macroalbuminuria and retinal photocoagulation therapy, strongly predicts major PAD in patients with type 2 diabetes, but macrovascular disease does not.

The relationship between vitamin K and peripheral arterial disease

Background and aimsA high dietary intake of vitamin K1 (phylloquinone) and vitamin K2 (menaquinones) is thought to decrease cardiovascular disease risk by reducing vascular calcification. The objective of this study is to explore if there is a relationship between phylloquinone and menaquinones intake and risk of PAD. MethodsWe investigated the association between intake of phylloquinone and menaquinones with PAD in a prospective cohort with 36,629 participants. Occurrence of PAD was obtained by linkage to national registries. Baseline intake of phylloquinone and menaquinones was estimated using a validated food-frequency questionnaire. Multivariate Cox regression was used to estimate adjusted hazard ratio's for the association. ResultsDuring 12.1 years (standard deviation 2.1 years) of follow-up, 489 incident cases of PAD were documented. Menaquinones intake was associated with a reduced risk of PAD with a hazard ratio (HR) of 0.71, 95% CI; 0.53–0.95 for the highest versus lowest quartile. A stronger association was observed (p interaction 0.0001) in participants with hypertension (HRQ4 versus Q1 0.59; 95% CI 0.39–0.87) or diabetes (HRQ4 versus Q1 0.56; 95% CI 0.18–1.91), though confidence intervals were wide in the small (n = 530) diabetes stratum. Phylloquinone intake was not associated with PAD risk. ConclusionsHigh intake of menaquinones was associated with a reduced risk of PAD, at least in hypertensive participants. High intake of phylloquinone was not associated with a reduced risk of PAD.

Long-term use of dual antiplatelet therapy for the secondary prevention of atherothrombotic events: Meta-analysis of randomized controlled trials.

The potential benefit of long-term dual antiplatelet therapy (DAPT) for secondary prevention of atherothrombotic events is unclear. Data from different randomized controlled trials (RCT) using different agents in different subgroups showed inconsistent results. We performed a systematic review and meta-analysis from RCTs that tested different prolonged durations of DAPT for secondary prevention. Long term DAPT arm was defined as those receiving DAPT for more than 12months. Long-term aspirin arm was defined as those receiving either aspirin alone long term or DAPT for less than 12months. The use of long term DAPT was associated with a significant decrease in composite of death, myocardial infarction (MI) and stroke (6.08% vs. 6.71%; odds ratio OR=0.86 [0.78-0.94]; P=0.001). This reduction of death, MI and stroke was mainly noticed in patients with prior MI or stroke, but not with PAD or multiple risk factors. The reduction was seen with post PCI patients with prasugrel and only in those with prior MI with clopidogrel and ticagrelor. Long-term use of DAPT was associated with significant increase in major bleeding (1.47% vs. 0.88%; OR=1.65 [1.23-2.21]; P=0.001). Long-term use of DAPT for secondary prevention is associated with lower risk of death, MI and stroke beneficial especially in patients with prior MI and stroke, but it is associated with increased risk of bleeding. Prolonging DAPT requires careful assessment of the trade-off between ischemic and bleeding complications and should probably be reserved for patients with higher risk for atherothrombotic events.

Is the peripheral arterial disease in low risk type 2 diabetic patients influenced by body mass index, lipidemic control, and statins?

