Risk Of Peripheral Arterial Disease Research Articles

Prevalence characters of peripheral artery disease and associated factors among Beijing residents aged equal and above 35 years old

Objective: To investigate the prevalence characters of peripheral artery disease (PAD) and associated factors among people aged 35 and above in Beijing. Methods: This was a cross-sectional study. A total of 5 208 community-based individuals aged equal and above 35 in Beijing were chosen with stratified multistage random sampling method. Structure questionnaire was used to collected the information of demographic factors, habits and chronic disease history. Ankle brachial blood pressure was detected and ankle brachial index (ABI) was calculated. ABI was used to diagnose PAD (ABI≤0.90). Based on the 2010 Beijing Municipal Population Census, the age-and gender-specific weight-adjusted sample was acquired to estimate the prevalence of PAD and corresponding 95% confidence intervals (CI). Multivariate logistic regression analysis was performed to estimate the associated factors of PAD. Results: The age-and sex-standardized prevalence of PAD was 3.84% (200/5 208, 95%CI 3.32%-4.36%). There was no significant difference between male and female (3.83%(102/2 664, 95%CI 3.10%-4.56%) vs. 3.85% (98/2 544, 95%CI 3.10%-4.60%), P=0.965). The prevalence of PAD in urban was higher than that in rural (4.34% (163/3 755, 95%CI 3.69%-4.99%) vs. 2.55% (37/1 453, 95%CI 1.74%-3.36%), P=0.001). Furthermore, the prevalence of PAD increased with age (P(trend)<0.01), and the difference between genders did not change with ageing (all P>0.05). In addition, age (OR=1.03, 95%CI 1.01-1.04), urban (OR=1.52, 95%CI 1.08-2.12), smoking (OR=1.83, 95%CI 1.29-2.59), hypertension (OR=1.61, 95%CI 1.17-2.22) and diabetes (OR=1.44, 95%CI 1.08-1.93) were related with increased risk of PAD in logistic regression analysis models. Conclusions: The prevalence of PAD increases with age in Beijing and there are significant difference between urban and rural on prevalence of PAD. Age, urban, smoking, hypertension and diabetes are related with increased risk of PAD.

Post-prandial dylipidemia and elevated serum ferritin levels in type 2 diabetes mellitus patients: A risk marker for accelerated atherosclerotic cardiovascular events

Aims and Objectives of the Study: The type 2 diabetes mellitus (T2DM) prevalence is increasing worldwide at alarming rates. The prevalence of T2DM is expected to be more than 350 million people worldwide in next 20 yrs. The risk of coronary and peripheral artery disease increases by 2 to 4 fold, while the risk of stroke is increased by 10 fold in type 2 diabetes mellitus patients. In type 2 diabetes mellitus, dyslipidemia plays an important role in the pathogenesis of accelerated atherosclerosis. Hyperlipidemia in postprandial state is thought to play an important role in atherosclerosis, and concentrations of triglycerides(TG) in post prandial state are superior to those of fasting TG for predicting cardiovascular disease. Increase in serum ferritin levels are associated with insulin resistance(IR), systemic inflammation, metabolic syndrome(MetS), type 2 diabetes mellitus and cardiovascular disease. Elevated body iron stores may contribute to insulin resistance through chronic inflammation and oxidative stress. The present study is under taken to assess the implication of post prandial dyslipidemia in comparison to fasting dyslipidemia in the pathogenesis of cardiovascular disease and to show the importance of increased serum ferritin levels in type 2 diabetes patients which acts as a potential risk marker for coronary artery disease. Materials and Methods: Fifty type 2 diabetes mellitus patients and fifty normal adults between age group 30-75yrs attending Medicine OPD, Rajarajeswari Medical College and Hospital, Bangalore were scree ned for lipid profile using enzymatic method by ERBA 360 autoanalyzer and serum ferritin levels by chemiluminiscence method. The statistical analysis was done by students unpaired t-test. Results: Serum lipid profile including TGs, LDL-C, VLDL-C were significantly increased in the postprandial state as compared to the fasting state in cases with p elevated in cases, compared to controls with p state compared to fasting state in cases w

Increased risk of developing peripheral artery disease in hemodialysis patients receiving statin treatments: a population-based cohort study in Taiwan.

