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Ershadifar S, Colback A, Basmaci UN, Wilson M, Birkeland AC, Silverman DA. Predictors of Donor-Site Wound Complications Following Fibula Free Flap Reconstruction. OTO Open 2025; 9:e70126. [PMID: 40331107 PMCID: PMC12053048 DOI: 10.1002/oto2.70126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2025] [Accepted: 04/15/2025] [Indexed: 05/08/2025] Open
Abstract
Objective The fibula free flap (FFF) remains the workhorse flap for head and neck defects necessitating osteocutaneous reconstruction. Although lower extremity angiography, ultrasound (US), and other vascular studies are routinely used for fibula assessment and patient selection, predictors of donor-site morbidity following harvest remain poorly understood. We sought to investigate the factors associated with FFF donor-site complications. Study Design Retrospective analysis of patients at a tertiary care center. Setting Tertiary care center. Methods In total, 119 patients undergoing FFF reconstruction during the years 2012 to 2022 were included. Multivariable logistic regression was used to identify independent predictors of soft-tissue donor-site wound complications. Results A total of 48 (40.3%) patients developed a donor-site wound complication with an average time to diagnosis of 24 days (±16) following surgery. In multivariable regression, history of alcohol use disorder (P = .0083) and method of donor-site closure (P = .0368) were independent predictors of donor-site wound complications. Split-thickness skin graft closure was associated with a 146% increased odds of wound complications (odds ratio [OR] = 2.46, 1.11-5.43, 95% confidence interval). Patient age, body mass index, Charlson comorbidity index, skin paddle size, and Doppler US characteristics were not predictive of postoperative donor-site morbidity. Conclusion Predictors of FFF donor-site wound complications included history of alcohol abuse and method of donor-site closure. This study highlights unique lower extremity Doppler US findings in patients undergoing FFF reconstruction in addition to modifiable risk factors associated with fibula donor-site morbidity and soft-tissue complications. Our findings underscore the need to critically evaluate wound closure techniques in this population.
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Affiliation(s)
- Soroush Ershadifar
- Department of Otolaryngology–Head and Neck SurgeryUniversity of California–DavisSacramentoCaliforniaUSA
| | - Angela Colback
- Department of Otolaryngology–Head and Neck SurgeryUniversity of California–DavisSacramentoCaliforniaUSA
| | - Ugur Nur Basmaci
- Department of Otorhinolaryngology–Head and Neck SurgeryMcGovern Medical School, The University of Texas Health Science Center at HoustonHoustonTexasUSA
| | - Machelle Wilson
- Department of Biostatistics, Epidemiology, and Research Design, Clinical and Translational Science CenterUniversity of California–DavisSacramentoCaliforniaUSA
| | - Andrew C. Birkeland
- Department of Otolaryngology–Head and Neck SurgeryUniversity of California–DavisSacramentoCaliforniaUSA
| | - Dustin A. Silverman
- Department of Otolaryngology–Head and Neck SurgeryUniversity of CincinnatiCincinnatiOhioUSA
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Schoenherr L, Heidler J, Kluckner M, Lobenwein D, Pesta D, Frese JP, Wipper SH, Gratl A. A Randomized Control Trial Investigating the Effect of Different Treatment Strategies on Mitochondrial Function in Peripheral Arterial Disease: A Study Protocol. J Surg Res 2025; 307:78-85. [PMID: 39987612 DOI: 10.1016/j.jss.2025.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 01/23/2025] [Accepted: 01/27/2025] [Indexed: 02/25/2025]
Abstract
Peripheral arterial disease encompasses different clinical symptoms, depending on the severity of the disease. In early stages, a walking-induced pain, known as intermittent claudication, is the leading clinical symptom. Repeating cycles of ischemia and reperfusion induce a typical myopathy, with mitochondria playing the key role within this pathophysiological condition. The aim of this study is to further evaluate the effects of different treatment strategies on mitochondrial function and overall cardiovascular outcomes within a randomized controlled trial. After inclusion, patients will be randomized into different study groups. Study group 1 will receive conservative treatment, while study group 2 will receive revascularization of underlying atherosclerotic lesions. Additionally, a healthy control group will be included. Muscle biopsies will be obtained from ischemic and nonischemic muscle regions, being defined by the anatomic localization of the atherosclerotic lesion, before initiation of treatment as well as after a time interval of 12 wk. Mitochondrial function and content will be evaluated using high-resolution respirometry and citrate synthase activity measurements. Cardiovascular outcomes will be determined by established protocols. This study is registered on ClinicalTrials.gov-NCT05644158. This study aims to gain further insights into the exact pathophysiological mechanism underlying mitochondrial dysfunction in peripheral arterial disease. The potential effects of mitochondrial regeneration within ischemic muscle regions following a conservative treatment approach will be compared to those reported after revascularization procedures. Additionally, correlation with cardiovascular outcome parameters and in vivo methods will provide a comprehensive approach to this research question.
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Affiliation(s)
- Laura Schoenherr
- Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Juliana Heidler
- Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria.
| | - Michaela Kluckner
- Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Daniela Lobenwein
- Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Dominik Pesta
- Institute of Aerospace Medicine, German Aerospace Center (DLR), Cologne, Germany; Centre for Endocrinology, Diabetes and Preventive Medicine (CEDP), University Hospital Cologne, Cologne, Germany; Cologne Excellence Cluster on Cellular Stress Responses in Aging-Associated Diseases (CECAD), Cologne, Germany
| | - Jan Paul Frese
- Department of Vascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Sabine Helena Wipper
- Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Alexandra Gratl
- Department of Vascular Surgery, Medical University of Innsbruck, Innsbruck, Austria
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3
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Zhang W, Wang JG. Cardio-ankle index, ankle-brachial index and supine hypertension for the improved prediction of cardiovascular outcomes in hypertension. Hypertens Res 2025; 48:844-845. [PMID: 39639137 DOI: 10.1038/s41440-024-02042-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2024] [Accepted: 11/20/2024] [Indexed: 12/07/2024]
Affiliation(s)
- Wei Zhang
- Department of Cardiovascular Medicine, Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ji-Guang Wang
- Department of Cardiovascular Medicine, Centre for Epidemiological Studies and Clinical Trials, Shanghai Key Laboratory of Hypertension, The Shanghai Institute of Hypertension, Department of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
- National Research Centre for Translational Medicine at Shanghai, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Bondonno NP, Parmenter BH, Murray K, Bondonno CP, Blekkenhorst LC, Wood AC, Post WS, Allison MA, Criqui MH, Lewis JR, Hodgson JM. Associations Between Flavonoid Intake and Subclinical Atherosclerosis: The Multi-Ethnic Study of Atherosclerosis. Arterioscler Thromb Vasc Biol 2024; 44:2347-2359. [PMID: 39263763 DOI: 10.1161/atvbaha.124.321106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 08/26/2024] [Indexed: 09/13/2024]
Abstract
BACKGROUND Flavonoids may play a role in mitigating atherosclerotic cardiovascular diseases, with evidence suggesting effects may differ between vascular beds. Studies examining associations with subclinical markers of atherosclerosis between subpopulations with different underlying risks of atherosclerosis are lacking. METHODS Among 5599 participants from the MESA (Multi-Ethnic Study of Atherosclerosis), associations between dietary flavonoid intakes (estimated from a food frequency questionnaire) and subclinical measures of atherosclerosis (ankle-brachial index, carotid plaques and intima-media thickness, and coronary artery calcification) were examined using repeated measures models. Exposures and outcomes were measured at exam 1 (2000-2002) and exam 5 (2010-2011). Stratified analyses and interaction terms were used to explore effect modification by time, sex, race/ethnicity, and smoking status. RESULTS In the analytic population, at baseline, ≈46% were men with a median age of 62 (interquartile range, 53-70) years and total flavonoid intakes of 182 (interquartile range, 98-308) mg/d. After multivariable adjustments, participants with the highest (quartile 4) versus lowest (quartile 1) total flavonoid intakes had 26% lower odds of having an ankle-brachial index <1 (odds ratio, 0.74 [95% CI, 0.60-0.92]) and 18% lower odds of having a carotid plaque (odds ratio, 0.82 [95% CI, 0.69-0.99]), averaged over exams 1 and 5. Moderate (quartile 3) to high (quartile 4) intakes of flavonols, flavanol monomers, and anthocyanins were associated with 19% to 34% lower odds of having an ankle-brachial index <1 and 18% to 20% lower odds of having carotid plaque. Participants with the highest intakes of anthocyanins (quartile 4) at baseline had a marginally slower rate of carotid plaque progression than those with moderate intakes (quartiles 2 and 3). There were no significant associations with intima-media thickness or coronary artery calcification. Observed associations did not differ by sex, race/ethnicity, or smoking status. CONCLUSIONS In this multi-ethnic population, higher dietary flavonoid intakes were associated with lower odds of peripheral and carotid artery atherosclerosis. Increasing intakes of healthy, flavonoid-rich foods may protect against atherosclerosis in the peripheral and carotid arteries.
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Affiliation(s)
- Nicola P Bondonno
- Nutrition & Health Innovation Research Institute, Royal Perth Hospital Research Foundation, Edith Cowan University, Australia (N.P.B., B.H.P., C.P.B., L.C.B., J.R.L., J.M.H.)
- Diet Cancer and Health Group, Danish Cancer Institute, Copenhagen, Denmark (N.P.B.)
| | - Benjamin H Parmenter
- Nutrition & Health Innovation Research Institute, Royal Perth Hospital Research Foundation, Edith Cowan University, Australia (N.P.B., B.H.P., C.P.B., L.C.B., J.R.L., J.M.H.)
- School of Biomedical Sciences, University of Western Australia, Royal Perth Hospital, Australia (B.H.P.)
| | - Kevin Murray
- School of Population and Global Health (K.M.), University of Western Australia, Perth, Australia
| | - Catherine P Bondonno
- Nutrition & Health Innovation Research Institute, Royal Perth Hospital Research Foundation, Edith Cowan University, Australia (N.P.B., B.H.P., C.P.B., L.C.B., J.R.L., J.M.H.)
- Medical School (C.P.B., L.C.B., J.R.L., J.M.H.), University of Western Australia, Perth, Australia
| | - Lauren C Blekkenhorst
- Nutrition & Health Innovation Research Institute, Royal Perth Hospital Research Foundation, Edith Cowan University, Australia (N.P.B., B.H.P., C.P.B., L.C.B., J.R.L., J.M.H.)
- Medical School (C.P.B., L.C.B., J.R.L., J.M.H.), University of Western Australia, Perth, Australia
| | - Alexis C Wood
- Department of Pediatrics, USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX (A.C.W.)
| | - Wendy S Post
- Division of Cardiology, Department of Medicine (W.S.P.), Johns Hopkins University, Baltimore, MD
- Department of Epidemiology, Bloomberg School of Public Health (W.S.P.), Johns Hopkins University, Baltimore, MD
| | - Matthew A Allison
- Department of Family Medicine, University of California San Diego (M.A.A., M.H.C.)
| | - Michael H Criqui
- Department of Family Medicine, University of California San Diego (M.A.A., M.H.C.)
- Division of Cardiology, Department of Medicine, University of California, La Jolla, San Diego (M.H.C.)
| | - Joshua R Lewis
- Nutrition & Health Innovation Research Institute, Royal Perth Hospital Research Foundation, Edith Cowan University, Australia (N.P.B., B.H.P., C.P.B., L.C.B., J.R.L., J.M.H.)
- Medical School (C.P.B., L.C.B., J.R.L., J.M.H.), University of Western Australia, Perth, Australia
- Centre for Kidney Research, School of Public Health, The University of Sydney, Australia (J.R.L.)
| | - Jonathan M Hodgson
- Nutrition & Health Innovation Research Institute, Royal Perth Hospital Research Foundation, Edith Cowan University, Australia (N.P.B., B.H.P., C.P.B., L.C.B., J.R.L., J.M.H.)
- Medical School (C.P.B., L.C.B., J.R.L., J.M.H.), University of Western Australia, Perth, Australia
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Masini G, Gargani L, Morizzo C, Guarini G, Bort IR, Baldini M, Tamborrino PP, Vitale C, Palombo C, De Caterina R. Prognostic impact of peripheral artery disease-related parameters in patients with acute coronary syndrome. J Cardiovasc Med (Hagerstown) 2024; 25:749-756. [PMID: 39101369 DOI: 10.2459/jcm.0000000000001653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
Abstract
BACKGROUND Lower extremity arterial disease (LEAD) and increased aortic stiffness are associated with higher mortality in patients with chronic coronary syndrome, while their prognostic significance after an acute coronary syndrome (ACS) is less known. METHODS We analyzed prevalence, clinical phenotypes and association of LEAD - assessed by the ankle-brachial index (ABI) - and increased aortic stiffness - assessed by the aortic pulse wave velocity (PWV) - with all-cause mortality and major adverse cardiovascular events (MACE) in patients admitted with an ACS. RESULTS Among 270 patients admitted for ACS (mean age 67 years, 80% males), 41 (15%) had an ABI ≤0.9, with 14 of them (34%) presenting with intermittent claudication (symptomatic LEAD). Patients with symptomatic LEAD, compared with those with asymptomatic LEAD or without LEAD, had higher prevalence of cardiovascular risk factors, lower estimated glomerular filtration rate and higher high-sensitivity C-reactive protein. Patients with LEAD, either symptomatic or asymptomatic, more frequently presented with non-ST-elevation myocardial infarction and more frequently had multivessel coronary artery disease. Both symptomatic and asymptomatic LEAD were significantly associated with all-cause mortality after adjustment for confounders, including multivessel disease or carotid artery disease (hazard ratio 4.03, 95% confidence interval 1.61-10.08, P < 0.01), whereas PWV was not associated with the outcome in the univariable model. LEAD and PWV were not associated with a higher risk of MACE (myocardial infarction or unstable angina, stroke, or transient ischemic attack). CONCLUSIONS LEAD, either clinical or subclinical, but not increased aortic stiffness, is an independent predictor of all-cause mortality in patients admitted for ACS.
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Affiliation(s)
- Gabriele Masini
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, Pisa University Hospital, and Chair of Cardiology, University of Pisa, Pisa, Italy
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Mazzolai L, Teixido-Tura G, Lanzi S, Boc V, Bossone E, Brodmann M, Bura-Rivière A, De Backer J, Deglise S, Della Corte A, Heiss C, Kałużna-Oleksy M, Kurpas D, McEniery CM, Mirault T, Pasquet AA, Pitcher A, Schaubroeck HAI, Schlager O, Sirnes PA, Sprynger MG, Stabile E, Steinbach F, Thielmann M, van Kimmenade RRJ, Venermo M, Rodriguez-Palomares JF. 2024 ESC Guidelines for the management of peripheral arterial and aortic diseases. Eur Heart J 2024; 45:3538-3700. [PMID: 39210722 DOI: 10.1093/eurheartj/ehae179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
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7
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Cimellaro A, Cavallo M, Mungo M, Suraci E, Spagnolo F, Addesi D, Pintaudi M, Pintaudi C. Cardiovascular Effectiveness and Safety of Antidiabetic Drugs in Patients with Type 2 Diabetes and Peripheral Artery Disease: Systematic Review. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1542. [PMID: 39336583 PMCID: PMC11434261 DOI: 10.3390/medicina60091542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2024] [Revised: 09/11/2024] [Accepted: 09/19/2024] [Indexed: 09/30/2024]
Abstract
Peripheral artery disease (PAD) is an atherosclerotic condition commonly complicating type 2 diabetes (T2D), leading to poor quality of life and increased risk of major adverse lower-limb (MALE) and cardiovascular (CV) events (MACE). Therapeutic management of PAD in T2D patients is much more arduous, often due to bilateral, multi-vessel, and distal vascular involvement, in addition to increased systemic polyvascular atherosclerotic burden. On the other hand, the pathophysiological link between PAD and T2D is very complex, involving mechanisms such as endothelial dysfunction and increased subclinical inflammation in addition to chronic hyperglycemia. Therefore, the clinical approach should not ignore vascular protection with the aim of reducing limb and overall CV events besides a mere glucose-lowering effect. However, the choice of the best medications in this setting is challenging due to low-grade evidence or lacking targeted studies in PAD patients. The present review highlighted the strong relationship between T2D and PAD, focusing on the best treatment strategy to reduce CV risk and prevent PAD occurrence and worsening in patients with T2D. The Medline databases were searched for studies including T2D and PAD up to June 2024 and reporting the CV effectiveness and safety of the most used glucose-lowering agents, with no restriction on PAD definition, study design, or country. The main outcomes considered were MACE-including nonfatal acute myocardial infarction, nonfatal stroke, and CV death-and MALE-defined as lower-limb complications, amputations, or need for revascularization. To the best of our current knowledge, GLP-1 receptor agonists and SGLT2 inhibitors represent the best choice to reduce CV risk in T2D and PAD settings, but a personalized approach should be considered. GLP-1 receptor agonists should be preferred in subjects with prevalent atherosclerotic burden and a history of previous MALE, while SGLT2 inhibitors should be used in those with heart failure if overall CV benefits outweigh the risk of lower-limb complications.