Objective:To correlate BMI, lipidemic control, and statin therapy with PAD measured by ABI in low risk type 2 diabetics.Materials and Methods:A sample of 101 nonsmoking, asymptomatic type 2 diabetics (50 males, 51 females) with known glycemic (fasting blood sugar, postprandial blood sugar, glycosylated hemoglobin) and lipidemic (total cholesterol, lipoproteins, and triglycerides [TGAs]) control was taken. Vascular Doppler was used to derive ABI and PAD was defined as ABI <0.9. ABI values were compared amongst groups and P < 0.05 was considered statistically significant.Results:We found fairly good lipid but poor glycemic control and prevalence of PAD 30%. There was insignificantly low ABI profile in patient having BMI ≥25, hyperlipidemia and absent statin therapy with odds ratio being highest for TGAs ≥150 (3.23) followed by BMI ≥25 (2.61), high-density lipoprotein ≤50 (1.61), low-density lipoprotein ≥100 (1.20), and disuse of statin (1.14) with significance only for BMI.Conclusion:We observed small, insignificant PAD risk by dyslipidemia or non-use of statins in low-risk ambulatory T2DM patients, not so by BMI. This suggests importance of good glycemic control, maintenance of optimum weight, and lifestyle modifications as primary prevention rather than opting for costly and inefficient secondary prevention.

Abstract 02: American Heart Association (AHA)’s Life’s Simple 7 and Risk of Lower Extremity Peripheral Artery Disease (PAD): The Multi-Ethnic Study of Atherosclerosis (MESA)

Background: Approximately 8.5 million Americans are affected by lower extremity PAD, which is associated with a substantially greater risk of cardiovascular (CV) events, mortality and functional decline. In 2010, the AHA initiated new CV health metrics (Life’s Simple 7) to monitor the goal of significantly improving CV health by the year 2020. The extent to which Life’s Simple 7 may be associated with risk of PAD or change in the ankle brachial index (ABI), the major clinical diagnostic criterion for PAD, has not been established. Methods: MESA is a population-based prospective cohort of 6814 Caucasian, African-American, Hispanic and Chinese men and women from six US field centers. The baseline exam occurred in 2000-02. Life’s Simple 7 at baseline included AHA definitions of poor, intermediate and ideal health behaviors (diet, body mass index, smoking, physical activity) and health factors (blood pressure, glucose, cholesterol), and was modeled continuously on a 0-14 point scale, with a higher score indicating better CV health. The scale was also categorized into overall inadequate (0-7points), average (8-11) and optimum (12-14) CV health. Incident PAD was defined as an ABI≤0.90 at Exam 3 (2004-05) or Exam 5 (2010-12), removing participants both with ABI&gt;1.40 and prevalent PAD at baseline. Cox models were used for incident PAD analyses and change in the ABI over time was assessed using mixed models. All models were adjusted for age, sex and race/ethnicity. Results: The mean±SD Life’s Simple 7 score was 8.4±2.1, with 33.8% of participants classified as inadequate, 59.6% average, and 6.6% classified as having optimum CV health. Adjusted rates of PAD per 1000 person-years were 7.3 for inadequate, 3.2 for average and 1.1 for optimum CV health. Each point higher on the Life’s Simple 7 scale was associated with a 20% lower risk of incident PAD (95% CI (0.76-0.85); p&lt;0.001). Compared to inadequate CV health, participants with average and optimum health had a 55% lower risk (95% CI (0.37-0.56), p&lt;0.001) and an 85% lower risk (95% CI (0.06-0.38); p&lt;0.001) of incident PAD, respectively. Each point higher on the scale was associated with a higher average ABI over a median follow-up time of 9.4 years (0.006 (95% CI (0.005, 0.007), p&lt;0.001). Compared to those with inadequate health, participants with average and optimum health maintained a 0.021 (95% CI (0.016, 0.027, p&lt;0.001) and a 0.030 (95% CI (0.018, 0.041, p&lt;0.001) greater average ABI over the follow-up period, respectively. Conclusions: Maintaining average or optimum CV health results in a substantially reduced risk of incident PAD and also in maintaining a higher average ABI over time, even when accounting for age, sex and race/ethnicity. Encouraging improvement in health behaviors, and treatment to achieve and maintain better levels of CV health metrics, may contribute to decreasing the rate of PAD.

Survey of ankle–brachial pressure index use and its perceived barriers by general practitioners in the UK

BackgroundPeripheral arterial disease (PAD) is often undetected until complications arise, despite it being a major healthcare burden and an independent risk factor for cardiovascular death and systemic atherosclerosis. Appropriate diagnostic...