Few investigations have evaluated the influences on peripheral arterial disease (PAD) risk of statin treatment in hemodialysis (HD) subjects with hyperlipidemia (HL). From the National Health Insurance Research Dataset, we identified 3658 HD patients with statin therapy for HL as the statin cohort, and then selected, by 1:1 propensity score matching, 3658 HD patients with HL but without statin use as the nonstatin cohort in 2000-07. The cohorts were followed through until the end of 2011. We used Cox proportional hazards regression analysis to assess the hazard ratio (HR) of PAD development. The average follow-up period was 4.18 years; the incident PAD risk was 1.35-fold greater in statin users than in nonusers (16.87 versus 12.46/1000 person-years), with an adjusted HR (aHR) of 1.34 for PAD [95% confidence interval (CI) 1.12-1.62]. The PAD risk increases were significant for patients receiving fluvastatin (aHR 1.88; 95% CI 1.12-3.14) and atorvastatin (aHR 1.60; 95% CI 1.24-2.08). The risk increased with higher annual average statin dosage (P for trend <0.0001); the risk was higher for those receiving moderate-intensity statin treatment. The sensitivity test revealed similar findings. HD patients with HL on statin medication were at increased PAD risk, which increased with cumulative statin dosage. Thorough considerations are needed before prescribing statins to HD patients.

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.

Genetic Variants in Selenoprotein Genes Selenos, GPX4, and SEPP1, but not Selenoprotein Levels, are Associated with the Development of Peripheral Artery Disease and the Inter-individual Variation in the Ankle-Brachial Index

Introduction - Selenium (Se) is an essential micronutrient with important functions in human health and relevance to several pathophysiological conditions. The biological effects of Se are largely mediated by Se-containing proteins, referred to as selenoproteins. To date, a total of 25 selenoproteins have been identified in humans. The concentration of selenoproteins has been documented to correlate with a range of inflammatory markers and glucose homeostasis, which suggests their role in the pathogenesis of atherosclerotic peripheral arterial disease (PAD). In this study we analyze the relationships of single nucleotide polymorphisms (SNPs) in SEPP1, SELENOS, TXNRD1, TXNRD2, GPX4, and SOD2 genes as well as selenoprotein P (SeP) and thioredoxin (Trx) concentrations with the development of PAD and the values of ankle-brachial pressure index (ABI), a noninvasive marker of this disease. Methods - The two study samples were evaluated: 503 PAD patients and 594 controls in the discovery phase, and 408 PAD patients and 933 controls in the replication phase. All individuals were of Caucasian origin. SNPs were ascertained using pre-designed TaqMan SNP assays, and plasma selenoprotein levels with the ELISA immunoassay method. The main effects of each SNP and SNP-covariate interactions were assessed. Results - The SELENOS rs34713741T (recessive model: OR=1.49, 95%CI: 1.01-2.18, P=.043) and GPX4 rs713041T (dominant model: OR=1.31, 95%CI: 1.02-1.68; P=.035) alleles were associated with PAD, with a stronger effect in type 2 diabetes mellitus (T2DM; respective ORs: 2.77 95%CI: 1.00-7.68, P=.043 and 2.05, 95%CI: 1.19-3.53; P=.009). T2DM was related to 2.09-fold (95%CI: 1.56-2.78; P<.0001) increase in PAD risk. The association of the GPX4 SNP with PAD was confirmed in both a replication (P=.049) and a combined analysis (the discovery plus replication samples; P=.002), while the SELENOS SNP in a combined analysis only (P=.039). The influence of these SNPs on PAD risk suggested SNP-T2DM interaction (SELENOS x T2DM: ORObserved=5.47 > ORExpected=2.32; GPX4 x T2DM: ORObserved =2.87 > ORExpected= 1.53). The simultaneous presence of both risk genotypes with T2DM resulted in a 9.71-fold increase in PAD risk (95% CI: 2.21-42.45; P=.0002). Additionally, the SEPP1 rs7579A allele was associated with the presence of T2DM in PAD. All these associations, were independent of the influence of conventional cardiovascular risk factors distribution, except for the influence of GPX4 SNP on PAD, as this effect became nonsignificant after adjustment for T2DM. The SELENOS rs34713741T and SEPP1 rs7579A alleles, were the independent predictors of ABI in PAD in a multivariable analysis (allele dose: β= - 0.250, P=.003 and β= - 0.232, P=.006, respectively), explaining a total of 12.4% of the inter-individual variation in ABI. SeP concentration was decreased in T2DM (5.20 ±2.45 mg/ml, N=50 vs 3.99 ±2.51 mg/ml, N=26; P=.049), while being positively correlated with blood cholesterol levels, especially HDLC (r= 0.422, P=.0001). Conclusion - We found a link between the SeP levels and the occurrence of a more favorable profile of cardiometabolic risk factors in PAD. The SELENOS, SEPP1 SNPs contributed to the inter-individual variation in ABI, while the SELENOS, GPX4, SEPP1 SNPs were associated with PAD related to T2DM. These results confirmed the complex genetic architecture of PAD and ABI, in which candidate gene SNP main effects and SNP-covariate interactions contribute to the risk.