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Affiliation(s)
- Antonio Cimellaro
- Internal Medicine Unit, Department of Medicine Specialties, “Pugliese-Ciaccio” Hospital of Catanzaro, Azienda Ospedaliero-Universitaria Renato Dulbecco, Via Pio X n.83, 88100 Catanzaro, Italy; (M.C.); (E.S.); (F.S.); (D.A.); (C.P.)
| | - Michela Cavallo
- Internal Medicine Unit, Department of Medicine Specialties, “Pugliese-Ciaccio” Hospital of Catanzaro, Azienda Ospedaliero-Universitaria Renato Dulbecco, Via Pio X n.83, 88100 Catanzaro, Italy; (M.C.); (E.S.); (F.S.); (D.A.); (C.P.)
| | - Marialaura Mungo
- Internal Medicine Unit, Department of Medical and Surgical Sciences, ‘Magna Græcia’ University of Catanzaro, Viale Europa, Località Germaneto, 88100 Catanzaro, Italy;
| | - Edoardo Suraci
- Internal Medicine Unit, Department of Medicine Specialties, “Pugliese-Ciaccio” Hospital of Catanzaro, Azienda Ospedaliero-Universitaria Renato Dulbecco, Via Pio X n.83, 88100 Catanzaro, Italy; (M.C.); (E.S.); (F.S.); (D.A.); (C.P.)
| | - Francesco Spagnolo
- Internal Medicine Unit, Department of Medicine Specialties, “Pugliese-Ciaccio” Hospital of Catanzaro, Azienda Ospedaliero-Universitaria Renato Dulbecco, Via Pio X n.83, 88100 Catanzaro, Italy; (M.C.); (E.S.); (F.S.); (D.A.); (C.P.)
| | - Desirée Addesi
- Internal Medicine Unit, Department of Medicine Specialties, “Pugliese-Ciaccio” Hospital of Catanzaro, Azienda Ospedaliero-Universitaria Renato Dulbecco, Via Pio X n.83, 88100 Catanzaro, Italy; (M.C.); (E.S.); (F.S.); (D.A.); (C.P.)
| | - Medea Pintaudi
- Unit of Plastic Surgery, Department of Surgery, Azienda Ospedaliero-Universitaria “Gaetano Martino”, 98124 Messina, Italy;
| | - Carmelo Pintaudi
- Internal Medicine Unit, Department of Medicine Specialties, “Pugliese-Ciaccio” Hospital of Catanzaro, Azienda Ospedaliero-Universitaria Renato Dulbecco, Via Pio X n.83, 88100 Catanzaro, Italy; (M.C.); (E.S.); (F.S.); (D.A.); (C.P.)
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Ji C, Wu S, Huang Z, Zhu C, Cui W. A Comparison of Oscillometrically Measured Ankle-to-Brachial Mean Arterial Pressure Ratio and Ankle-Brachial Index in Predicting Cardiovascular Events and All-Cause Mortality. Anatol J Cardiol 2024; 28:486-492. [PMID: 39189996 PMCID: PMC11460557 DOI: 10.14744/anatoljcardiol.2024.4262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 07/02/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND The oscillometrically measured ankle-brachial index (omABI), which is determined by the ratio of ankle to brachial systolic blood pressure measured through oscillography, has been demonstrated as a robust predictor of cardiovascular events. However, the reliability of mean arterial pressure measured by oscillography may be higher than that of systolic blood pressure based on the principle of oscillographic oscillation. We aimed to compare the predictive value of oscillometrically measured ankle-tobrachial mean arterial pressure ratio (omMAPR) and omABI for cardiovascular events and all-cause mortality. METHODS The observation cohort consisted of a total of 37 803 employees from the Chinese Kailuan Group who underwent limb blood pressure measurements during their participation in physical examination between 2010 and 2017. RESULTS After an average follow-up period of 3 years, a total of 589 cardiovascular events and 570 cases of all-cause mortality were observed. The predictive performance of omMAPR was found to be slightly superior to omABI in terms of cardiovascular events (C-statistics: 0.55 vs. 0.51, P < .001) and all-cause mortality (C-statistics: 0.60 vs. 0.55, P <.001). After adjusting for confounders, within a specific range (omMAPR ≤ 1.06 or omABI ≤ 1.12), each 0.1-unit increase in omMAPR was associated with reductions of 14% (HR = 0.86, 95% CI: 0.77-0.96) and 23% (HR = 0.77, 95% CI: 0.70-0.84) in cardiovascular events and all cause mortality, respectively, while each 0.1-unit increase in omABI was associated with reductions of 12% (HR = 0.88, 95% CI: 0.79-0.97) and 22% (HR = 0.78, 95% CI: 0.72-0.85) in cardiovascular events and all-cause mortality, respectively. However, once out of that range (omMAPR > 1.06 or omABI > 1.12), neither omMAPR nor omABI was significantly associated with cardiovascular events or all-cause mortality. CONCLUSION Both omMAPR and omABI within specific ranges (omMAPR ≤ 1.06 or omABI ≤ 1.12) were independent predictors for cardiovascular events and all-cause mortality. Moreover, omMAPR exhibited a slightly superior predictive ability compared to omABI in relation to cardiovascular events and all-cause mortality. The trial registration number is ChiCTR-TNRC-11001489.
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Affiliation(s)
- Chunpeng Ji
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Zhe Huang
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Chenrui Zhu
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Wei Cui
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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Maruhashi T, Kajikawa M, Kishimoto S, Yamaji T, Harada T, Hashimoto Y, Mizobuchi A, Tanigawa S, Yusoff FM, Nakano Y, Chayama K, Nakashima A, Goto C, Higashi Y. Upstroke time is a more useful marker of atherosclerosis than percentage of mean arterial pressure for detecting coronary artery disease in subjects with a normal ankle-brachial index. Hypertens Res 2024; 47:2009-2018. [PMID: 38760524 PMCID: PMC11298401 DOI: 10.1038/s41440-024-01707-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 04/03/2024] [Accepted: 04/07/2024] [Indexed: 05/19/2024]
Abstract
Upstroke time (UT) and percentage of mean arterial pressure (%MAP) at the ankle have been shown to serve as atherosclerotic markers. The purpose of this study was to directly compare the diagnostic accuracy of UT with that of %MAP for clinical coronary artery disease (CAD) in subjects with a normal ankle-brachial index (ABI) in both legs. We measured UT and %MAP in 1953 subjects with a normal ABI. The optimal cutoff values of UT and %MAP derived from a receiver operating characteristic (ROC) curve to diagnose CAD were 148 ms and 40.4%, respectively. Multivariable analyses revealed that both UT ≥ 148 ms (odds ratio [OR], 2.72; p < 0.001) and %MAP ≥ 40.4% (OR, 1.28; p = 0.003) were significantly associated with CAD. When the subjects were divided into four groups according to the cutoff values of UT and %MAP, there was no significant difference in the risk of CAD between subjects with UT ≥ 148 ms and %MAP < 40.4% and those with UT ≥ 148 ms and %MAP ≥ 40.4% (OR, 1.45; p = 0.09). ROC curve analyses revealed that the area under the curve value of UT was significantly higher than that of %MAP (0.69 vs. 0.53, p < 0.001). The addition of UT to traditional risk factors significantly improved the diagnostic accuracy for CAD (0.82 to 0.84, p = 0.004), whereas the addition of %MAP to traditional risk factors did not improve the diagnostic accuracy for CAD (0.82 to 0.82, p = 0.84). UT is more useful than %MAP for identifying individuals with CAD among those with a normal ABI.
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Affiliation(s)
- Tatsuya Maruhashi
- Department of Regenerative Medicine, Division of Radiation Medical Science, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Masato Kajikawa
- Division of Regeneration and Medicine, Medical Center for Translational and Clinical Research, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Shinji Kishimoto
- Department of Regenerative Medicine, Division of Radiation Medical Science, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Takayuki Yamaji
- Department of Regenerative Medicine, Division of Radiation Medical Science, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Takahiro Harada
- Department of Regenerative Medicine, Division of Radiation Medical Science, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Yu Hashimoto
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Aya Mizobuchi
- Department of Regenerative Medicine, Division of Radiation Medical Science, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Shunsuke Tanigawa
- Department of Regenerative Medicine, Division of Radiation Medical Science, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Farina Mohamad Yusoff
- Department of Regenerative Medicine, Division of Radiation Medical Science, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Kazuaki Chayama
- Department of Medicine and Molecular Science, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Ayumu Nakashima
- Department of Stem Cell Biology and Medicine, Graduate School of Biomedical and Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Chikara Goto
- Department of Rehabilitation, Faculty of general Rehabilitation, Hiroshima International University, 555-36, Kurosegakuendai, Higashihiroshima, 739-2695, Japan
| | - Yukihito Higashi
- Department of Regenerative Medicine, Division of Radiation Medical Science, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8553, Japan.
- Division of Regeneration and Medicine, Medical Center for Translational and Clinical Research, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
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10
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Oliveira LB, Cieslak PH, Batista S, Rabelo NN, Bertani R, Welling LC, Figueiredo EG. Letter: Low and Borderline Ankle-Brachial Index Is Associated With Intracranial Aneurysms: A Retrospective Cohort Study. Neurosurgery 2024; 95:e45-e46. [PMID: 38767384 DOI: 10.1227/neu.0000000000003014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/18/2024] [Indexed: 05/22/2024] Open
Affiliation(s)
- Leonardo B Oliveira
- Department of Neurosurgery, State University of Ponta Grossa, Ponta Grossa , Brazil
| | | | - Sávio Batista
- Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro , Brazil
| | | | - Raphael Bertani
- Department of Neurosurgery, University of São Paulo, São Paulo , Brazil
| | - Leonardo C Welling
- Department of Neurosurgery, State University of Ponta Grossa, Ponta Grossa , Brazil
- Department of Neurosurgery, University of São Paulo, São Paulo , Brazil
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11
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Wu X, Zhang Y, Zheng X. Association between ankle-brachial blood pressure index and erectile dysfunction in US adults: a large population-based cross-sectional study. Front Endocrinol (Lausanne) 2024; 15:1436043. [PMID: 39129923 PMCID: PMC11310141 DOI: 10.3389/fendo.2024.1436043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 07/15/2024] [Indexed: 08/13/2024] Open
Abstract
Background Erectile dysfunction (ED) is a very common condition among adult men and its prevalence increases with age. The ankle-brachial blood pressure index (ABPI) is a noninvasive tool used to assess peripheral vascular disease (PAD) and vascular stiffness. However, the association between ABPI and ED is unclear. We aimed to explore the association between ABPI and ED in the US population. Methods Our study used data from two separate National Health and Nutrition Examination Survey (NHANES) datasets (2001-2002 and 2003-2004). Survey-weighted logistic regression models were used to explore the association between ABPI as a continuous variable and quartiles with ED. We further assessed the association between ABPI and ED using restricted cubic regression while selecting ABPI thresholds using two-piecewise Cox regression models. In addition, we performed subgroup analyses stratified by BMI, race, marital status, diabetes, and hypertension. Main outcome measure ABPI was calculated by dividing the mean systolic blood pressure at the ankle by the mean systolic blood pressure at the arm. Results Finally, 2089 participants were enrolled in this study, including 750 (35.90%) ED patients and 1339 (64.10%) participants without ED. After adjusting for all confounding covariates, logistic regression analyses showed a significant association between ABPI and ED (OR=0.19; 95% CI, 0.06-0.56, P=0.01); with ABPI as a categorical variable, compared with the lowest quartile, the OR and 95% CI for the second quartile were 0.58 (0.34-0.97; P = 0.04).Besides, splines indicated that there was an L-shaped relationship between ABPI levels and the risk of ED. Piecewise Cox regression demonstrated the inflection point at 1.14, below which the OR for ED was 0.06 (0.02-0.20; P < 0.001), and above which the OR was 2.79 (0.17-4.53; P = 0.469). Conclusion In our study, lower ABPI was independently associated with ED risk. In addition, the lowest ABPI level associated with ED risk was 1.14, below this level, lower ABPI was associated with higher ED risk.
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Affiliation(s)
- Xu Wu
- Department of Urology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yuyang Zhang
- Department of Urology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xuejie Zheng
- Department of Pediatrics, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
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12
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Barforoshi S, Manubolu VS, Wang R, McClelland RL, Budoff MJ. Incremental value of ABI and CAC beyond traditional risk markers in long-term prediction of cardiovascular disease incidence in participants with diabetes and impaired fasting glucose: Multi-Ethnic Study of Atherosclerosis. Atherosclerosis 2024; 394:117186. [PMID: 37532595 DOI: 10.1016/j.atherosclerosis.2023.117186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND AND AIMS Subclinical atherosclerosis (SA) diagnosis is key to primary prevention of atherosclerotic cardiovascular disease (ASCVD). SA is common among diabetics. Ankle brachial index (ABI) and coronary artery calcium (CAC) are markers of SA. This study examined whether adding ABI and CAC to diabetic individuals improved ASCVD risk prediction beyond established risk factors. METHODS MESA is an observational cohort of 6814 participants without clinical cardiovascular disease. All participants with diabetes and impaired fasting glucose were included in the analysis. The association between CAC, ABI, and incident ASCVD, and all-cause mortality was examined using Cox proportional hazard regression. The risk prediction models including ABI and/or CAC in addition to standard risk factors alone were compared. RESULTS Of the 1719 participants, 55% were male and average age was 64 (±9.6) years old. Participants with diabetes or impaired fasting glucose with higher CAC and lower ABI had higher ASCVD and all-cause mortality. ABI and CAC enhanced ASCVD discrimination over standard risk factors, with C-index (95% CI) of 0.689 (0.66, 0.718) for risk factors alone, 0.696 (0.668, 0.724) for ABI, 0.719 (0.691, 0.747) for CAC, and 0.721 (0.693, 0.749) for CAC + ABI. Similarly, for all-cause mortality, both CAC and ABI improved risk discrimination in addition to standard risk factors alone. CONCLUSIONS In a large population-based study of individuals with diabetes or impaired fasting glucose, the addition of ABI and CAC to conventional risk factors improved 10-year ASCVD risk prediction. ABI and CAC are non-invasive and cost-effective tests; therefore, these markers should be included into ASCVD risk stratification for primary prevention in the diabetic and impaired fasting glucose population.