One in Three Black Americans Will Experience PAD

ORLANDO — One in three black Americans and one in five whites and Hispanics will develop lower extremity peripheral arterial disease during their lifetime, according to the first-ever lifetime risk estimate calculated for this important manifestation of atherosclerotic vascular disease. “Our results suggest that race is a critical factor in PAD risk. Current clinical guidelines recommend measuring ankle-brachial index according to age, traditional cardiovascular risk factors, and leg symptoms. Our results suggest race should also be taken into account,” Kunihiro Matsushita, MD, PhD, said at the American Heart Association scientific sessions. This lifetime risk estimate for PAD was derived from national prevalence and mortality data from the National Health and Nutrition Examination Survey (NHANES) and the National Vital Statistics System. The analytic methods employed have previously been used to estimate lifetime risk of kidney disease and other major health issues with significant impact upon quality of life and longevity, noted Dr. Matsushita of Johns Hopkins University, Baltimore. Over an 80-year time horizon, the projected risk of experiencing PAD was similar for men and women of the same race, but 1.5-fold higher for blacks, compared with whites or Hispanics (see chart). An estimated 10% of black Americans will develop PAD by age 60. Among whites and Hispanics, a 10% prevalence is not reached until age 70. For individuals who don’t have PAD by age 65, their risk during the next 15 years is in the range of 28%–30% for black men and women, and 16%–18% in white or Hispanic men and women, according to Dr. Matsushita. He declared having no financial conflicts related to this study. His work is supported by an AHA award. Bruce Jancin is with the Denver bureau of Frontline Medical News.

Peripheral arterial disease and atrial fibrillation and risk of stroke, heart failure hospitalization and cardiovascular death: A nationwide cohort study

BackgroundPeripheral arterial disease (PAD) and atrial fibrillation (AF) share several comorbidities and contribute to similar cardiovascular (CV) outcomes. Only few studies have evaluated the correlation between PAD, AF, and their interaction effects on CV outcomes. MethodsWe included 597,164 adults from Taiwan's National Health Insurance Research Database to conduct a cohort study to assess whether PAD was an independent risk factor of AF and vice versa. We also examined if PAD and AF increased the incident stroke, heart failure hospitalization and CV death. ResultsPeople with PAD had a significant higher risk of incident AF than those without PAD [adjusted hazard ratio (HR): 1.29, 95% confidence interval (CI): 1.17–1.42]. Meanwhile, people with AF did not have an increased risk of incident PAD compared to those without AF (adjusted HR: 1.00, 95% CI: 0.89–1.11). Both AF and PAD increased the risk of stroke [adjusted HR being 1.29 (95% CI: 1.17–1.43) and 1.41 (95% CI: 1.35–1.47), respectively], heart failure hospitalization [adjusted HR being 1.96 (95% CI: 1.77–2.17) and 1.35 (95% CI: 1.28–1.42), respectively], and CV death [adjusted HR being 3.33 (95% CI: 2.58–4.30) and 2.08 (95% CI: 1.80–2.41), respectively]. However, we found no interaction effects of AF and PAD on these outcomes. ConclusionsPAD is an independent risk factor of incident AF but not vice versa. Both PAD and AF are independent risk factors for stroke, heart failure hospitalization, and CV death.

Prevalence of lower extremity peripheral artery disease among adult diabetes patients in southwestern Uganda.