The Association of Blood Glucose and Diabetes with Abdominal Aortic Aneurysm, Carotid Stenosis and Peripheral Arterial Disease: An Observational Study of 630,000 Patients Attending Vascular Screening

Introduction - Diabetes is an important risk factor for atherosclerotic vascular disease, and previous studies have also shown a positive continuous association between blood glucose concentrations throughout the “normal” reference range and cardiovascular disease. However, diabetes appears to be inversely associated with abdominal aortic aneurysm (AAA). This study reports associations between blood glucose concentration and diabetes with AAA, carotid stenosis and peripheral arterial disease (PAD). Methods - Between 2008 and 2013, 3.3 million self-referred individuals attended cardiovascular screening clinics (Life Line Screening) in the US and UK. Assessments included an aortic ultrasound scan, a carotid duplex, and ankle-brachial pressure index (ABPI). Major cardiovascular risk factors and medical history were recorded, and approximately one fifth of participants also underwent blood glucose assays. Diabetes was defined according to previous diagnosis or treatment. Participants with incomplete data or prior cardiovascular disease were excluded, yielding 628 246 individuals in the current report. Results - The mean age at screening was 63 ± 10 years, and 64% of attendees were women. The following prevalences were observed: AAA (infra-renal aorta ≥ 30mm) = 0.5%; carotid artery stenosis (peak systolic velocity generally ≥110cm/s) = 3.5%; PAD (ABPI <0.9) = 2.6%. A prior diagnosis of diabetes was associated with higher risk of PAD (OR, 95%CI: 1.77, 1.71-1.84) and carotid stenosis (1.71, 1.66-1.76), and among participants without a prior diagnosis of diabetes the prevalence of carotid stenosis and PAD increased with higher blood glucose levels across the normal reference range. For AAA, a prior diagnosis of diabetes was associated with a significantly lower risk (0.83 0.77-0.90), however among attendees without diabetes, the prevalence of AAA increased with higher blood glucose levels across the normal reference range. Conclusion - Across the normal reference range, higher blood glucose concentrations are associated with increased risk of carotid stenosis, PAD and AAA, but a diagnosis of diabetes was associated with a lower risk of AAA. This raises the possibility that the “protection” conferred by diabetes against AAA could be due to a treatment effect, but this hypothesis needs to be tested in randomised trials.