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Affiliation(s)
- Shiva Barforoshi
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA, USA.
| | | | - Rui Wang
- Department of Biostatistics, University of Washington, Seattle, WA, USA
| | | | - Matthew J Budoff
- Lundquist Institute, Harbor-UCLA Medical Center, Torrance, CA, USA
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13
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Parmar GM, Tanikella R, Gupta K, Dicks AB, Sakhuja R, Schainfeld R, Dua A, Weinberg I. High ankle-brachial index participants experienced similar long-term mortality as peripheral artery disease in a national sample of community-dwelling adults. J Vasc Surg 2024:S0741-5214(24)01249-7. [PMID: 38866374 DOI: 10.1016/j.jvs.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 06/02/2024] [Accepted: 06/05/2024] [Indexed: 06/14/2024]
Abstract
BACKGROUND Only a few small studies have shown the association between high ankle-brachial pressure index (ABI >1.4) and adverse cardiovascular (CV) events and mortality. Although there is abundant literature depicting the association between ABI and overall systemic atherosclerosis, it typically focuses on low ABI. Furthermore, historically, many studies focusing on peripheral artery disease have excluded high ABI participants. We aimed to study the mortality outcomes of persons with high ABI in the National Health and Nutrition Examination Survey (NHANES). METHODS We obtained ABI from participants aged ≥40 years for survey years 1999 to 2004. We defined low a ABI as ≤0.9, normal ABI as 0.9 to 1.4, and high ABI as >1.4 or if the ankle pressures were >245 mm Hg. Demographics, various comorbidities, and laboratory test results were obtained at the time of the survey interview. Multivariable adjusted hazard ratios (HRs) along with 95% confidence intervals (CIs) were calculated for CV and all-cause mortality via Cox proportional hazards regression. Mortality was linked to all NHANES participants for follow-up through December 31, 2019, by the Centers for Disease Control and Prevention. RESULTS We identified 7639 NHANES participants with available ABI. Of these, 6787 (89%) had a normal ABI, 646 (8%) had a low ABI, and 206 (3%) had elevated ABI. Of participants with high ABI, 50% were men, 15% were African Americans, 10% were current smokers, 56% had hypertension, 33% had diabetes, 15% had chronic kidney disease (CKD), and 18% had concomitant coronary artery disease (CAD). Diabetes (odds ratio [OR], 2.4; 95% CI, 1.7-3.2), CAD (OR, 1.6; 95% CI, 1.0-2.4), and CKD (OR, 1.5; 95% CI, 1.0-2.3) at baseline were associated with having a high ABI, respectively. A high ABI was associated independently with elevated CV (HR, 2.6; 95% CI, 2.1-3.1; P < .0001) and all-cause mortality (HR, 2.5; 95% CI, 2.2-2.8; P < .0001) after adjusting for covariates, including diabetes, CKD, CAD, current smoking, cancer, and hypertension. CONCLUSIONS A high ABI is associated with an elevated CV and all-cause mortality, similar to patients with PAD. High ABI participants should receive the same attention and aggressive medical therapies as patients with PAD.
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Affiliation(s)
- Gaurav M Parmar
- Section of Vascular Medicine, Massachusetts General Hospital, Boston, MA.
| | | | - Kamal Gupta
- Department of Cardiovascular Medicine, Kansas University Medical Center, Kansas City, KS
| | - Andrew B Dicks
- Department of Vascular Surgery, Prisma Health, University of South Carolina School of Medicine, Greenville, SC
| | - Rahul Sakhuja
- Section of Vascular Medicine, Massachusetts General Hospital, Boston, MA
| | - Robert Schainfeld
- Section of Vascular Medicine, Massachusetts General Hospital, Boston, MA
| | - Anahita Dua
- Division of Vascular Surgery and Endovascular Therapy, Massachusetts General Hospital, Boston, MA
| | - Ido Weinberg
- Section of Vascular Medicine, Massachusetts General Hospital, Boston, MA
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14
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Xu L, Wang L, Wang Y, Wang Y, Jiang Y, Du P, Cheng J, Zhang C, Wang R, Jiao T, Xing L, Ma J, Li J. PCSK9 inhibitors ameliorate arterial stiffness in ACS patients: evidences from Mendelian randomization, a retrospective study and basic experiments. Front Med (Lausanne) 2024; 11:1408760. [PMID: 38860206 PMCID: PMC11163136 DOI: 10.3389/fmed.2024.1408760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 05/09/2024] [Indexed: 06/12/2024] Open
Abstract
Background Current evidences suggest that Proprotein Convertase Subtilisin/kexin Type 9 inhibitors (PCSK9i) exhibit a protective influence on acute coronary syndrome (ACS). Nevertheless, further investigation is required to comprehend the impact and mechanisms of these pharmaceutical agents on inflammatory factors and arterial stiffness (AS) in patients with ACS. Consequently, the objective of this study is to ascertain the influence of PCSK9i on arterial stiffness in ACS patients and elucidate the underlying mechanisms behind their actions. Methods This study employed Mendelian randomization (MR) analysis to examine the association between genetic prediction of PCSK9 inhibition and arterial stiffness. Data of 71 patients with ACS were retrospectively collected, including PCSK9i group (n = 36, PCSK9 inhibitors combined with statins) and control group (n = 35, statins only). Blood lipid levels, inflammatory markers and pulse wave velocity (PWV) data were collected before treatment and at 1 and 6 months after treatment for analysis. Additionally, cell experiments were conducted to investigate the impact of PCSK9i on osteogenesis of vascular smooth muscle cells (VSMCs), utilizing western blot (WB), enzyme-linked immunosorbent assay (ELISA), and calcification index measurements. Results The results of the MR analysis suggest that genetic prediction of PCSK9 inhibition has potential to reduce the PWV. Following treatment of statins combined with PCSK9 inhibitors for 1 and 6 months, the PCSK9i group exhibited significantly lower levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), C-reactive protein (CRP), interleukin-6 (IL-6), fibrinogen (FIB) and procalcitonin (PCT) compared to the control group (p < 0.05). Additionally, PWV in the PCSK9i group demonstrated significant reduction after 6 months of treatment and was found to be associated with the circulating CRP level. In cell experiments, PCSK9i pretreatment ameliorated osteogenesis of VSMCs through reducing the deposition of calcium ions, alkaline phosphatase (ALP) activity, and expression of runt-related transcription factor 2 (RUNX2). Conclusion PCSK9i have potential to enhance arterial stiffness in ACS patients. Specifically, at the clinical level, this impact may be attributed to alterations in circulating CRP levels. At the cellular level, it is associated with the signaling pathway linked to RUNX2.
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Affiliation(s)
- Linghao Xu
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Liang Wang
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yuanqi Wang
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yiqiong Wang
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yuanzhen Jiang
- Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Peizhao Du
- Department of Cardiology, Baoshan District Hospital of Integrated Traditional Chinese and Western Medicine of Shanghai, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jing Cheng
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Chunsheng Zhang
- Department of Cardiology, East Hospital of Clinical Medical College, Nanjing Medical University, Nanjing, China
| | - Ruijie Wang
- Department of Cardiology, Harbin Medical University First Affiliated Hospital, Harbin, China
| | - Tiantian Jiao
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lijian Xing
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jiangping Ma
- School of Medicine, Tongji University, Shanghai, China
| | - Jiming Li
- Department of Cardiology, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China
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15
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Niiranen O, Virtanen J, Rantasalo V, Ibrahim A, Venermo M, Hakovirta H. The Association between Major Adverse Cardiovascular Events and Peripheral Artery Disease Burden. J Cardiovasc Dev Dis 2024; 11:157. [PMID: 38921658 PMCID: PMC11203764 DOI: 10.3390/jcdd11060157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/19/2024] [Accepted: 05/20/2024] [Indexed: 06/27/2024] Open
Abstract
OBJECTIVE The aim of the present study was to investigate the possible relationship between the segmental burden of lower limb atherosclerosis and Major Adverse Cardiovascular Events (MACEs). METHODS All the consecutive symptomatic peripheral artery disease (PAD) patients admitted for digital subtraction angiography (DSA) at Turku University Hospital department of Vascular Surgery between 1 January 2009 and 30 July 2011 were retrospectively analyzed. Angiography due to symptomatic PAD was used as the index date for the inclusion in the study. The segmental burden of atherosclerosis based on DSA was divided into three categories according to the highest disease burden of the defined artery segment: aorto-iliac, femoropopliteal, or tibial segments. The major association for the study was MACEs (defined as a cerebrovascular event, heart failure (HF) and myocardial infarction requiring hospital admission). Demographic data and MACEs were obtained from the hospital electronic medical records system. RESULTS The lower limb atherosclerosis burden of tibial vessels was related to an increased probability for HF (OR 3.9; 95%CI 2.4-6.5) and for MACEs overall (OR 2.3; 95%CI 1.4-3.6). The probability of both HF and MACEs overall rose with the increasing severity of the atherosclerosis burden. Moreover, the more severe the tibial vessel atherosclerosis, the higher the risk of HF and MACEs. The most extensive tibial atherosclerosis patients had an OR 4.5; 95%CI 2.6-8.0 for HF and an OR 3.1; and 95%CI 1.7-5.6 for MACEs overall. The femoropopliteal disease burden was also associated with an increased risk of HF (OR 2.3; 95%CI 1.6-3.2) and MACE (OR 1.9; 95%CI 1.3-2.7). However, the increasing extent of atherosclerosis of the femoropopliteal segment solely increased the risk of MACEs. CONCLUSIONS PAD patients with severe tibial atherosclerosis are likely to present with MACEs. The risk is further enhanced as the extent of tibial vessel atherosclerosis is increased. An association between MACE and severe atherosclerosis on the aortoiliac segment was not detected. However, when the femoropopliteal segment was the most affected artery segment, the risk of MACEs was increased.
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Affiliation(s)
- Oskari Niiranen
- Department of Surgery, University of Turku, 20520 Turku, Finland; (O.N.)
| | - Juha Virtanen
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, 00100 Helsinki, Finland; (J.V.); (M.V.)
| | - Ville Rantasalo
- Department of Surgery, University of Turku, 20520 Turku, Finland; (O.N.)
| | - Amer Ibrahim
- Department of Surgery, KFSHRC, King Faisal Specialist Hospital and Research Centre, Madinah 11211, Saudi Arabia;
| | - Maarit Venermo
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, 00100 Helsinki, Finland; (J.V.); (M.V.)
| | - Harri Hakovirta
- Department of Surgery, University of Turku, 20520 Turku, Finland; (O.N.)
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, 00100 Helsinki, Finland; (J.V.); (M.V.)
- Department of Surgery, Satasairaala, 28500 Pori, Finland
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16
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Bagheri A, Shirani S, Jalali A, Salehbeigi S, Bagheri J. Predictive factors of thoracic aortic calcification in patients candidate for cardiac surgery. J Cardiothorac Surg 2024; 19:152. [PMID: 38521956 PMCID: PMC10960493 DOI: 10.1186/s13019-024-02636-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 03/11/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND The presence of the severe thoracic aortic calcification (TAC) in cardiac surgery patients is associated with adverse post-operative outcome. However, the relationship between cardiovascular risk factors and aortic plaque burden remains unknown. The objective of this study was to determine the predictive factors of TAC in patients candidate for cardiac surgery. METHODS Patients who underwent thoracic CT scan prior to cardiac surgery between August 2020 to April 2021 were included. Of 556 patients, 209 (36.7%) had a thoracic aortic calcium score (TACS) ≥ 400 mm [3] and were compare with the remaining patients. Predictors of severe TAC were assessed through stepwise multivariable logistic regression analysis. RESULTS The patients with TACS ≥ 400 had a higher mean age (67.3 ± 7.1 vs. 55.7 ± 10.6; p < 0.001) with a higher frequency of diabetes mellitus (40.7% vs. 30.8%; p = 0.018), dyslipidemia (49.8% vs. 38.6%; p = 0.010), hypertension (60.8% vs. 44.7%; p < 0.001), opium addiction (18.2% vs. 11.2%; p = 0.023), peripheral vascular disease (PVD) (7.7% vs. 2.3%; p = 0.005) as compared with TACS < 400. The multiple determinants of TAC were PVD (OR = 2.86) followed by opium addiction, diabetes and age. CONCLUSIONS Thoracic CT scan prior to cardiac surgery for patients with older age, diabetes, opium addiction and PVD is recommended. Our study could serve as a foundation for future research endeavors aimed at establishing a risk score for TAC.
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Affiliation(s)
- Amin Bagheri
- Cardiovascular Diseases Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
- Cardiovascular Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shapour Shirani
- Cardiovascular Diseases Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Jalali
- Cardiovascular Diseases Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahrzad Salehbeigi
- Cardiovascular Diseases Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Jamshid Bagheri
- Cardiovascular Diseases Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Cardiac Surgery, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran.
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17
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McGinigle KL. Peripheral Vascular Disease. Prim Care 2024; 51:83-93. [PMID: 38278575 DOI: 10.1016/j.pop.2023.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
Peripheral artery disease is most often caused by atherosclerosis. Arterial insufficiency from atherosclerotic blockages in the limbs can impair walking distance and put patients with severe disease at risk of limb loss. Management of the disease centers around early diagnosis, supervised exercise therapy and lifestyle modification, optimizing medical care (with the goal of reducing fatal cardiac and cerebrovascular events), and revascularization.
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Affiliation(s)
- Katharine L McGinigle
- Division of Vascular Surgery, School of Medicine, University of North Carolina at Chapel Hill, 3021 Burnett Womack Building, Campus Box 7212, Chapel Hill, NC 27599, USA.
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18
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Kiss LZ, Nyárády BB, Pállinger É, Lux Á, Jermendy ÁL, Csobay-Novák C, Soós P, Szelid Z, Láng O, Kőhidai L, Dinya E, Dósa E, Merkely B, Bagyura Z. Association of growth and differentiation factor-15 with coronary artery calcium score and ankle-brachial index in a middle-aged and elderly Caucasian population sample free of manifest cardiovascular disease. GeroScience 2024; 46:1343-1350. [PMID: 37548881 PMCID: PMC10828406 DOI: 10.1007/s11357-023-00899-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/30/2023] [Indexed: 08/08/2023] Open
Abstract
Growth and differentiation factor-15 (GDF-15) is a stress-associated cytokine of the transforming growth factor-β superfamily. The inflammatory and angiogenic effects of GDF-15 in atherosclerosis are controversial, and its correlation with the long asymptomatic phase of the disease is not well understood. Coronary artery calcium score (CACS) and ankle-brachial index (ABI) are sensitive markers of subclinical atherosclerosis. To date, only a few studies have examined the impact of GDF-15 on coronary artery calcification, and the association between GDF-15 and ABI has not been evaluated. Therefore, we aimed to investigate the possible relationship between serum GDF-15 concentrations and CACS and ABI in a Caucasian population sample of middle-aged (35-65 years) and elderly (> 65 years) people. In addition to recording demographic and anthropometric characteristics, atherosclerotic risk factors, and laboratory tests including serum HDL-cholesterol, LDL-cholesterol, hemoglobin A1c (HbA1c), high-sensitivity C-reactive protein, and N-terminal pro-B-type natriuretic peptide (NT-proBNP); GDF-15 level, cardiac computed tomography, and ABI measurements were also performed. A total of 269 asymptomatic individuals (men, n = 125; median age, 61.5 [IQR, 12.7] years) formed the basis of this study. Participants were divided into two groups according to their age (middle-aged, n = 175 and elderly, n = 94). Hypertension and diabetes mellitus were significantly more prevalent and CACS values and HbA1c, NT-proBNP, and GDF-15 levels were significantly higher (all p < 0.001) in the elderly group compared to the middle-aged group. Multivariate ridge regression analysis revealed a significant positive association between GDF-15 and CACS (middle-aged group: β = 0.072, p = 0.333; elderly group: β = 0.148, p = 0.003), and between GDF-15 and ABI (middle-aged group: β = 0.062, p = 0.393; elderly group: β = 0.088, p = 0.041) only in the elderly group. Our results show that GDF-15 is not only a useful biomarker of inflammation but can also predict early signs of asymptomatic atherosclerosis, especially in elderly people with chronic systemic inflammation associated with aging (inflammaging).