BackgroundPeripheral artery disease (PAD) is a major complication of atherosclerosis. PAD can be diagnosed with low-cost diagnostic techniques and is associated with significant morbidity and mortality. While the major epidemiologic risk factors for PAD have been established in the western world, data from resource-poor countries are limited. We performed a cross-sectional study to determine the prevalence and correlates of PAD among patients with diabetes at Mbarara Referral Hospital in southwestern Uganda.MethodsWe consecutively enrolled diabetes patients aged 50 years or greater presenting to the outpatient clinic. We collected blood for fasting lipid profile, HIV serology, and glycosylated hemoglobin, measured blood pressure and ankle brachial index, and administered the Edinburgh Claudication Questionnaire (ECQ). We also surveyed patients for other PAD risk factors. We used logistic regression to determine correlates of PAD.ResultsWe enrolled 229 diabetes patients. The median age of 60 years (IQR 55–66), and 146 (63.7%) were female. Fifty five patients (24%) had PAD (ABI of ≤ 0.9). Of these, 48 /55 (87.27%) had mild PAD (ABI 0.71-0.9) while 7/55 (12.73%) had moderate to severe PAD (ABI < 0.7). Amongst those with PAD, 24/55 (43.64%) reported claudication by the ECQ. Correlates of PAD included female sex (AOR 2.25, 95% CI 1.06 - 4.77, p = 0.034), current high blood pressure (AOR 2.59, 95% CI 1.25-5.33, p = 0.01), and being on a sulfonylurea–glibenclamide (AOR 3.47, 95% CI 1.55 - 7.76, p = 0.002).ConclusionPAD was common in diabetic patients in southwestern Uganda. Given its low cost and ease of measurement, ABI deserves further assessment as a screening tool for both PAD and long term cardiovascular risk amongst diabetics in this region.

OP0101 First Report of IL-38 in Systemic Lupus Erythematosus (SLE)

BackgroundThe cytokine IL-38 (IL-1F10) is a member of the IL-1 superfamily, which binds to IL-36R. IL-38 polymoprhisms have been associated with spondylitis and rheumatoid arthritis, and while IL-38 function is...

Association of borderline ankle-brachial index with mortality and the incidence of peripheral artery disease in diabetic patients

ObjectivePeripheral artery disease (PAD) and diabetes mellitus are significant risk factors for all-cause death or cardiovascular death. PAD occurs more frequently in diabetic than in non-diabetic patients. However, the association of ankle-brachial index (ABI), especially borderline ABI, with clinical outcomes has not been fully elucidated in diabetic patients. This study aimed to investigate the association of ABI with mortality and the incidence of PAD in Japanese diabetic patients. MethodsThis observational study included 3981 diabetic patients (61.0 ± 11.8 years of age, 59.4% men), registered in the Kyushu Prevention Study for Atherosclerosis. Patients were divided into 3 groups according to the value of ABI at baseline: ABI ≤0.90 (abnormal ABI:354 patients), 0.91 ≤ ABI ≤ 0.99 (borderline ABI:333 patients), and 1.00 ≤ ABI ≤ 1.40 (normal ABI:3294 patients). ResultsCumulative incidence of all-cause death was significantly higher in patients with abnormal and borderline ABI than in those with normal ABI (34.4% vs. 13.5%, P < 0.0001 and 26.1% vs. 13.5%, P < 0.0001, respectively). In multivariate analysis, the risks for all-cause death in patients with abnormal ABI (HR:2.16; 95%CI:1.46–3.14; P = 0.0002) and borderline ABI (HR:1.78; 95%CI:1.14–2.70; P = 0.01) were significantly higher than in those with normal ABI. The incidence of PAD was remarkably higher in patients with borderline ABI than in those with normal ABI (32.2% vs.9.6%, P < 0.0001). After adjustment, the risk for PAD was significantly higher in patients with borderline ABI than in those with normal ABI (HR:3.10; 95%CI:1.90–4.95; P < 0.0001). ConclusionsBorderline ABI in diabetic patients was associated with significantly higher risks for mortality and PAD compared with normal ABI.

Ankle–Brachial Index Screening to Improve Health Outcomes: Where Is the Evidence?

This issue includes the updated USPSTF recommendation on ABI screening for PAD and CVD risk assessment, as well as the systematic review used to inform it. The USPSTF concluded that the current evi...