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.

Valvular calcification and risk of peripheral artery disease: the Multi-Ethnic Study of Atherosclerosis (MESA).

The detection of cardiac valvular calcification on routine imaging may provide an opportunity to identify individuals at increased risk for peripheral artery disease (PAD). We investigated the associations of aortic valvular calcification (AVC) and mitral annular calcification (MAC) with risk of developing clinical PAD or a low ankle-brachial index (ABI). AVC and MAC were measured on cardiac computed tomography in 6778 Multi-Ethnic Study of Atherosclerosis participants without baseline PAD between 2000 and 2002. Clinical PAD was ascertained through 2015. Incident low ABI, defined as ABI <0.9 and decline of ≥0.15, was assessed among 5762 individuals who had an ABI >0.9 at baseline and at least one follow-up ABI measurement 3-10 years later. Adjusted Cox proportional hazards and Poisson regression modelling were used to determine the association of valvular calcification with clinical PAD and low ABI, respectively. There were 117 clinical PAD and 198 low ABI events that occurred over a median follow-up of 14 years and 9.2 years, respectively. The presence of MAC was associated with an increased risk of clinical PAD [hazard ratio 1.79; 95% confidence interval (CI) 1.04-3.05] but not a low ABI (rate ratio 1.28; 95% CI 0.75-2.19). No significant associations were noted for the presence of AVC and risk of either clinical PAD. MAC is associated with an increased risk of developing clinical PAD. Future studies are needed to corroborate our findings and better understand whether MAC holds any predictive value as a risk marker for PAD.

Bilateral photoplethysmography for peripheral arterial disease screening in haemodialysis patients using astable multivibrator and machine learning classifier

Peripheral arterial disease (PAD) is highly prevalent in haemodialysis (HD) patients with type 2 diabetes. Atherosclerosis may occur in both lower and upper peripheral arteries, causing progressive dialysis access stenosis in HD patients. To assess the risk of PAD, non-invasive bilateral photoplethysmography (PPG) can be used to obtain continuous variations in blood flow volume in in vivo examinations. The authors propose an astable multivibrator to model the peripheral circulation system and to produce PPG oscillation with time constants, duty ratio (rising time), and amplitude ratio of systolic and diastolic pressures. Then, the bilateral differences in the time constant and duty ratio are used to separate the normal condition from PAD. The machine learning decision-making process utilises a screening method to automatically detect subjects with and without the risk of PAD. The radial-based function is employed to parameterise the similarity and dissimilarity levels using probability values. Colour relation analysis incorporates the probability values into the perceptual colour relationships for PAD screening. The experimental results indicate that in comparison with bilateral timing parameters, degree of stenosis, and resistive index, the proposed screening method is efficient in preventing complications of PAD and is easily implemented in an embedded system.

Associations between habitual flavonoid intake and hospital admissions for atherosclerotic cardiovascular disease: a prospective cohort study