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Affiliation(s)
- Loretta Zsuzsa Kiss
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary.
| | - Balázs Bence Nyárády
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Éva Pállinger
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, 4 Nagyvárad Square, 1089, Budapest, Hungary
| | - Árpád Lux
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
- Department of Cardiology, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University Medical Center, Maastricht, Netherlands
| | - Ádám Levente Jermendy
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Csaba Csobay-Novák
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Pál Soós
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Zsolt Szelid
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Orsolya Láng
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, 4 Nagyvárad Square, 1089, Budapest, Hungary
| | - László Kőhidai
- Department of Genetics, Cell- and Immunobiology, Semmelweis University, 4 Nagyvárad Square, 1089, Budapest, Hungary
| | - Elek Dinya
- Institute of Digital Health Sciences, Semmelweis University, 15 Ferenc Square, 1094, Budapest, Hungary
| | - Edit Dósa
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
| | - Zsolt Bagyura
- Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary
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19
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Prasad A, Choh AC, Gonzalez ND, Garcia M, Lee M, Watt G, Maria Vasquez L, Laing S, Wu S, McCormick JB, Fisher-Hoch S. A high burden of diabetes and ankle brachial index abnormalities exists in Mexican Americans in South Texas. Prev Med Rep 2024; 38:102604. [PMID: 38375159 PMCID: PMC10874877 DOI: 10.1016/j.pmedr.2024.102604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Revised: 01/06/2024] [Accepted: 01/08/2024] [Indexed: 02/21/2024] Open
Abstract
Ethnic differences exist in the United States in the interrelated problems of diabetes (DM), peripheral arterial disease (PAD), and leg amputations. The purpose of this study was to determine the prevalence and risk factor associations for subclinical PAD in a population sample of Mexican Americans using the ankle brachial (ABI) index. The ABI-High (higher of the two ankle pressures/highest brachial pressure) and ABI-Low (lower of the two ankle pressures/highest brachial pressure) were calculated to define PAD. Toe brachial index (TBI) was also calculated. 746 participants were included with an age of 53.4 ± 0.9 years, 28.3 % had diabetes mellitus (DM), 12.6 % were smokers, and 51.2 % had hypertension (HTN). Using ABI-High ≤ 0.9, the prevalence of PAD was 2.7 %. This rose to 12.7 % when an ABI-Low ≤ 0.9 was used; 4.0 % of the population had an ABI-High > 1.4. The prevalence of TBI < 0.7 was 3.9 %. DM was a significant risk factor for ABI-High ≤ 0.9 and ABI-High > 1.4, and TBI < 0.7. Increased age, HTN, smoking was associated with ABI-High ≤ 0.9, while being male was associated with ABI-High > 1.4. Increased age, smoking, and lower education were all associated with abnormal TBI. Despite relatively younger mean age than other studied Hispanic cohorts, the present population has a high burden of ABI abnormalities. DM was a consistent risk factor for PAD. These abnormalities indicate an important underlying substrate of vascular and metabolic disease that may predispose this population to the development of symptomatic PAD and incident amputations.
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Affiliation(s)
- Anand Prasad
- The University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Audrey C. Choh
- University of Texas School of Public Health Brownsville Regional Campus, USA
| | - Nelson D. Gonzalez
- University of Texas School of Public Health Brownsville Regional Campus, USA
| | - Marlene Garcia
- The University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Miryoung Lee
- University of Texas School of Public Health Brownsville Regional Campus, USA
| | - Gordon Watt
- Memorial Sloan Kettering Cancer Center, Department of Epidemiology and Biostatistics, India
| | | | - Susan Laing
- The University of Texas Health Science Center at Houston, USA
| | - Shenghui Wu
- The University of Texas Health Science Center San Antonio, San Antonio, TX, USA
| | - Joseph B. McCormick
- University of Texas School of Public Health Brownsville Regional Campus, USA
| | - Susan Fisher-Hoch
- University of Texas School of Public Health Brownsville Regional Campus, USA
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20
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Maruhashi T, Kajikawa M, Kishimoto S, Yamaji T, Harada T, Hashimoto Y, Mizobuchi A, Tanigawa S, Yusoff FM, Nakano Y, Chayama K, Nakashima A, Goto C, Higashi Y. Percentage of mean arterial pressure as a marker of atherosclerosis for detecting patients with coronary artery disease. Hypertens Res 2024; 47:281-290. [PMID: 37794241 PMCID: PMC10838767 DOI: 10.1038/s41440-023-01442-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 08/18/2023] [Accepted: 09/04/2023] [Indexed: 10/06/2023]
Abstract
The percentage of mean arterial pressure (%MAP) is the height of the mean arterial waveform divided by the peak amplitude of the waveform of pulse volume recording. The purpose of this study was to determine whether the cutoff value of 45% for %MAP at the ankle, which is recommended for the diagnosis of lower extremity artery disease, in combination with ankle-brachial index (ABI) is useful for detecting patients with clinical coronary artery disease (CAD) and investigate the optimal cutoff value of %MAP to diagnose patients with CAD. We measured ABI and %MAP in 2213 subjects (mean age: 61.2 ± 15.5 years). Multivariate analysis revealed that %MAP ≥ 45% was significantly associated with a higher risk of CAD after adjusting for traditional cardiovascular risk factors (odds ratio [OR], 2.14; 95% confidence interval [CI], 1.43-3.21; p < 0.001). However, the association was no longer significant after adjusting for ABI (OR, 1.39; 95% CI, 0.83-2.33; p = 0.21), whereas ABI was significantly associated with CAD (OR, 0.98; 95% CI, 0.97-0.99; p = 0.005). The optimal cutoff value of %MAP derived from a receiver operating characteristic curve to diagnose CAD was 40.3%. Multivariate analysis revealed that %MAP ≥ 40.3% was significantly associated with a higher risk of CAD (OR, 1.63; 95% CI, 1.19-2.24; p = 0.002) independent of ABI (OR, 0.98; 95% CI, 0.97-0.99; p = 0.002). The cutoff value of 40.3%, but not 45%, for %MAP may be useful for detecting patients with advanced atherosclerosis and for cardiovascular risk assessment independent of ABI. REGISTRATION INFORMATION: http://www.umin.ac.jp (University Hospital Medical Information Network Clinical Trials Registry) (UMIN000039512).
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Affiliation(s)
- Tatsuya Maruhashi
- Department of Regenerative Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, Japan
| | - Masato Kajikawa
- Division of Regeneration and Medicine, Medical Center for Translational and Clinical Research, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima, Japan
| | - Shinji Kishimoto
- Department of Regenerative Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, Japan
| | - Takayuki Yamaji
- Department of Regenerative Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, Japan
| | - Takahiro Harada
- Department of Regenerative Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, Japan
| | - Yu Hashimoto
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, Japan
| | - Aya Mizobuchi
- Department of Regenerative Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, Japan
| | - Shunsuke Tanigawa
- Department of Regenerative Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, Japan
| | - Farina Mohamad Yusoff
- Department of Regenerative Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, Japan
| | - Kazuaki Chayama
- Department of Medicine and Molecular Science, Hiroshima University Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, Japan
| | - Ayumu Nakashima
- Department of Stem Cell Biology and Medicine, Graduate School of Biomedical and Sciences, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, Japan
| | - Chikara Goto
- Department of Rehabilitation, Faculty of general Rehabilitation, Hiroshima International University, 555-36, Kurosegakuendai, Higashihiroshima, Japan
| | - Yukihito Higashi
- Department of Regenerative Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, Japan.
- Division of Regeneration and Medicine, Medical Center for Translational and Clinical Research, Hiroshima University Hospital, 1-2-3, Kasumi, Minami-ku, Hiroshima, Japan.
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21
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Carvalho TD, Freitas OGAD, Chalela WA, Hossri CAC, Milani M, Buglia S, Precoma DB, Falcão AMGM, Mastrocola LE, Castro I, Albuquerque PFD, Coutinho RQ, Brito FSD, Alves JDC, Serra SM, Santos MAD, Colombo CSSDS, Stein R, Herdy AH, Silveira ADD, Castro CLBD, Silva MMFD, Meneghello RS, Ritt LEF, Malafaia FL, Marinucci LFB, Pena JLB, Almeida AEMD, Vieira MLC, Stier Júnior AL. Brazilian Guideline for Exercise Test in the Adult Population - 2024. Arq Bras Cardiol 2024; 121:e20240110. [PMID: 38896581 PMCID: PMC11656589 DOI: 10.36660/abc.20240110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024] Open
Affiliation(s)
- Tales de Carvalho
- Clínica de Prevenção e Reabilitação Cardiosport, Florianópolis, SC - Brasil
- Universidade do Estado de Santa Catarina, Florianópolis, SC - Brasil
| | | | - William Azem Chalela
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP - Brasil
| | | | - Mauricio Milani
- Universidade de Brasília (UnB), Brasília, DF, Brasil
- Hasselt University, Hasselt - Bélgica
- Jessa Ziekenhuis, Hasselt - Bélgica
| | - Susimeire Buglia
- Instituto Dante Pazzanese de Cardiologia, São Paulo, SP - Brasil
| | | | - Andréa Maria Gomes Marinho Falcão
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP - Brasil
| | | | - Iran Castro
- Instituto de Cardiologia do Rio Grande do Sul, Porto Alegre, RS - Brasil
| | | | | | | | | | - Salvador Manoel Serra
- Instituto Estadual de Cardiologia Aloysio de Castro (IECAC), Rio de Janeiro, RJ - Brasil
| | - Mauro Augusto Dos Santos
- Instituto Nacional de Cardiologia do Rio de Janeiro, Rio de Janeiro, RJ - Brasil
- Linkcare Saúde, Rio de Janeiro, RJ - Brasil
| | | | - Ricardo Stein
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
| | - Artur Haddad Herdy
- Clínica de Prevenção e Reabilitação Cardiosport, Florianópolis, SC - Brasil
| | - Anderson Donelli da Silveira
- Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS - Brasil
- Hospital de Clínicas de Porto Alegre, Porto Alegre, RS - Brasil
- Hospital Moinhos de Vento, Porto Alegre, RS - Brasil
| | - Claudia Lucia Barros de Castro
- Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ - Brasil
- CLINIMEX - Clínica de Medicina de Exercício, Rio de Janeiro, RJ - Brasil
| | | | | | - Luiz Eduardo Fonteles Ritt
- Escola Bahiana de Medicina e Saúde Pública, Salvador, BA - Brasil
- Instituto D'Or de Pesquisa e Ensino, Salvador, BA - Brasil
- Hospital Cárdio Pulmonar, Salvador, BA - Brasil
| | - Felipe Lopes Malafaia
- Hospital Samaritano Paulista, São Paulo, SP - Brasil
- UnitedHealth Group Brasil, São Paulo, SP - Brasil
| | - Leonardo Filipe Benedeti Marinucci
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP - Brasil
| | - José Luiz Barros Pena
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG - Brasil
- Hospital Felício Rocho, Belo Horizonte, MG - Brasil
| | | | - Marcelo Luiz Campos Vieira
- Instituto do Coração do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (InCor-HCFMUSP), São Paulo, SP - Brasil
- Hospital Israelita Albert Einstein, São Paulo, SP - Brasil
| | - Arnaldo Laffitte Stier Júnior
- Universidade Federal do Paraná (UFPR), Curitiba, PR - Brasil
- Secretaria Municipal de Saúde Curitiba, Curitiba, PR - Brasil
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22
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Laukka D, Kangas E, Kuusela A, Hirvonen J, Rissanen T, Rahi M, Kivelev J, Rantasalo V, Venermo M, Rinne J, Hakovirta H. Low and Borderline Ankle-Brachial Index Is Associated With Intracranial Aneurysms: A Retrospective Cohort Study. Neurosurgery 2024; 94:00006123-990000000-01031. [PMID: 38270446 PMCID: PMC11073771 DOI: 10.1227/neu.0000000000002837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/24/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND AND OBJECTIVES A low ankle-brachial index (ABI) has been linked to systemic inflammation and an elevated risk of cardiovascular events, most notably myocardial infarction and stroke. Intracranial aneurysms (IAs) share similar risk factors with other cardiovascular diseases. However, the association between low ABI and IAs has not been sufficiently investigated. Our objective was to investigate the potential connection between ABI values and the prevalence of unruptured IAs. METHODS This retrospective cohort study reviewed 2751 patients who had ABI measurements at a public tertiary hospital from January 2011 to December 2013. Patients with available cerebrovascular imaging or a diagnosis of ruptured IA were included in the study (n = 776) to examine the association between ABI and saccular IAs. The patients were classified into 4 groups: low ABI (≤0.9, n = 464), borderline ABI (0.91-0.99; n = 47), high ABI (>1.4, n = 57), and normal ABI (1.00-1.40; n = 208). RESULTS The prevalence of IAs was 20.3% (18.1% unruptured IAs) in the low ABI group, 14.9% (12.8% unruptured IAs) in the borderline ABI group, 7.0% (5.3% unruptured IAs) in the high ABI group, and 2.4% (1.9% unruptured IAs) in the normal ABI group (P < .001). There were no significant differences in the prevalence of ruptured IAs between the ABI groups (P = .277). Sex- and age-adjusted multinomial regression, including clinically relevant variables, revealed that low ABI (odds ratio [OR], 13.02; 95% CI, 4.01-42.24), borderline ABI (OR, 8.68; 95% CI, 2.05-36.69), and smoking history (OR, 2.01; 95% CI, 1.07-3.77) were associated with unruptured IAs. CONCLUSION The prevalence of unruptured IAs was 9-fold higher in the low ABI group and nearly 7-fold higher in the borderline ABI group when compared with the normal ABI group. ABI measurements could be clinically relevant for identifying individuals at higher risk of IAs and may help guide screening and preventive strategies.
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Affiliation(s)
- Dan Laukka
- Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
- Clinical Neurosciences, University of Turku, Turku, Finland
| | - Essi Kangas
- Department of Surgery, University of Turku, Turku, Finland
- Department of Vascular Surgery, Turku University Hospital, Turku, Finland
| | - Aino Kuusela
- Department of Surgery, University of Turku, Turku, Finland
| | - Jussi Hirvonen
- Department of Radiology, Turku University Hospital and University of Turku, Turku, Finland
- Department of Radiology, University of Tampere, Tampere, Finland
| | - Tiia Rissanen
- Department of Clinical Medicine, Biostatistics, University of Turku, Turku, Finland
- Department of Biostatistics, University of Turku and Turku University Hospital, Turku, Finland
| | - Melissa Rahi
- Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
- Clinical Neurosciences, University of Turku, Turku, Finland
| | - Juri Kivelev
- Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
- Clinical Neurosciences, University of Turku, Turku, Finland
| | - Ville Rantasalo
- Department of Surgery, University of Turku, Turku, Finland
- Department of Vascular Surgery, Turku University Hospital, Turku, Finland
| | - Maarit Venermo
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jaakko Rinne
- Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
- Clinical Neurosciences, University of Turku, Turku, Finland
| | - Harri Hakovirta
- Department of Surgery, University of Turku, Turku, Finland
- Department of Vascular Surgery, Turku University Hospital, Turku, Finland
- Department of Surgery, Satasairaala, Pori, Finland
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23
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Poredos P, Stanek A, Catalano M, Boc V. Ankle-Brachial Index: Diagnostic Tool of Peripheral Arterial Disease and Predictor of Cardiovascular Risk-An Update of Current Knowledge. Angiology 2024:33197241226512. [PMID: 38176685 DOI: 10.1177/00033197241226512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2024]
Abstract
The ankle-brachial index (ABI) was introduced as a screening method for the diagnosis of lower extremity peripheral arterial disease (PAD). Later findings recognized ABI as a prognostic marker of adverse cardiovascular events due to its relation to atherosclerosis in other vascular territories. This narrative review aims to appraise the validity, reliability, and utility of ABI in the detection of PAD and the determination of global atherosclerotic cardiovascular risk. While the ABI value can be influenced by different physiological characteristics including age, sex, body position, and techniques used for ABI determination, it has high specificity and reproducibility in the assessment of vascular patients. In conclusion, when used correctly, the ABI remains a reliable and invaluable indicator of lower-limb perfusion and a useful tool for predicting the risk of future cardiovascular events. However, its underutilization in clinical settings is noteworthy.