Ankle–brachial index in relation to the natriuretic peptide system polymorphisms and urinary sodium excretion in Chinese

ObjectiveRecent studies have demonstrated that the natriuretic pepetides induce endothelial regeneration and angiogenesis after vascular injury through the autocrine or paracrine action, and might have an inhibitory effect on atherosclerosis. We therefore systematically investigated single nucleotide polymorphisms (SNPs) in the natriuretic peptide system in relation to ankle–brachial index (ABI) in a Chinese population. MethodsThe study population was recruited from a mountainous area 500 km south of Shanghai from 2003 to 2009. Using the SNapShot method, we first genotyped 951 subjects enrolled in 2005 for 16 SNPs and then the remaining 1355 subjects as validation for 5 SNPs selected from the primary study. ABI and plasma proBNP were measured using the Omron VP-2000/1000 device and the Elecsys proBNP immunoassay, respectively. ResultsOverall, the genetic associations were not significant (P ≥ 0.07). However, in the primary study, there was significant (Pint ≤ 0.045) interaction between 3 SNPs (rs6668352, rs198388, and rs198389) at the NPPA–NPPB locus and urinary sodium excretion in relation to ABI, and the rs6668352 polymorphism had the strongest association (Pint = 0.018). In the primary combined with the validation study populations, the interaction between the rs6668352 polymorphism and urinary sodium excretion in relation to ABI remained statistically significant (Pint = 0.0036). After adjustment for covariates, the rs6668352 A allele carriers, compared with GG homozygotes, had a higher ABI (mean ± standard error, 1.103 ± 0.006 vs. 1.084 ± 0.004, P = 0.009) and lower risk of peripheral arterial disease (PAD, defined as an ABI < 0.90, odds ratio 0.37, 95% confidence interval: 0.14–0.98, P = 0.04) in the subjects of high sodium intake. ConclusionThe minor alleles of 3 SNPs at the NPPA–NPPB locus are associated with a lower risk of PAD, especially in the subjects of high sodium intake.

An Improved Random Forest Algorithm for Class-Imbalanced Data Classification and its Application in PAD Risk Factors Analysis

The classification problem is one of the important research subjects in the field of machine learning. However, most machine learning algorithms train a classifier based on the assumption that the number of training examples of classes is almost equal. When a classifier was trained on imbalanced data, the performance of the classifier declined clearly. For resolving the class-imbalanced problem, an improved random forest algorithm was proposed based on sampling with replacement. We extracted multiple example subsets randomly with replacement from majority class, and the example number of extracted example subsets is as the same with minority class example dataset. Then, multiple new training datasets were constructed by combining the each exacted majority example subset and minority class dataset respectively, and multiple random forest classifiers were training on these training dataset. For a prediction example, the class was determined by majority voting of multiple random forest classifiers. The experimental results on five groups UCI datasets and a real clinical dataset show that the proposed method could deal with the class-imbalanced data problem and the improved random forest algorithm outperformed original random forest and other methods in literatures.

Abstract P077: Plasma Homocysteine, Dietary B Vitamins, and Risk of Peripheral Artery Disease

Background: Clinical trials of vitamin B supplements to lower homocysteine levels have not consistently lowered risk of PAD, but these interventions were typically 1-2 years duration and limited to participants with pre-existing vascular disease. Whether long-term homocysteine levels influence the development of incident PAD remains uncertain. Objective: To examine the association between levels of plasma homocysteine and dietary B vitamins (folate, B6 and B12) and risk of PAD. Methods: We identified 276 cases of PAD in the Nurses’ Health Study (NHS) which followed 121,700 female nurses from 1980-2010, and 406 cases in the Health Professionals Follow-up Study (HPFS) which followed 51,529 male health professionals from 1986 to 2008. B vitamin intake was measured using a FFQ administered every four years. After excluding individuals with a history of CVD at baseline, plasma homocysteine was measured in baseline blood samples in two nested case-control studies with three controls matched to each case: NHS (1989-2010; 144 cases and 432 controls) and HPFS (1994-2008; 143 cases and 429 controls). PAD cases were confirmed by medical record based on at least one of: (1) amputation, bypass, or revascularization procedure, (2) angiogram/ultrasound confirming at least 50% stenosis, (3) ankle-brachial index &lt; 0.9, or (4) documented physician’s diagnosis. We used Cox proportional hazards models to estimate hazard ratios (HR) for PAD in the cohorts and conditional logistic regression to estimate relative risks (RR) for PAD in the nested case-control studies. Results: Men in the highest tertile of plasma homocysteine had more than double the risk of PAD compared to men in the lowest tertile (Table). This association was not replicated in women. Lower folate intake was also associated with an increased risk of PAD in men but not women (Table). Total B6 and B12 intake was not consistently associated with risk of PAD in men or women. Conclusions: Higher plasma homocysteine levels were associated with an increased risk of PAD in men but not women.