Flavonoids, compounds found in plant-based foods and beverages, might ameliorate vascular damage and atherosclerosis. Therefore, our aim was to assess the association between flavonoid intake and hospital admissions due to atherosclerotic cardiovascular disease. In this prospective cohort study, participants from the Danish Diet, Cancer, and Health Study were cross-linked with Danish nationwide registries. Eligible participants were aged 50-65 years, had no previous history of atherosclerotic cardiovascular disease, and had completed a food-frequency questionnaire at baseline. We examined associations between flavonoid intake (calculated from food-frequency questionnaires with use of the Phenol-Explorer database) and hospital admissions for atherosclerotic cardiovascular disease, ischaemic heart disease, ischaemic stroke, or peripheral arterial disease. We obtained hazard ratios (HRs) using restricted cubic splines based on Cox proportional hazards models. Of the participants recruited to the Danish Diet, Cancer, and Health study between 1993 and 1997, our study population was comprised of 53 552 participants, with a median follow-up of 21 years (IQR 15-22). During follow-up, 8773 participants were admitted to hospital for atherosclerotic cardiovascular disease. We observed non-linear associations between flavonoid intake and hospital admissions, plateauing at total flavonoid intakes of approximately 1000 mg per day. Compared with an intake of 175 mg per day, an intake of 1000 mg per day was associated with a 14% lower risk of atherosclerotic cardiovascular disease (HR 0·86, 95% CI 0·81-0·91). For disease subtypes, we observed a 9% lower risk of ischaemic heart disease (0·91, 0·85-0·98), a non-significant 9% lower risk of ischaemic stroke (0·91, 0·82-1·01), and a 32% lower risk of peripheral artery disease (0·68, 0·60-0·78). The overall associations were stronger in smokers than in non-smokers, as well as stronger in consumers of high (>20 g per day) quantities of alcohol than in those consuming low-to-moderate (≤20 g per day) quantities. Our results suggest that ensuring an adequate consumption of flavonoid-rich foods, particularly in subpopulations at risk of atherosclerosis such as smokers and consumers of high quantities of alcohol might mitigate some of the risk of atherosclerotic cardiovascular disease. More studies are needed to support and validate these data. Danish Cancer Society.

Peripheral Arterial Disease Prevention in Women: Awareness and Action.

Peripheral Arterial Disease Prevention in Women: Awareness and Action.

Contributions of HIV, hepatitis C virus, and traditional vascular risk factors to peripheral artery disease in women.

HIV and hepatitis C virus (HCV) have been associated with cardiovascular disease (CVD), but it is unclear whether HIV and HCV are also associated with peripheral artery disease (PAD). We examined the association of HIV, HCV, and traditional CVD risk factors with PAD in the Women's Interagency HIV Study, a multicenter US cohort. In this cross-sectional study, ankle-brachial index was estimated using Doppler ultrasound and manual sphygmomanometer in 1899 participants aged more than 40 years with HIV/HCV coinfection, HCV or HIV monoinfection, or neither infection. Multivariable logistic regression was used to estimate the odds of PAD (ankle-brachial index ≤0.9) after controlling for demographic, behavioral, and CVD risk factors. Over two-thirds were African-American, median age was 50 years, and PAD prevalence was 7.7% with little difference by infection status. After multivariable adjustment, neither HIV nor HCV infection was associated with greater odds of PAD. Factors associated with PAD included older age [adjusted odds ratio (aOR): 2.01 for age 61-70 vs. 40-50 years; 95% confidence interval (CI): 1.04, 3.87], Black race (aOR: 2.30; 95% CI: 1.15, 4.63), smoking (aOR: 1.27 per 10-pack-year increment; 95% CI: 1.09, 1.48), and higher SBP (aOR: 1.14 per 10 mmHg; 95% CI: 1.01, 1.28). The high PAD prevalence in this nationally representative cohort of women with or at risk for HIV is on par with general population studies in individuals a decade older than our study's median age. HIV and HCV infection are not associated with greater PAD risk relative to uninfected women with similar risk factors. Modifiable traditional CVD risk factors may be important early intervention targets in women with and at risk for HIV.

Diabetes and risk of peripheral artery disease in patients undergoing first-time coronary angiography between 2000 and 2012 \u2013 a nationwide study