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Affiliation(s)
- Pavel Poredos
- Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Milan, Italy
| | - Agata Stanek
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Milan, Italy
- Department of Internal Medicine, Angiology and Physical Medicine, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Bytom, Poland
| | - Mariella Catalano
- VAS-European Independent Foundation in Angiology/Vascular Medicine, Milan, Italy
- Inter-University Research Centre on Vascular Diseases, University of Milan, Milan, Italy
| | - Vinko Boc
- Department of Vascular Diseases, University Medical Centre Ljubljana, Ljubljana, Slovenia
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24
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Garg PK, Bhatia HS, Allen TS, Grainger T, Pouncey AL, Dichek D, Virmani R, Golledge J, Allison MA, Powell JT. Assessment of Subclinical Atherosclerosis in Asymptomatic People In Vivo: Measurements Suitable for Biomarker and Mendelian Randomization Studies. Arterioscler Thromb Vasc Biol 2024; 44:24-47. [PMID: 38150519 PMCID: PMC10753091 DOI: 10.1161/atvbaha.123.320138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
BACKGROUND One strategy to reduce the burden of cardiovascular disease is the early detection and treatment of atherosclerosis. This has led to significant interest in studies of subclinical atherosclerosis, using different phenotypes, not all of which are accurate reflections of the presence of asymptomatic atherosclerotic plaques. The aim of part 2 of this series is to provide a review of the existing literature on purported measures of subclinical disease and recommendations concerning which tests may be appropriate in the prevention of incident cardiovascular disease. METHODS We conducted a critical review of measurements used to infer the presence of subclinical atherosclerosis in the major conduit arteries and focused on the predictive value of these tests for future cardiovascular events, independent of conventional cardiovascular risk factors, in asymptomatic people. The emphasis was on studies with >10 000 person-years of follow-up, with meta-analysis of results reporting adjusted hazard ratios (HRs) with 95% CIs. The arterial territories were limited to carotid, coronary, aorta, and lower limb arteries. RESULTS In the carotid arteries, the presence of plaque (8 studies) was independently associated with future stroke (pooled HR, 1.89 [1.04-3.44]) and cardiac events (7 studies), with a pooled HR, 1.77 (1.19-2.62). Increased coronary artery calcium (5 studies) was associated with the risk of coronary heart disease events, pooled HR, 1.54 (1.07-2.07) and increasing severity of calcification (by Agaston score) was associated with escalation of risk (13 studies). An ankle/brachial index (ABI) of <0.9, the pooled HR for cardiovascular death from 7 studies was 2.01 (1.43-2.81). There were insufficient studies of either, thoracic or aortic calcium, aortic diameter, or femoral plaque to synthesize the data based on consistent reporting of these measures. CONCLUSIONS The presence of carotid plaque, coronary artery calcium, or abnormal ankle pressures seems to be a valid indicator of the presence of subclinical atherosclerosis and may be considered for use in biomarker, Mendelian randomization and similar studies.
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Affiliation(s)
- Parveen K Garg
- Division of Cardiology, University of Southern California, Keck School of Medicine, Los Angeles (G.P.)
| | - Harpreet S Bhatia
- Division of Cardiovascular Medicine, University of California San Diego (B.H., A.T., A.M.A.)
| | - Tara S Allen
- Division of Cardiovascular Medicine, University of California San Diego (B.H., A.T., A.M.A.)
| | - Tabitha Grainger
- Department of Surgery & Cancer, Imperial College London (G.T., P.A.-L., P.J.T.)
| | - Anna L Pouncey
- Department of Surgery & Cancer, Imperial College London (G.T., P.A.-L., P.J.T.)
| | - David Dichek
- Division of Cardiology, Department of Medicine, University of Washington, Seattle (D.D.)
| | | | - Jonathan Golledge
- Queensland Research Centre for Peripheral Vascular Disease, James Cook University and Townsville University Hospital, Australia (G.J.)
| | - Matthew A Allison
- Division of Cardiovascular Medicine, University of California San Diego (B.H., A.T., A.M.A.)
| | - Janet T Powell
- Department of Surgery & Cancer, Imperial College London (G.T., P.A.-L., P.J.T.)
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25
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Tang R, Liu Y, Chen J, Deng J, Liu Y, Xu Q. Association of a low ankle brachial index with progression to end-stage kidney disease in patients with advanced-stage diabetic kidney disease. Ren Fail 2023; 45:2160347. [PMID: 36632822 PMCID: PMC9848234 DOI: 10.1080/0886022x.2022.2160347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTIONS The effect of a low ankle-brachial index (ABI) in patients with advanced-stage diabetic kidney disease is not fully understood. This study investigates the prevalence of a low ABI in patients with advanced-stage diabetic kidney disease, which was defined as a urinary albumin-to-creatinine ratio (UACR) ≥300 mg/g and an estimated glomerular filtration rate (eGFR) between 15-60 mL/min/1.73 m2. Furthermore, the association between a low ABI and end-stage kidney disease (ESKD) was determined. METHODS This single-center, retrospective, cohort study included 529 patients with advanced-stage diabetic kidney disease who were stratified into groups according to the ABI: high (>1.3), normal (0.9-1.3), and low (<0.9). The Kaplan-Meier method and Cox proportional analysis were used to examine the association between the ABI and ESKD. RESULTS A total of 42.5% of patients with a low ABI progressed to ESKD. A low ABI was associated with a greater risk of ESKD (hazard ratio (HR): 1.073). After adjusting for traditional chronic kidney disease risk factors, a low ABI remained associated with a greater risk of ESKD (HR: 1.758; 95% confidence interval: 1.243-2.487; p = 0.001). CONCLUSIONS These results indicate that patients with a low ABI should be monitored carefully. Furthermore, preventive therapy should be considered to improve the long-term kidney survival of patients with residual kidney function.
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Affiliation(s)
- Ruiying Tang
- Department of Nephrology, Jiangmen Central Hospital, Jiangmen City, China
| | - Yun Liu
- Department of Nephrology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou City, China
| | - Jiexin Chen
- Department of Nephrology, Jiangmen Central Hospital, Jiangmen City, China
| | - Jihong Deng
- Department of Nephrology, Jiangmen Central Hospital, Jiangmen City, China
| | - Yan Liu
- Department of Nephrology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou City, China
| | - Qingdong Xu
- Department of Nephrology, Jiangmen Central Hospital, Jiangmen City, China,CONTACT Qingdong Xu Department of Nephrology, Jiangmen Central Hospital, Jiangmen City, China
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26
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Shah AJ, Pavlatos N, Kalra DK. Preventive Therapies in Peripheral Arterial Disease. Biomedicines 2023; 11:3157. [PMID: 38137379 PMCID: PMC10741180 DOI: 10.3390/biomedicines11123157] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 11/16/2023] [Accepted: 11/21/2023] [Indexed: 12/24/2023] Open
Abstract
Atherosclerosis, while initially deemed a bland proliferative process, is now recognized as a multifactorial-lipoprotein-mediated inflammation-driven pathway. With the rising incidence of atherosclerotic disease of the lower extremity arteries, the healthcare burden and clinical morbidity and mortality due to peripheral artery disease (PAD) are currently escalating. With a healthcare cost burden of over 21 billion USD and 200 million patients afflicted worldwide, accurate knowledge regarding the pathophysiology, presentation, and diagnosis of the disease is crucial. The role of lipoproteins and their remnants in atherosclerotic vessel occlusion and plaque formation and progression has been long established. This review paper discusses the epidemiology, pathophysiology, and presentation of PAD. PAD has been repeatedly noted to portend to poor cardiovascular and limb outcomes. We discuss major therapeutic avenues for the prevention of major cardiovascular adverse events and major limb adverse events in patients with PAD.
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Affiliation(s)
- Aangi J. Shah
- Department of Internal Medicine, University of Louisville School of Medicine, Louisville, KY 40202, USA; (A.J.S.); (N.P.)
| | - Nicholas Pavlatos
- Department of Internal Medicine, University of Louisville School of Medicine, Louisville, KY 40202, USA; (A.J.S.); (N.P.)
| | - Dinesh K. Kalra
- Division of Cardiology, University of Louisville School of Medicine, Louisville, KY 40202, USA
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27
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Meng Z, Jiang Y, Xu C, Zheng H, Li H. Association between ankle-brachial blood pressure index with all-cause and cardiovascular mortality in adults without arterial stiffness. BMC Geriatr 2023; 23:635. [PMID: 37814212 PMCID: PMC10563285 DOI: 10.1186/s12877-023-04332-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/20/2023] [Indexed: 10/11/2023] Open
Abstract
PURPOSE To explore the relationship between ankle-brachial blood pressure index (ABPI) and all-cause or cardiovascular mortality in adults without arterial stiffness. METHODS A total of 6784 participants without arterial stiffness were enrolled from National Health and Nutrition Examination Survey 1999-2004. The hazard ratio (HR) and 95% confidence interval (CI) of ABPI associating with the risk of all-cause and cardiovascular mortality was calculated by Cox proportional regression models adjusted for demographic and traditional risk factors. Dose-response relationship was explored with restricted cubic spines. RESULTS After an average follow-up of 12.1 years, 1844 all-cause deaths and 299 cardiovascular deaths occurred. Compared with the lowest ABPI quartile, the second quartile was associated with the lowest risk of all-cause mortality (HR 0.89, 95%CI 0.79-0.98; p = 0.036) and cardiovascular mortality (HR 0.75, 95%CI 0.56-0.98; p = 0.048). Besides, dose-response analysis revealed that ABPI was nonlinearly correlated to all-cause mortality (p for nonlinearity < 0.001) and linearly correlated to cardiovascular mortality (p for nonlinearity = 0.459). CONCLUSIONS The relationship between ABPI and all-cause and cardiovascular mortality followed a L-shape curve. A lower ABPI was independently associated with an increased risk of all-cause and cardiovascular mortality in adults without arterial stiffness.
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Affiliation(s)
- Zhe Meng
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yaohui Jiang
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Chang Xu
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Huifen Zheng
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Haiyu Li
- Department of Cardiology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
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Zheng M, Zhang X, Zhao Q, Chen S, Guo X, Wang C, Jonas JB, Wu S, Guo C. The impact of bilateral brachial-ankle pulse wave velocity difference on cardiovascular disease and all-cause mortality. Front Cardiovasc Med 2023; 10:1234325. [PMID: 37868781 PMCID: PMC10588177 DOI: 10.3389/fcvm.2023.1234325] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 09/21/2023] [Indexed: 10/24/2023] Open
Abstract
Background This study aims to investigate the association between an elevated bilateral pulse wave velocity difference (BPWVD) and cardiovascular diseases (CVDs) and all-cause mortality. Methods This study included a total of 38,356 participants. A multivariable Cox proportional hazards regression was used to assess the association between high BPWVD and the increased risk of CVDs and all-cause mortality by calculating hazard ratios (HRs) with 95% confidence intervals. Results A total of 1,213 cases of CVDs were identified over a mean duration of 6.19 years, including 886 cases of cerebral infarction (CI), 105 cases of intracerebral hemorrhage (ICH), and 222 cases of myocardial infarction (MI), along with 1,182 cases of all-cause mortality. The median BPWVD was 42 cm/s (19-80 cm/s). After adjusting for all confounders and baseline brachial-ankle PWV (baPWV), our analysis revealed a significant correlation between a higher risk of CVDs, MI, and all-cause mortality with an increase in BPWVD per standard deviation. HRs (95% confidence interval) were found to be 1.06 (1.01-1.11), 1.11 (1.02-1.21), and 1.07 (1.04-1.10), respectively. Among the participants with higher baPWV on the left side, the HRs (95% confidence interval) were 1.08 (1.02-1.14) for CVDs, 1.27 (1.10-1.46) for incident ICH, 1.16 (1.00-1.24) for incident MI, and 1.10 (1.07-1.15) for all-cause mortality, for per standard deviation increase in BPWVD. Conclusions Our findings reveal a significant correlation between elevated BPWVD and the risks of developing CVDs and all-cause mortality. This highlights the importance of thoroughly evaluating BPWVD as a means of detecting individuals at risk for CVDs and mortality.
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Affiliation(s)
- Mengyi Zheng
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xinyuan Zhang
- Channing Division of Network Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, United States
| | - Quanhui Zhao
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Shuohua Chen
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Xinying Guo
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Chi Wang
- Department of Cardiology, the Sixth Medical Center, Chinese PLA General Hospital, Beijing, China
| | - Jost B. Jonas
- Department of Ophthalmology, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Shouling Wu
- Department of Cardiology, Kailuan General Hospital, Tangshan, China
| | - Caixia Guo
- Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Artyszuk Ł, Błażejowska E, Danielecka Z, Jurek J, Olek E, Abramczyk P. Peripheral atherosclerosis evaluation through ultrasound: A promising diagnostic tool for coronary artery disease. Echocardiography 2023; 40:841-851. [PMID: 37464959 DOI: 10.1111/echo.15652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/08/2023] [Accepted: 07/07/2023] [Indexed: 07/20/2023] Open
Abstract
Effective treatment, but also proper diagnosis of cardiovascular diseases, remains a major challenge in everyday practice. A quick, safe, and economically acceptable non-invasive procedure should play a leading role in cardiovascular risk assessment before invasive diagnostics is performed. The staging of subclinical atherosclerosis may help in further clinical decisions. Safe, widely available, and relatively inexpensive, ultrasonography is a promising examination that should find wider application in clinical practice. The latest ESC guidelines emphasize the usefulness of carotid ultrasound in the diagnosis of coronary artery disease (CAD) and subclinical assessment of atherosclerosis, which help to determine the level of cardiovascular risk. Ultrasound examination of peripheral arteries, especially superficial vessels such as the femoral arteries, is quite easy, quick, and accurate. Other vascular beds, such as iliac and renal, are more demanding to examine, but can also provide valuable information. This review summarizes important studies comparing the severity of atherosclerosis in ultrasound-visible vascular beds in patients with established CAD. We especially emphasize the benefits of the combined assessment of atherosclerosis features, which were characterized by high sensitivity and specificity in the diagnosis of CAD and other serious cardiovascular diseases.