Peripheral artery disease in peritoneal dialysis and hemodialysis patients: single-center retrospective study in Taiwan

BackgroundPeripheral artery disease (PAD) is a condition characterized by restricted blood flow to the extremities, and is especially common in the elderly. PAD increases the risk for mortality and morbidity in patients with end-stage renal disease (ESRD), especially those on hemodialysis (HD).MethodsThe records of 484 patients with end-stage renal disease who were on HD or peritoneal dialysis (PD) were reviewed. PAD was diagnosed based on the ankle-brachial pressure index (ABI). Demographic and clinical characteristics were analyzed.ResultsPAD had an overall prevalence of 18.2% and was significantly more common in HD patients (21.8%) than in PD patients (4.8%). Advanced age, diabetes mellitus, smoking, low parathyroid hormone level, elevated serum ferritin, elevated serum glucose, and low serum creatinine levels increased the risk for PAD. PAD was independently associated with advanced age, diabetes mellitus, duration of dialysis, low serum creatinine, and hyperlipidemia. PD patients had a significantly lower prevalence of PAD than HD patients, maybe due to their younger age and lower prevalence of diabetes mellitus in this present study.ConclusionsThe prevalence of PAD was greater in the HD group than the PD group. Most of the risk factors for PAD were specific to HD, and no analyzed factor was significantly associated with PAD in PD patients.

Association between estimated glomerular filtration rate and ankle brachial index

ObstructiveChronic kidney disease (CKD) is strongly associated with cardiovascular disease (CVD) events and mortality. The prevalence of reduced glomerular filtration rate (eGFR) and a low ABI increase with aging. Thus,...

The prevalence of peripheral arterial disease in korean patients with type 2 diabetes mellitus attending a university hospital.

BackgroundPeripheral arterial disease (PAD) is a common manifestation of systemic atherosclerosis and is associated with significant morbidity and mortality. Diabetes is known to increase the risk of PAD two- to four-fold. The prevalence of PAD in Korean diabetic patients has not been established. In this study, we investigated the prevalence of PAD in Korean patients with type 2 diabetes attending a large university hospital and analyzed the factors associated with PAD.MethodsA total of 2,002 patients with type 2 diabetes who underwent ankle-brachial index (ABI) measurement in an outpatient clinic were enrolled. PAD was defined as an ABI ≤0.9. Clinical characteristics of 64 patients with PAD were compared with those of 192 age- and sex-matched control patients without PAD.ResultsOf the 2,002 type 2 diabetic patients, 64 (3.2%) were diagnosed as having PAD. PAD was associated with higher prevalences of retinopathy, nephropathy, neuropathy, cerebrovascular and coronary artery disease. Patients with PAD had higher systolic blood pressure and serum triglyceride level and reported higher pack-years of smoking. Multivariate analysis showed that the presence of micro- and macrovascular complications and high systolic blood pressure are factors independently associated with PAD.ConclusionThe prevalence of PAD in diabetic patients was 3.2%, suggesting that the prevalence in Korean diabetic patients is lower than that of patients in Western countries.