BackgroundThe risk of peripheral artery disease (PAD) in patients with diabetes mellitus (DM) and coronary artery disease (CAD) is an important and inadequately addressed issue. Our aim is to examine the impact of DM on risk of PAD in patients with different degrees of CAD characterized by coronary angiography (CAG).MethodsUsing nationwide registers we identified all patients aged ≥18 years, undergoing first time CAG between 2000 and 2012. Patients were categorized into DM/Non-DM group, and further classified into categories according to the degree of CAD i.e., no-vessel disease, single-vessel disease, double-vessel disease, triple-vessel disease, and diffuse disease. Risk of PAD was estimated by 5-year cumulative-incidence and adjusted multivariable Cox-regression models.ResultsWe identified 116,491 patients undergoing first-time CAG. Among these, a total of 23.969 (20.58%) had DM. Cumulative-incidence of PAD among DM patients vs. non-DM were 8.8% vs. 4.9% for no-vessel disease, 8.2% vs. 4.8% for single-vessel disease, 10.2% vs. 6.0% for double-vessel disease, 13.0% vs. 8.4% for triple-vessel disease, and 6.8% vs. 6.1% for diffuse disease, respectively. For all patients with DM, the cox-regression analysis yielded significantly higher hazards of PAD compared with non-DM patients with HR 1.70 (no-vessel disease), 1.96 (single-vessel disease), 2.35 (double-vessel disease), 2.87 (triple-vessel disease), and 1.46 (diffuse disease), respectively (interaction-p 0.042).ConclusionDM appears to be associated with increased risk of PAD in patients with and without established CAD, with increasing risk in more extensive CAD. This observation indicates awareness on PAD risk in patients with DM, especially among patients with advanced CAD.

Physical Activity and Subsequent Risk of Hospitalization With Peripheral Artery Disease and Critical Limb Ischemia in the ARIC Study.

BackgroundWhether physical activity is a determinant of peripheral artery disease (PAD) remains unclear. We therefore assessed the association of physical activity (amount and intensity) with subsequent risk of hospitalization with PAD and its severe form, critical limb ischemia, in the ARIC (Atherosclerosis Risk in Communities) study.Methods and ResultsWe included 12 513 participants free of cardiovascular disease at baseline (1987–1989), with a mean age of 53.9 years, 55.3% women, and 25.0% black. Physical activity was assessed using a modified Baecke questionnaire and categorized into poor (no moderate [3 to <6 metabolic equivalents] or vigorous [≥6 metabolic equivalents] exercise), intermediate (1–74 min/wk vigorous or 1–149 min/wk moderate plus vigorous exercise), and recommended (≥75 min/wk vigorous or ≥150 min/wk moderate plus vigorous exercise). We also modeled moderate and vigorous exercise individually. All analyses applied Cox regression models. Intermediate and recommended exercise were seen in 24.7% and 38.1%, respectively. During a median follow‐up of 25.4 years, 434 incident hospitalizations with PAD (166 critical limb ischemia) were documented. Recommended versus poor activity was associated with a lower demographically adjusted PAD risk (hazard ratio, 0.68; 95% CI, 0.54–0.85) but attenuated after accounting for lifestyle factors (hazard ratio, 0.84; 95% CI, 0.66–1.05). When analyzing moderate and vigorous exercise separately, vigorous exercise was robustly related to lower risk of hospitalization with PAD, and critical limb ischemia in particular (hazard ratio, 0.72; 95% CI, 0.54–0.97 per 200 metabolic equivalents*min/wk increment in the most extended model).ConclusionsHigher amount and intensity of physical activity were related to lower risks of hospitalization with PAD and critical limb ischemia, further highlighting the importance of engaging in physical activity for vascular health.

Retinal microvascular findings and risk of incident peripheral artery disease: An analysis from the Atherosclerosis Risk in Communities (ARIC) Study