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Affiliation(s)
- Łukasz Artyszuk
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Ewelina Błażejowska
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Zuzanna Danielecka
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Jonasz Jurek
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Ewa Olek
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Abramczyk
- Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland
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Wang SH, Shyu VBH, Chiu WK, Huang RW, Lai BR, Tsai CH. An Overview of Clinical Examinations in the Evaluation and Assessment of Arterial and Venous Insufficiency Wounds. Diagnostics (Basel) 2023; 13:2494. [PMID: 37568858 PMCID: PMC10417660 DOI: 10.3390/diagnostics13152494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 08/13/2023] Open
Abstract
Arterial and venous insufficiency are two major causes of chronic wounds with different etiology, pathophysiology, and clinical manifestations. With recent advancements in clinical examination, clinicians are able to obtain an accurate diagnosis of the underlying disease, which plays an important role in the treatment planning and management of patients. Arterial ulcers are mainly caused by peripheral artery diseases (PADs), which are traditionally examined by physical examination and non-invasive arterial Doppler studies. However, advanced imaging modalities, such as computed tomography angiography (CTA) and indocyanine green (ICG) angiography, have become important studies as part of a comprehensive diagnostic process. On the other hand, chronic wounds caused by venous insufficiency are mainly evaluated by duplex ultrasonography and venography. Several scoring systems, including Clinical-Etiology-Anatomy-Pathophysiology (CEAP) classification, the Venous Clinical Severity Score (VCSS), the Venous Disability Score, and the Venous Segmental Disease Score (VSDS) are useful in defining disease progression. In this review, we provide a comprehensive overlook of the most widely used and available clinical examinations for arterial and venous insufficiency wounds.
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Affiliation(s)
- Szu-Han Wang
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan; (S.-H.W.); (V.B.-H.S.); (B.-R.L.)
- Graduate Institute of Biomedical Informatics, Taipei Medical University, Taipei 110, Taiwan
| | - Victor Bong-Hang Shyu
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan; (S.-H.W.); (V.B.-H.S.); (B.-R.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Wen-Kuan Chiu
- Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan;
- Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan
| | - Ren-Wen Huang
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
- Division of Trauma Plastic Surgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Bo-Ru Lai
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan; (S.-H.W.); (V.B.-H.S.); (B.-R.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
| | - Chia-Hsuan Tsai
- Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Keelung Branch, Keelung 204, Taiwan; (S.-H.W.); (V.B.-H.S.); (B.-R.L.)
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan;
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Lanzer P, Ferraresi R. Medial Sclerosis-Epidemiology and Clinical Significance. DEUTSCHES ARZTEBLATT INTERNATIONAL 2023; 120:365-372. [PMID: 36978268 PMCID: PMC10413967 DOI: 10.3238/arztebl.m2023.0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 02/07/2022] [Accepted: 03/07/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND Medial sclerosis (MeS) is a chronic systemic vascular disease that mainly affects the arteries of the lower limb. Its prevalence in the general population is approximately 2.5% (range: 1.6% to 10.0%). It is more common in men than in women. METHODS This review is based on pertinent publications retrieved by a selective search in PubMed. RESULTS MeS is the final common pathway of a wide variety of diseases; its pathogenesis is not fully understood. It often remains clinically silent for decades and is usually diagnosed as an incidental finding or in a late stage. MeS with or without atherosclerosis is the most common histologic finding after limb amputation. MeS of the below-the-knee arteries is a major risk factor for chronic critical leg ischemia (OR:13.25, 95% confidence interval: [1.69; 104.16]) and amputation (RR 2.27, [1.89; 2.74]). Patients with peripheral arterial occlusive disease and marked calcification have a much higher risk of amputation (OR 2.88, [1.18; 12.72]) and a higher mortality (OR 5.16, [1.13; 21.61]). MeS is a risk factor for the failure of endovascular treatment of the pedal arteries (OR 4.0, [1.1; 16.6]). The more marked the calcification, the higher the risk of major amputation (HR 10.6 [1.4; 80.7] to HR 15.5 [2.0; 119]). Patients with vascular calcifications have been found to have lower patency rates and higher treatment failure rates two years after open surgical revascularization of the below-the-knee arteries. No pharmacotherapy for MeS is available to date. CONCLUSION MeS is an important risk factor for chronic critical lower limb ischemia, amputation, morbidity, and complications, particularly after endovascular and surgical procedures.
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Affiliation(s)
- Peter Lanzer
- Middle German Heart Center-Bitterfeld, Bitterfeld-Wolfen Health Care Center, Bitterfeld, Germany
| | - Roberto Ferraresi
- Diabetic Foot Unit, Clinica San Carlo, Paderno Dugnano, Milan, Italy
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Bethel M, Annex BH. Peripheral arterial disease: A small and large vessel problem. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 28:100291. [PMID: 38511071 PMCID: PMC10945902 DOI: 10.1016/j.ahjo.2023.100291] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/22/2024]
Abstract
Peripheral arterial disease (PAD) is one clinical manifestation of systemic atherosclerosis and is very common. Despite its prevalence, PAD remains underdiagnosed, undertreated, and understudied. The most common symptom in patients with PAD is intermittent claudication (IC), or pain in the lower extremities with walking or exertion, which is relieved after a short period of rest. Many patients with confirmed PAD are asymptomatic or have symptoms other than IC. Regardless of symptoms, patients with PAD have poor cardiovascular outcomes. PAD has largely been viewed a disease of large vessel atherosclerosis but what is becoming clear is that arterial plaques and occlusions are only one piece of the puzzle. Recent work has shown that abnormalities in the microvasculature contribute to the outcome of patients with PAD. From the perspective of the leg, limitation in blood flow is not the only problem as patients have a myriad of other problems, including muscle fibrosis, neuropathic changes, changes in the cellular respiration machinery and dysfunction of the small vessels that perfuse skeletal muscle and the supporting structures. Supervised exercise training remains one of the most effective tool to treat patients with PAD, however, the mechanisms behind its effectiveness are still being elucidated and use of structured exercise programs is not widespread. Medical therapy to treat systemic atherosclerosis is underutilized in patients with PAD. Invasive therapies are used only when patients with PAD have reached an advanced stage. While invasive strategies are effective in some patients with PAD, these strategies are costly, carry risk, and many patients are not amenable to invasive therapy. Appreciating the complex pathophysiology of PAD will hopefully spur new research and development of effective therapies for PAD.
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Affiliation(s)
- Monique Bethel
- Department of Medicine, Division of Cardiology, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Brian H. Annex
- Department of Medicine, Division of Cardiology, Medical College of Georgia, Augusta University, Augusta, GA, USA
- Vascular Biology Center, Medical College of Georgia, Augusta University, Augusta, GA, USA
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Chaturvedi A, Castro-Dominguez Y, Gertz ZM, Lawson BD, Chandrika P, Gupta R, Milioglou I, Sung JG, Desai NR, Vetrovec G, Kochar A, Guha A. Patterns of Care and Outcomes of Ambulatory Endovascular Interventions in Lower Extremity Peripheral Arterial Disease. Am J Cardiol 2023; 194:17-26. [PMID: 36924641 DOI: 10.1016/j.amjcard.2023.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 01/18/2023] [Accepted: 02/06/2023] [Indexed: 03/18/2023]
Abstract
Lower extremity endovascular intervention (LE-EVI) is gaining popularity as the primary treatment modality for patients with symptomatic peripheral artery disease refractory to noninvasive management. We examined the contemporary patterns of care, regional variation, and outcomes of ambulatory LE-EVI in the United States. The National Ambulatory Surgery Sample was analyzed to identify 266,563 records with peripheral artery disease and LE-EVI between January 1, 2016 and December 31, 2017. The mean age of the study cohort was 68.9 years and 40.5% were women. The majority of the endovascular interventions were performed at large (58.1%), urban teaching (64.1%), private not-for-profit (76.8%) centers, and the southern region accounted for most cases (43%). Periprocedural major adverse renal and cardiovascular events and other complications were 0.5% and 3.3%, respectively. Most patients (97.6%) were discharged home after the procedure. Age, female gender, uncontrolled hypertension, ischemic heart disease, heart failure, arrhythmia, chronic kidney disease, malnutrition, non-Medicare insurance, private for-profit, urban teaching facilities, and southern and midwest regions were associated with higher odds of major adverse renal and cardiovascular events. The mean charges per patient encounter were $56,500, with significant differences across various patient and facility characteristics. In conclusion, our study demonstrates the use, patterns of care, financial aspect, and overall safety of ambulatory LE-EVIs in a real-world setting.
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Affiliation(s)
| | | | - Zachary M Gertz
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Barbara D Lawson
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Parul Chandrika
- Department of Medicine, East Carolina University, Greenville, North Carolina
| | - Rahul Gupta
- Division of Cardiology, Lehigh Valley Health Network, Allentown, Pennsylvania
| | | | - Jonathan G Sung
- Division of Cardiology, Brigham & Women's Hospital, Boston, Massachusetts
| | - Nihar R Desai
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, Connecticut
| | - George Vetrovec
- Pauley Heart Center, Virginia Commonwealth University, Richmond, Virginia
| | - Ajar Kochar
- Division of Cardiology, Brigham & Women's Hospital, Boston, Massachusetts
| | - Avirup Guha
- Division of Cardiology, Medical College of Georgia, Augusta, Georgia
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Tedla YG, Driver S, Szklo M, Kuller L, Lima JA, Michos ED, Ning H, deFilippi CR, Greenland P. Joint effect of highly-sensitive cardiac troponin T and ankle-brachial index on incident cardiovascular events: The MESA and CHS. Am J Prev Cardiol 2023; 13:100471. [PMID: 36873803 PMCID: PMC9975219 DOI: 10.1016/j.ajpc.2023.100471] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 12/17/2022] [Accepted: 02/03/2023] [Indexed: 02/13/2023] Open
Abstract
Background Elevated highly-sensitive cardiac troponin-T (hs-cTnT≥14 ng/L) and low ankle-brachial index (ABI<0.9) are risk factors for atherosclerotic cardiovascular diseases (ASCVD) but their joint effect on the risk of ASCVD events is unknown. Methods We used data from the two population-based cohort studies, the Multi-Ethnic study of Atherosclerosis (MESA) and Cardiovascular Heart Study (CHS) among 10,897 participants free of CVD events at baseline (mean age 66.3 years, 44.7% males). Incident ASCVD was defined as CHD (fatal/non-fatal MI or revascularization), transient ischemic attack, or stroke,. Hazard ratio (HR) and 95% CI was calculated from a Cox regression model. Interaction on the additive scale was assessed using relative excess risk due to interaction (RERI) and interaction on the multiplicative scale was assessed by Likelihood ratio (LR) test. Results At baseline (2000-2002 for MESA and 1989-1990 for CHS), 10.2% of participants had elevated hs-cTnT and 7.5% had low ABI. During a median follow-up of 13.6 years (interquartile range, 7.5-14.7 years), there were 2590 incident ASCVD and 1542 incident CHD events. The hazard of CHD and ASCVD was higher in participants with both elevated hs-cTnT and low ABI [HR(95% CI): CHD: 2.04 (1.45, 2.88), ASCVD: 2.05 (1.58, 2.66)] than those with only elevated hs-cTnT [CHD: 1.65 (1.37, 1.99), ASCVD: 1.67 (1.44, 1.99)] or only low ABI [CHD: 1.87 (1.52, 2.31), ASCVD: 1.67 (1.42, 1.97)]. Antagonistic multiplicative interaction was observed for CHD (LR test p-value=0.042) but not for ASCVD (LR test p-value =0.08). No significant additive interaction was detected for CHD and ASCVD (RERI p-value ≥0.23). Conclusion The observed joint effect of elevated cTnT and low ABI on ASCVD risk was smaller (i.e., antagonistic interaction) than that expected by the combined independent effects of each risk factor.
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Affiliation(s)
- Yacob G Tedla
- Vanderbilt University Medical Center, Department of Medicine, Division of Epidemiology, Nashville, TN, United States
| | - Steven Driver
- Advocate Aurora Health, Advocate Heart Institute, Chicago, IL, United States
| | - Moyses Szklo
- Johns Hopkins University Bloomberg School of Public Health, Department of Epidemiology, Baltimore, MD, United States
| | - Lewis Kuller
- University of Pittsburgh, School of Public Health, Department of Epidemiology, Pittsburgh, PA, United States
| | - Joao Ac Lima
- Johns Hopkins University, School of Medicine, Department of Medicine, Baltimore, MD, United States
| | - Erin D Michos
- Johns Hopkins University, School of Medicine, Department of Medicine, Baltimore, MD, United States
| | - Hongyan Ning
- Northwestern University Feinberg School of Medicine, Department of Preventive Medicine, Chicago, IL, United States
| | | | - Philip Greenland
- Northwestern University Feinberg School of Medicine, Department of Preventive Medicine, Chicago, IL, United States
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Ozbay M, Abdelmottaleb W. Triglyceride Glucose Index in Peripheral Artery Disease. Angiology 2023; 74:297. [PMID: 36044659 DOI: 10.1177/00033197221124767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Mustafa Ozbay
- Department of Internal Medicine, New York Medical College, 25063Metropolitan Hospital Center, New York, NY, USA
| | - Wael Abdelmottaleb
- Department of Internal Medicine, New York Medical College, 25063Metropolitan Hospital Center, New York, NY, USA
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Sartore G, Caprino R, Ragazzi E, Bianchi L, Lapolla A, Piarulli F. The ankle-brachial index for assessing the prevalence of peripheral artery disease and cardiovascular risk in patients with type 2 diabetes mellitus. Nutr Metab Cardiovasc Dis 2023; 33:560-567. [PMID: 36646602 DOI: 10.1016/j.numecd.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 10/20/2022] [Accepted: 11/14/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND AIMS Type 2 diabetes mellitus (T2DM) is an important risk factor for peripheral artery disease (PAD). Ankle-Brachial Index (ABI) was found associated with a higher cardiovascular (CV) risk and mortality. The main goals of this study were to establish the prevalence of PAD in a T2DM population, and assess the relationship between PAD and the CV risk calculated with the CUORE Project score (CPS) (https://www.cuore.iss.it/). The association between the ABI, the main risk factors for PAD and T2DM complications was also investigated. METHODS AND RESULTS Two hundred patients were consecutively enrolled. The prevalence of PAD in this population was 17%. The CV risk tended to be higher (p = 0.0712) in the group with a pathological ABI than in the group with a normal ABI. Glycated hemoglobin (r = -0.1591; p = 0.0244), total cholesterol (r = -0.1958; p = 0.0054), LDL cholesterol (r = -0.1708; p = 0.0156) and systolic blood pressure (r = -0.1523; p = 0.0313) correlated significantly and inversely with the left ABI. The frequency of diabetic retinopathy was significantly higher in the group with a pathological ABI (p = 0.0316). CONCLUSIONS The data reveal a high prevalence of PAD in patients with T2DM. The CPS confirmed that patients with a pathological ABI have tendency to a higher CV risk. The results point to the importance of an accurate CV assessment - also measuring individuals' ABI and calculating their CPS - to better pinpoint those at high risk of PAD, especially among patients with T2DM.
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Affiliation(s)
| | | | - Eugenio Ragazzi
- Department of Pharmaceutical and Pharmacological Sciences (DSF), University of Padua, Italy.