Background and aimsLower-extremity peripheral artery disease (PAD) is usually considered large artery disease. Interestingly, retinal microvascular findings were shown to predict PAD progression in diabetes. However, it is unknown whether retinal microvascular parameters are associated with incident PAD and its severe form, critical limb ischemia (CLI), in a community-based cohort. MethodsAmong 9371 ARIC participants (aged 49–72 years) free of a history of PAD, we quantified the associations of several retinal measures by retinal photography during the period 1993–1995 with PAD risk using Cox models. Incident PAD was defined as the first hospitalization with PAD diagnosis or leg revascularization (considered CLI if an additional diagnosis of ulcer, gangrene, or amputation). ResultsDuring a median follow-up of 18.8 years, 303 participants developed PAD (including 91 CLI cases). Although generalized retinal arteriolar narrowing was not associated with PAD, most measures of retinopathy demonstrated strong associations with PAD beyond potential confounders including diabetes, with adjusted hazard ratios (HR) of 3.26 (95% CI 2.18–4.90) for blot-shaped hemorrhages, 3.11 (1.83–5.29) for hard exudates, and 2.18 (1.62–2.95) for any retinopathy. Adjusted HRs were significantly greater for CLI (ranging from 3.2 to 5.9) than for PAD (all p-values <0.05). Retinopathy measures showed particularly strong associations in participants with diabetes (p-value for interaction [vs. those without diabetes] <0.001). ConclusionsSeveral retinopathy measures were strongly associated with PAD, especially with CLI and in diabetes. Our results support the contribution of microvascular abnormalities to the development and progression of PAD and would have implications on its preventive and therapeutic approaches.

Vitamin D as A Protector of Arterial Health: Potential Role in Peripheral Arterial Disease Formation.

Atherosclerotic occlusive diseases and aneurysms that affect large and medium-sized arteries outside the cardiac and cerebral circulation are collectively known as peripheral arterial disease (PAD). With a rise in the rate of aging population worldwide, the number of people diagnosed with PAD is rapidly increasing. The micronutrient vitamin D is an important steroid hormone that acts on many crucial cellular mechanisms. Experimental studies suggest that optimal levels of vitamin D have beneficial effects on the heart and blood vessels; however, high vitamin D concentrations have been implicated in promoting vascular calcification and arterial stiffness. Observations from various clinical studies shows that deficiency of vitamin D has been associated with a greater risk of PAD. Epidemiological studies have often reported an inverse relation between circulating vitamin D status measured in terms of 25-hydroxivitamin D [25(OH)D] levels and increased cardiovascular disease risk; however, randomized controlled trials did not show a consistent positive effect of vitamin D supplementation on cardiovascular disease risk or events. Even though PAD shares all the major risk factors with cardiovascular diseases, the effect of vitamin D deficiency in PAD is not clear. Current evidence suggests a strong role of vitamin D in promoting genomic and epigenomic changes. This review summarises the current literature that supports the notion that vitamin D deficiency may promote PAD formation. A better understanding of underlying pathological mechanisms will open up new therapeutic possibilities which is the main unmet need in PAD management. Furthermore, epigenetic evidence shows that a more holistic approach towards PAD prevention that incorporates a healthy lifestyle, adequate exercise and optimal nutrition may be more effective in protecting the genome and maintaining a healthy vasculature.

P5337Neutrophil-lymphocyte ratio and peripheral arterial disease in HIV infection

Abstract Background/Introduction While antiretroviral therapy has increased survival in HIV-infected patients, cardiovascular mortality is now their leading cause of death. Together with a high prevalence of traditional cardiovascular risk factors in HIV infection, chronic inflammation may be also responsible of an increased risk of cardiovascular diseases. Purpose To determine the association between a systemic inflammation-based biomarker, the neutrophil-lymphocyte ratio, and the occurrence of peripheral arterial disease in HIV infected patients. Methods In a case-control design, 41 patients with peripheral arterial disease and HIV infection were compared to 119 patients with HIV infection but no peripheral arterial disease. All patients were recruited at a Regional Hospital. The ankle-brachial index was measured in all subjects and peripheral arterial disease was defined as an ankle-brachial index &gt;0.9. The neutrophil-lymphocyte ratio was assessed using neutrophil and lymphocyte levels in the complete blood count measurement, from routine hemograms performed six to twelve months before measurement of the ankle-brachial index. The cut-off of neutrophil-lymphocyte ratio &gt;2 was used to categorize patients into low- and high- neutrophil-lymphocyte ratio groups. Odds ratios (OR) with 95% confidence intervals were used to estimate the strength of association. In order to control for potential confounders, a multiple logistic regression model was used. Results There was a significant association between elevated neutrophil-lymphocyte ratio and the presence of peripheral arterial disease (OR 7.25 [3.32–15.85], after adjustment for age (OR 1.07 [1.04–1.11]), smoking index (OR 1.12 [1.02–1.24]. Other considered variables did not contribute to the model (HDL-cholesterol, LDL-cholesterol, triglycerides, sex, diabetes, obesity and treatment). Conclusions The ankle-brachial index is a simple, cost-effective and validated method to assess peripheral arterial disease, which its presence increases the risk of cardiovascular disease morbidity and mortality. The neutrophil-lymphocyte ratio is a simple, rapid and novel inflammation parameter, that may help to identify HIV-infected patients with a higher risk of peripheral arterial disease.