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Full KM, Huang T, Shah NA, Allison MA, Michos ED, Duprez DA, Redline S, Lutsey PL. Sleep Irregularity and Subclinical Markers of Cardiovascular Disease: The Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc 2023; 12:e027361. [PMID: 36789869 PMCID: PMC10111477 DOI: 10.1161/jaha.122.027361] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 12/02/2022] [Indexed: 02/16/2023]
Abstract
Background Sleep irregularity has been linked to incident cardiovascular disease. Less is known about associations of sleep regularity with atherosclerosis. We examined cross-sectional associations of actigraphy-assessed sleep duration and sleep timing regularity with subclinical atherosclerosis in the community-based MESA (Multi-Ethnic Study of Atherosclerosis). Methods and Results MESA Sleep Ancillary Study participants (N=2032; mean age, 68.6±9.2 years; 37.9% White) completed 7-day wrist actigraphy. Participants underwent assessments of coronary artery calcium, carotid plaque presence, carotid intima-media thickness, and the ankle-brachial index. Sleep regularity was quantified by the 7-day with-in person SD of sleep duration and sleep onset timing. Relative risk regression models were used to calculate prevalence ratios and 95% CIs. Models are adjusted for demographics, cardiovascular disease risk factors, and other objectively assessed sleep characteristics including obstructive sleep apnea, sleep duration, and sleep fragmentation. After adjustment, compared with participants with more regular sleep durations (SD ≤60 minutes), participants with greater sleep duration irregularity (SD >120 minutes) were more likely to have high coronary artery calcium burden (>300; prevalence ratio, 1.33 [95% CI, 1.03-1.71]) and abnormal ankle-brachial index (<0.9; prevalence ratio, 1.75 [95% CI, 1.03-2.95]). Compared with participants with more regular sleep timing (SD ≤30 minutes), participants with irregular sleep timing (SD >90 minutes) were more likely to have high coronary artery calcium burden (prevalence ratio, 1.39 [95% CI, 1.07-1.82]). Associations persisted after adjustment for cardiovascular disease risk factors and average sleep duration, obstructive sleep apnea, and sleep fragmentation. Conclusions Sleep irregularity, particularly sleep duration irregularity, was associated with several measures of subclinical atherosclerosis. Sleep regularity may be a modifiable target for reducing atherosclerosis risk. Future investigation into cardiovascular risk reduction interventions targeting sleep irregularity may be warranted.
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Affiliation(s)
- Kelsie M. Full
- Division of Epidemiology and Community HealthUniversity of Minnesota School of Public HealthMinneapolisMN
| | - Tianyi Huang
- Channing Division of Network Medicine, Brigham and Women’s HospitalHarvard UniversityBostonMA
- Division of Sleep MedicineHarvard Medical SchoolBostonMA
| | - Neomi A. Shah
- Division of Pulmonary, Critical Care and Sleep MedicineIcahn School of Medicine at Mount SinaiNew YorkNY
| | - Matthew A. Allison
- Division of Preventive MedicineUniversity of California San DiegoSan DiegoCA
| | - Erin D. Michos
- Division of CardiologyJohns Hopkins School of MedicineBaltimoreMD
| | - Daniel A. Duprez
- Cardiovascular DivisionUniversity of Minnesota School of MedicineMinneapolisMN
| | - Susan Redline
- Division of Sleep MedicineHarvard Medical SchoolBostonMA
- Brigham and Women’s Hospital, Division of Sleep and Circadian DisordersHarvard Medical SchoolBostonMA
| | - Pamela L. Lutsey
- Division of Epidemiology and Community HealthUniversity of Minnesota School of Public HealthMinneapolisMN
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Laivuori M, Biancari F, Sinisalo J, Albäck A, Hakovirta H, Sund R, Venermo M. Statin use improves survival of patients with known or suspected lower extremity artery disease on all ankle brachial index levels. VASA 2023; 52:54-62. [PMID: 36458408 DOI: 10.1024/0301-1526/a001041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background: Statin medication improves the prognosis of patients with lower extremity artery disease (LEAD). Research has previously focused on patients with a lowered ankle brachial index (ABI) excluding patients with a normal or elevated ankle brachial index. The aim of this study was to analyze the impact of statin use on survival and cardiovascular mortality in patients with LEAD of different severity depicted by the ABI level. Patients and methods: 4128 ABI measurements by trained and experienced nurses between 2000 and 2009 were combined with medication data from the Social Insurance Institution and causes of death data from the national causes of death registry. End of follow-up was set at the end of 2014. The data of statin use included all statin medication with the Anatomical Therapeutic Chemical (ATC) classification codes between C10AA01 and C10AA08. Results: 1956 (47.4%) patients had statin medication. Statin use was associated with improved overall survival and amputation free survival (AFS) on all ABI levels. When adjusted for age, sex and diabetes the greatest overall survival benefit from statin use was for the patients with ABI>1.3 (hazard ratio, HR: 0.67, 95% CI: 0.48-0.94, p=0.020, reference group statin non-users) and ABI 0.9-1.3 (HR: 0.78, 95% CI: 0.65-0.94, p=0.008). In propensity score matched pairs statin treatment was associated with significantly lower all-cause mortality (p<0.0001), cardiovascular mortality (p=0.034), cerebrovascular mortality (p=0.003) and embolic stroke related mortality (p=0.001) in patients with ABI >1.3 or <0.9. Overall survival benefit was significant in females with ABI<0.5 and in males across several ABI levels. Conclusions: According to our study, statins seem to improve overall and amputation free survival regardless of ABI level. Statin use was associated with lower mortality from cerebrovascular disease, overall mortality and in the propensity score matched patients with ABI<0.9 or >1.3 with cardiovascular mortality.
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Affiliation(s)
- Mirjami Laivuori
- Department of Vascular Surgery, Abdominal Center, Helsinki University Hospital and University of Helsinki, Finland
| | - Fausto Biancari
- Department of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Finland.,Clinica Montevergine, GVM Care & Research, Mercogliano, Italy
| | - Juha Sinisalo
- Department of Cardiology, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Finland
| | - Anders Albäck
- Department of Vascular Surgery, Abdominal Center, Helsinki University Hospital and University of Helsinki, Finland
| | - Harri Hakovirta
- Department of Vascular Surgery, University of Turku and Turku University Hospital, Turku, Finland.,Department of Surgery, Satasairaala, Pori, Finland
| | - Reijo Sund
- Institute of Clinical Medicine, Surgery, Kuopio Musculoskeletal Research Unit, University of Eastern Finland, Kuopio, Finland
| | - Maarit Venermo
- Department of Vascular Surgery, Abdominal Center, Helsinki University Hospital and University of Helsinki, Finland
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Shao X, Jiang J. The predictive value of ankle-brachial index in hemodialysis patients. Vascular 2022; 30:1017-1018. [PMID: 34256629 DOI: 10.1177/17085381211032772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Xiaolu Shao
- Intensive Care Unit, 584020Zhejiang Hospital, Hangzhou, Zhejiang, China
| | - Jianping Jiang
- Internal Medicine Department, Pinghu First People's Hospital, Pinghu, Zhejiang, China
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Armas-Padrón AM, Sicilia-Sosvilla M, Rodríguez-Bello S, López-Carmona MD, Ruiz-Esteban P, Hernández D. Abnormal ankle-brachial index, cardiovascular risk factors and healthy lifestyle factors in hypertensive patients: prospective cohort study from a primary care urban population. BMC PRIMARY CARE 2022; 23:232. [PMID: 36085011 PMCID: PMC9463763 DOI: 10.1186/s12875-022-01837-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 08/30/2022] [Indexed: 11/24/2022]
Abstract
Background Peripheral arterial disease (PAD) and arterial stiffness (AS) may be hypertension-mediated vascular lesions. Both are determined by an abnormal ankle-brachial index (ABI) and are predictors of cardiovascular disease (CVD) and mortality. We assessed the relationship in urban hypertensive patients between an abnormal ABI and an ideal cardiovascular health (CVH) score, plus other healthy factors, with unfavourable outcomes. Methods We studied 243 hypertensive patients from a primary care urban population, followed for two years. Clinical data, comorbid conditions, including hypertension-mediated organ damage (HMOD) and hypertension-related comorbidities (HRC), hospitalizations and mortality were also recorded. Results A low prevalence of ideal CVH was observed in urban hypertensive patients. The ABI ≤ 0.9 group (n = 16) showed a higher proportion of prior CVD other than PAD, mortality and hospitalizations than the ABI > 1.4 group (n = 41), and a poorer lipid, metabolic and renal profile. An inverse relationship between CVH score and ABI ≤ 0.9 and unfavourable outcomes (HMOD, HRC, death or hospitalization) was observed. Chronic kidney disease (CKD) and diabetes were independently associated with an ABI ≤ 0.9. Age, sex, diabetes, CKD, ABI ≤ 0.9 and ideal cholesterol were also associated with outcomes, but not other CVH metrics. Conclusions Besides a low prevalence of ideal CVH, an inverse relationship between CVH score and ABI ≤ 0.9 and unfavourable outcomes was observed in hypertensive patients from an urban population. Stronger efforts to promote ideal CVH may improve outcomes in this particular population. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01837-1.
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Xu C, Tian Q, Yu H, Ge W, Zheng H, Huang D. Predictive Value of the Ankle-Brachial Index for All-Cause and Cardio-Cerebrovascular Mortality. Angiology 2022:33197221121016. [PMID: 36052942 DOI: 10.1177/00033197221121016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The present study explored the relationship between the ankle-brachial index (ABI) (>.9) and all-cause or cardio-cerebrovascular mortality. Participant details were obtained from the National Health and Nutrition Examination Survey 1999-2004. The association between baseline ABI and the risk of mortality was evaluated by a priori defined quartile categories and on a continuous scale (per .1-unit change) with Cox regression models adjusted for demographic and traditional risk factors. A total of 7087 individuals (age: 59.6 ± 12.8 years) were included; 3612 (51.0%) were male. After an average follow-up of 12.2 years, 1926 deaths occurred. Kaplan-Meier analysis showed that the lowest ABI quartile (<1.06) was associated with the highest risk of all-cause, cardio-cerebrovascular and cancer mortality (all P < .001). However, after adjusting for potential confounders, ABI ranging between 1.06 and 1.12 was associated with the lowest risk of all-cause mortality (hazard ratio .88, 95% confidence interval .78-1.00, P < .05) compared with the reference group (<1.06). Besides, splines showed the relationship was nonlinear (P < .05) and the inflection point was 1.11. In conclusion, the level of ABI associated with the lowest risk of all-cause mortality was 1.11, under which a lower ABI was independently associated with an increased risk of all-cause mortality.
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Affiliation(s)
- Chang Xu
- Department of Neurology, 546775Geriatric Hospital of Nanjing Medical University, Jiangsu Province Official Hospital, Nanjing, China.,Cognitive Impairment Research Institute of Geriatric Hospital of Nanjing Medical University, 546775Jiangsu Province Official Hospital, Nanjing, China
| | - Qi Tian
- Department of Neurology, 546775Geriatric Hospital of Nanjing Medical University, Jiangsu Province Official Hospital, Nanjing, China.,Cognitive Impairment Research Institute of Geriatric Hospital of Nanjing Medical University, 546775Jiangsu Province Official Hospital, Nanjing, China
| | - Hao Yu
- Jangsu Provincial Center for Disease Control and Prevention
| | - Wei Ge
- Department of Chinese Traditional Medicine, 546775Geriatric Hospital of Nanjing Medical University, Jiangsu Province Official Hospital, Nanjing, China
| | - Huifen Zheng
- Department of Neurology, 546775Geriatric Hospital of Nanjing Medical University, Jiangsu Province Official Hospital, Nanjing, China.,Cognitive Impairment Research Institute of Geriatric Hospital of Nanjing Medical University, 546775Jiangsu Province Official Hospital, Nanjing, China
| | - Danqing Huang
- Department of Neurology, 546775Geriatric Hospital of Nanjing Medical University, Jiangsu Province Official Hospital, Nanjing, China.,Cognitive Impairment Research Institute of Geriatric Hospital of Nanjing Medical University, 546775Jiangsu Province Official Hospital, Nanjing, China
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Maruhashi T, Kajikawa M, Kishimoto S, Yamaji T, Harada T, Hashimoto Y, Mizobuchi A, Tanigawa S, Yusoff FM, Nakano Y, Chayama K, Nakashima A, Goto C, Yoshimura K, Higashi Y. The prevalence of cardiovascular disease is higher in patients with bilateral low ankle-brachial index than in patients with unilateral low ankle-brachial index. Atherosclerosis 2022; 360:8-14. [DOI: 10.1016/j.atherosclerosis.2022.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 09/09/2022] [Accepted: 09/27/2022] [Indexed: 12/24/2022]
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[Evolution of the prevalence of peripheral artery disease in clinical practice: A descriptive population study with real databases (SIDIAP-CMBD)]. Aten Primaria 2022; 54:102437. [PMID: 35964545 PMCID: PMC9399170 DOI: 10.1016/j.aprim.2022.102437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 06/29/2022] [Accepted: 07/01/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate, with real world data (SIDIAP and CMBD), the evolution of the prevalence of peripheral arterial disease (PAD) in the Catalan population and the cardiovascular risk factors present in people with this pathology. DESIGN Longitudinal descriptive population study. SITE: Primary health care. PARTICIPANTS Patients listed in SIDIAP and CMBD with a diagnosis of peripheral artery disease between 2008 and 2018 ≥ 35 years, as well as those without a diagnosis, but with an ABI < 0.9 in SIDIAP. INTERVENTIONS AND MAIN MEASUREMENTS Main variable AP (ICD-9, ICD-10). Sociodemographic data, risk factors and cardiovascular disease, drug use and prevalent cardiovascular events at the time of diagnosis. RESULTS 141,520 patients were studied. 75% had hypertension, 58% were smokers or former smokers, and 23% had a myocardial infarction. The global prevalence increased from 1.15% in 2008 to 3.10% in 2018. The prevalence of PAD increased with age, with a moderate increase at younger ages, and more pronounced in > 55 years, exceeding 10% in > 85 years. CONCLUSION This is a population study where it is observed that the evolution of the prevalence of peripheral artery disease has presented a constant increase during the years 2008-2018, being higher in men, especially from 55 years of age. Studies with large databases can facilitate the design and implementation of new policies in national health systems.
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Natt Och Dag Y, Engström G, Rosvall M. Cross-sectional associations of optimism with artery calcification and function: The SCAPIS study. J Public Health Res 2022; 11:22799036221110021. [PMID: 36185414 PMCID: PMC9523866 DOI: 10.1177/22799036221110021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/09/2022] [Indexed: 11/24/2022] Open
Abstract
Background: An increasing amount of research indicates that positive psychological factors, such as optimism, might be beneficial for cardiovascular health. However, most studies have focused on cardiovascular events. The present study aimed to investigate associations between optimism and subclinical outcomes related to cardiovascular health. Methods: This cross-sectional study used data from SCAPIS Malmö, Sweden, including 6251 randomly selected men and women from the Malmö municipality area, aged 50 to 64 years. Optimism was assessed via the LOT-R questionnaire, but also by using the two subscales of LOT-R, assessing optimism and pessimism separately. Arterial health was assessed as the coronary artery calcium score, ankle-brachial index, and aortic augmentation index. Cardiovascular risk was estimated using the SCORE instrument. Adjustments were made for sociodemographic factors, depression, and cardiovascular risk factors. Results: Those who were most optimistic had lower odds of coronary artery calcification, with an odds ratio of 0.74 (95% confidence interval 0.58, 0.93), compared to those who were least optimistic. Also, higher levels of optimism were associated with a general pattern of lower aortic augmentation index, and with higher ankle-brachial index on both left and right side. For coronary artery calcification associations seemed to be mediated primarily through an absence of pessimism. The associations were reduced after adjustments, but persisted for measures of arterial function. Conclusions: The results indicate that optimism might be health protective with regard to arterial function, but with regard to coronary artery calcification it was rather the absence of pessimism that was of importance.