Lifetime Risk of Lower-Extremity Peripheral Artery Disease Defined by Ankle-Brachial Index in the United States.

BackgroundThere are no available lifetime risk estimates of lower‐extremity peripheral artery disease (PAD).Methods and ResultsUsing data from 6 US community‐based cohorts and the vital statistics, we estimated the prevalence and incidence of PAD, defined as an ankle‐brachial index < 0.90, at each year of age from birth to 80 years for white, black, and Hispanic men and women. Then, we used Markov Monte Carlo simulations in a simulated cohort of 100 000 individuals to estimate lifetime risk of PAD. On the basis of odds ratios of PAD for traditional atherosclerotic risk factors (eg, diabetes mellitus and smoking), we developed a calculator providing residual lifetime risk of PAD. In an 80‐year horizon, lifetime risks of PAD were 30.0% in black men and 27.6% in black women, but ≈19% in white men and women and ≈22% in Hispanic men and women. From another perspective, 9% of blacks were estimated to develop PAD by 60 years of age, while the same proportion was seen at ≈70 years for whites and Hispanics. The residual lifetime risk within the same race/ethnicity varied by 3.5‐ to 5‐fold according to risk factors (eg, residual lifetime risk in 45‐year‐old black men was 19.9% when current smoking, diabetes mellitus, and history of cardiovascular disease were absent versus 70.4% when all were present).ConclusionsIn the United States, ≈30% of blacks are estimated to develop PAD during their lifetime, whereas the corresponding estimate is ≈20% for whites and Hispanics. The residual lifetime risk within the same race/ethnicity substantially varies according to traditional risk factors.

Restless Leg Syndrome in Peripheral Artery Disease: Prevalence among Patients with Claudication and Benefits from Low-Intensity Exercise.

Restless leg syndrome (RLS) disrupts sleep, affecting the quality of life of patients with various chronic diseases. We assessed the prevalence of RLS in peripheral artery disease (PAD) patients and the effects of a pain-free exercise program. A total of 286 patients with claudication were enrolled in a home-based low-intensity exercise program prescribed at the hospital. RLS was determined through standardized questions. Hemodynamics, degree of calf deoxygenation, and mobility were assessed using the ankle-brachial-index, a treadmill test assisted by near-infrared spectroscopy and the 6-min walk test, respectively. During hospital visits, persistence of RLS, adherence to exercise, hemodynamics, and mobility were assessed. At the enrollment, 101 patients (35%) presented RLS, with higher prevalence among females (p = 0.032). Compared to RLS-free patients, they showed similar hemodynamics but more severe calf deoxygenation (p < 0.001) and lower mobility (p = 0.040). Eighty-seven RLS patients (83%) reported the disappearance of symptoms after 39 (36−70) days of exercise. This subgroup, compared to nonresponders, showed higher adherence (p < 0.001), hemodynamic (p = 0.041), and mobility improvements (p = 0.003). RLS symptoms were frequent in PAD but were reduced by a pain-free walking exercise aimed at inducing peripheral aerobic adaptations. The concomitant recovery of sleep and mobility may represent a synergistic action against the cardiovascular risk in PAD.