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Affiliation(s)
- Yvonne Natt Och Dag
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences in Malmö, Lund University, Malmö, Sweden
| | - Maria Rosvall
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Social Medicine, Primary Health Care, Regionhälsan, Region Västra Götaland, Gothenburg, Sweden
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Disparity in association of obesity measures with ankle and brachial systolic blood pressures in Europeans and South Asians. Sci Rep 2022; 12:9174. [PMID: 35655080 PMCID: PMC9163110 DOI: 10.1038/s41598-022-13372-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 05/17/2022] [Indexed: 11/22/2022] Open
Abstract
Obesity causes increases in brachial systolic-blood-pressures (SBP), risks of type 2 diabetes (T2DM) and cardiovascular diseases (CVD). Brachial and ankle SBPs have differential relationship with T2DM and CVD. Our objective was to study the relationship of obesity measures with brachial and ankle SBPs. A population of 1098 adults (South Asians n = 699; 41.70% male and 58.3% female) were recruited over 5 years from primary care practices in England. Their four limbs SBPs were measured using Doppler machine and body-mass-index (BMI) and waist-to-height-ratio (WHtR) calculated. Linear regressions were performed between SBPs and obesity measures, after adjustments for sex, age, ethnicity, T2DM and CVD. The mean age of all participants was 51.3 (SD = 17.2), European was 57.7 (SD 17.2) and South Asian was 47.8 (SD = 16.1). The left posterior tibial [Beta = 1.179, P = 4.559 × 10−15] and the right posterior tibial SBP [Beta = 1.178, P = 1.114 × 10−13] most significantly associated with the BMI. In South Asians, although the left brachial [Beta = 25.775, P = 0.032] and right brachial SBP [Beta = 22.792, P = 0.045] were associated to the WHtR, the left posterior tibial SBP [Beta = 39.894, P = 0.023], association was the strongest. For the first time, we have demonstrated that ankle SBPs had significant association with generalised obesity than brachial systolic blood pressures (SBP), irrespective of ethnicity. However, with respect to visceral obesity, the association with ankle SBP was more significant in South Asians compared to Europeans.
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The Cardiovascular-Mortality-Based Estimate for Normal Range of the Ankle-Brachial Index (ABI). J Cardiovasc Dev Dis 2022; 9:jcdd9050147. [PMID: 35621858 PMCID: PMC9144270 DOI: 10.3390/jcdd9050147] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/02/2022] [Accepted: 05/03/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The ankle−brachial index (ABI) is a first-line examination in cardiovascular risk evaluation. Since cut-off values for normal ABI vary, the aim of the present study was to identify the cardiovascular-mortality-based estimate for the normal range of the ABI. After determining the reference range for the ABI, the corresponding toe−brachial index (TBI) and toe pressure for normal ABI were analyzed. Methods: All consecutive non-invasive pressure measurements in the vascular laboratory of a large university hospital 2011−2013 inclusive were collected and combined with patient characteristics and official dates and causes of death. Patients with an ABI range of 0.8−1.4 on both lower limbs were included in this study. Results: From 2751 patients, 868 had bilateral ABI values within the inclusion. Both ABI category ranges 0.80−0.89 and 0.90−0.99 had poorer survival compared to ABI categories 1.00−1.29 (p < 0.05). The 1-, 3-, and 5-year cardiovascular-death-free survival for respective ABI categories 0.80−0.99 vs. 1.00−1.29 were 90% vs. 96%, 84% vs. 92%, and 60% vs. 87%. The 1-, 3-, and 5-year overall survival for ABI categories 0.80−0.99 vs. 1.00−1.29 were 85% vs. 92%, 75% vs. 83%, and 42% vs. 74%. Conclusions: Borderline ABI (0.90−0.99) associates with higher overall and cardiovascular mortality compared to ABI values 1.00−1.29.
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Manichaikul A, Lin H, Kang C, Yang C, Rich SS, Taylor KD, Guo X, Rotter JI, Craig Johnson W, Cornell E, Tracy RP, Peter Durda J, Liu Y, Vasan RS, Adrienne Cupples L, Gerszten RE, Clish CB, Jain D, Conomos MP, Blackwell T, Papanicolaou GJ, Rodriguez A. Lymphocyte activation gene-3-associated protein networks are associated with HDL-cholesterol and mortality in the Trans-omics for Precision Medicine program. Commun Biol 2022; 5:362. [PMID: 35501457 PMCID: PMC9061762 DOI: 10.1038/s42003-022-03304-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 03/21/2022] [Indexed: 12/11/2022] Open
Abstract
Deficiency of the immune checkpoint lymphocyte activation gene-3 (LAG3) protein is significantly associated with both elevated HDL-cholesterol (HDL-C) and myocardial infarction risk. We determined the association of genetic variants within ±500 kb of LAG3 with plasma LAG3 and defined LAG3-associated plasma proteins with HDL-C and clinical outcomes. Whole genome sequencing and plasma proteomics were obtained from the Multi-Ethnic Study of Atherosclerosis (MESA) and the Framingham Heart Study (FHS) cohorts as part of the Trans-Omics for Precision Medicine program. In situ Hi-C chromatin capture was performed in EBV-transformed cell lines isolated from four MESA participants. Genetic association analyses were performed in MESA using multivariate regression models, with validation in FHS. A LAG3-associated protein network was tested for association with HDL-C, coronary heart disease, and all-cause mortality. We identify an association between the LAG3 rs3782735 variant and plasma LAG3 protein. Proteomics analysis reveals 183 proteins significantly associated with LAG3 with four proteins associated with HDL-C. Four proteins discovered for association with all-cause mortality in FHS shows nominal associations in MESA. Chromatin capture analysis reveals significant cis interactions between LAG3 and C1S, LRIG3, TNFRSF1A, and trans interactions between LAG3 and B2M. A LAG3-associated protein network has significant associations with HDL-C and mortality.
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Affiliation(s)
- Ani Manichaikul
- Center for Public Heath Genomics, University of Virginia, Charlottesville, VA, USA
| | - Honghuang Lin
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Chansuk Kang
- Center for Public Heath Genomics, University of Virginia, Charlottesville, VA, USA
| | - Chaojie Yang
- Center for Public Heath Genomics, University of Virginia, Charlottesville, VA, USA
| | - Stephen S Rich
- Center for Public Heath Genomics, University of Virginia, Charlottesville, VA, USA
| | - Kent D Taylor
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Xiuqing Guo
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Jerome I Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | | | | | | | | | | | - Ramachandran S Vasan
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - L Adrienne Cupples
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Robert E Gerszten
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Clary B Clish
- Metabolite Profiling, Broad Institute, Cambridge, MA, USA
| | | | | | | | | | - Annabelle Rodriguez
- Center for Vascular Biology, University of Connecticut Health, Farmington, CT, USA.
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Alzamora MT, Forés R, Serra N, Martinez E, Pera G, Seda G, Lopez Palencia J, Gomis M, Heras Tébar A, Valverde M, Garnacho MV, Torán P. Supervised physical activity in patients with symptomatic peripheral arterial disease: protocol for a randomized clinical trial (ARTPERfit Study). BMJ Open 2022; 12:e054352. [PMID: 35477870 PMCID: PMC9047770 DOI: 10.1136/bmjopen-2021-054352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Peripheral arterial disease (PAD) is a marker of cardiovascular morbidity, causing disability, loss of mobility and poor quality of life, manifesting clinically in the form of intermittent claudication (IC). Physical exercise increases the distance walked and improves quality of life. The aim of our study will be increased walking distance prolonging the time of onset of pain in patients with symptomatic PAD (IC). METHODS AND ANALYSIS This study will be performed in Mataró Hospital's vascular surgery service and School of Health Sciences, TecnoCampus. This population comes from 15 primary healthcare centres ofNorth Barcelona, Spain (450 000 inhabitants).This study will be a four-group parallel, longitudinal, randomised controlled trial, blind to analysis.The main primary outcome of this study will be the improvement in pain-free walking distance. Others primary objectives are and improvement in functional status, quality of life and Ankle-Brachial Index (ABI). Secondary outcomes will be the analysis of cardiorespiratory fitness, evaluation of muscle fitness, determine the maintenance of primary objectives at 6 and 12 months.We will be included 124 patients (31 per group). The changes of the outcome (Barthel, SF-12, VascQOL-6, ABI) of the three intervention groups vs the control group at 3, 6 and 12 months will be compared, both continuously (linear regression) and categorically (logistic regression). A person who has not performed at least 75% of the training will be considered to have not completed the intervention. ETHICS AND DISSEMINATION The study will be conducted according to the Declaration of Helsinki . It was approved by the Ethics Committee of the Research Institute Primary Health IDIAP Jordi Gol (20/035 P),Barcelona 6 October 2020. Informed consent will be obtained from all patients before the start of the study. We will disseminate results through academic papers and conference presentations. TRIAL REGISTRATION NUMBER NCT04578990.
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Affiliation(s)
- Maria Teresa Alzamora
- Family Medicine Riu Nord-Riu Sud, Institut Català de la Salut, Santa Coloma de Gramenet, Spain
- USR Metropolitana Nord, IDIAP Jordi Gol, Barcelona, Spain
| | - Rosa Forés
- USR Metropolitana Nord, IDIAP Jordi Gol, Barcelona, Spain
- Family Medicine Riu Nord-Riu Sud. Santa Coloma de Gramenet, Institut Català de la Salut, Barcelona, Spain
| | - Noemi Serra
- Universitat Pompeu Fabra Escola Superior Politècnica del TecnoCampus, Mataro, Spain
| | | | - Guillem Pera
- USR Metropolitana Nord. Mataró, IDIAP Jordi Gol, Barcelona, Spain
| | - Gemma Seda
- Institut Catala De La Salut, Barcelona, Spain
| | | | - Manuel Gomis
- Universitat Pompeu Fabra Escola Superior Politècnica del TecnoCampus, Mataro, Spain
| | - Antonio Heras Tébar
- USR Metropolitana Nord, IDIAP Jordi Gol, Barcelona, Spain
- Primary Healthcare Center Riu Nord-Riu SUD, Institut Catala De La Salut, Barcelona, Spain
| | - Marta Valverde
- Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra
| | | | - Pere Torán
- Unitat de Suport a la Recerca Metropolitana Nord, Institut Català de la Salut, Barcelona, Spain
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Caicedo D, Alvarez CV, Perez-Romero S, Devesa J. The Inflammatory Pattern of Chronic Limb-Threatening Ischemia in Muscles: The TNF-α Hypothesis. Biomedicines 2022; 10:biomedicines10020489. [PMID: 35203700 PMCID: PMC8962305 DOI: 10.3390/biomedicines10020489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/23/2022] [Accepted: 02/14/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Vascular inflammation plays a crucial role in peripheral arterial disease (PAD), although the role of the mediators involved has not yet been properly defined. The aim of this work is to investigate gene expression and plasma biomarkers in chronic limb-threating ischemia (CLTI). Methods: Using patients from the GHAS trial, both blood and ischemic muscle samples were obtained to analyze plasma markers and mRNA expression, respectively. Statistical analysis was performed by using univariate (Spearman, t-Student, and X2) and multivariate (multiple logistic regression) tests. Results: A total of 35 patients were available at baseline (29 for mRNA expression). Baseline characteristics (mean): Age: 71.4 ± 12.4 years (79.4% male); TNF-α: 10.7 ± 4.9 pg/mL; hsCRP:1.6 ± 2.2 mg/dL; and neutrophil-to-lymphocyte ratio (NLR): 3.5 ± 2.8. Plasma TNF-α was found elevated (≥8.1) in 68.6% of patients, while high hsCRP (≥0.5) was found in 60.5%. Diabetic patients with a high level of inflammation showed significantly higher levels of NOX4 expression at baseline (p = 0.0346). Plasma TNF-α had a negative correlation with NOS3 (eNOS) expression (−0.5, p = 0.015) and plasma hsCRP with VEGFA (−0.63, p = 0.005). The expression of NOX4 was parallel to that of plasma TNF-α (0.305, p = 0.037), especially in DM. Cumulative mortality at 12 months was related to NLR ≥ 3 (p = 0.019) and TNF-α ≥ 8.1 (p = 0.048). The best cutoff point for NLR to predict mortality was 3.4. Conclusions: NOX4 and TNF-α are crucial for the development and complications of lower limb ischemia, especially in DM. hsCRP could have a negative influence on angiogenesis too. NLR and TNF-α represent suitable markers of mortality in CLTI. These results are novel because they connect muscle gene expression and plasma information in patients with advanced PAD, deepening the search for new and accurate targets for this condition.
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Affiliation(s)
- Diego Caicedo
- Angiology and Vascular Surgery Department, Complejo Hospitalario de Santiago de Compostela, 15706 Santiago de Compostela, Spain
- Correspondence: ; Tel.: +34-981-950-043
| | - Clara V. Alvarez
- Neoplasia & Endocrine Differentiation P0L5, Centro de Investigación en Medicina Molecular y Enferme-dades Crónicas (CIMUS), University of Santiago de Compostela (USC), 15783 Santiago de Compostela, Spain; (C.V.A.); (S.P.-R.)
| | - Sihara Perez-Romero
- Neoplasia & Endocrine Differentiation P0L5, Centro de Investigación en Medicina Molecular y Enferme-dades Crónicas (CIMUS), University of Santiago de Compostela (USC), 15783 Santiago de Compostela, Spain; (C.V.A.); (S.P.-R.)
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You M, Liu Y, Wang B, Li L, Zhang H, He H, Zhou Q, Cao T, Wang L, Zhao Z, Zhu Z, Gao P, Yan Z. Asprosin induces vascular endothelial-to-mesenchymal transition in diabetic lower extremity peripheral artery disease. Cardiovasc Diabetol 2022; 21:25. [PMID: 35168605 PMCID: PMC8848671 DOI: 10.1186/s12933-022-01457-0] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 01/25/2022] [Indexed: 12/03/2022] Open
Abstract
Background Altered adipokine secretion in dysfunctional adipose tissue facilitates the development of atherosclerotic diseases including lower extremity peripheral artery disease (PAD). Asprosin is a recently identified adipokine and displays potent regulatory role in metabolism, but the relationship between asprosin and lower extremity PAD remains uninvestigated. Methods 33 type 2 diabetes mellitus (T2DM) patients (DM), 51 T2DM patients with PAD (DM + PAD) and 30 healthy normal control (NC) volunteers were recruited and the blood samples were collected for detecting the circulatory asprosin level and metabolomic screening. RNA sequencing was performed using the aorta tissues from the type 2 diabetic db/db mice and human umbilical vein endothelial cells (HUVECs) were treated with asprosin to determine its impact on the endothelial-to-mesenchymal transition (EndMT). Results The circulating levels of asprosin in DM + PAD group were significantly higher than that of NC group and the DM group. Circulating asprosin level was remarkably negatively correlated with ankle-brachial index (ABI), even after adjusting for age, sex, body mass index (BMI) and other traditional risk factors of PAD. Logistic regression analysis revealed that asprosin is an independent risk factor for PAD and receiver-operator characteristic (ROC) curve determined a good sensitivity (74.5%) and specificity (74.6%) of asprosin to distinguish PAD. Data from metabolomics displayed a typical characteristics of de novo amino acid synthesis in collagen protein production by myofibroblasts in patients with PAD and activation of TGF-β signaling pathway appeared in the aortic tissue of db/db mice. Asprosin directly induces EndMT in HUVECs in a TGF-β-dependent manner as TGF-β signaling pathway inhibitor SB431542 erased the promotional effect of asprosin on EndMT. Conclusions Elevated circulatory asprosin level is an independent risk factor of lower extremity PAD and might serve as a diagnostic marker. Mechanistically, asprosin directly induces EndMT that participates in vascular injury via activation of TGF-β signaling pathway. Trial registration This trial was registered at clinicaltrials.gov as NCT05068895 Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01457-0.
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Affiliation(s)
- Mei You
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, 10 Chang Jiang Zhi Lu, Yuzhong District, Chongqing, 400042, China
| | - Yushuang Liu
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, 10 Chang Jiang Zhi Lu, Yuzhong District, Chongqing, 400042, China
| | - Bowen Wang
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, 10 Chang Jiang Zhi Lu, Yuzhong District, Chongqing, 400042, China
| | - Li Li
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, 10 Chang Jiang Zhi Lu, Yuzhong District, Chongqing, 400042, China
| | - Hexuan Zhang
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, 10 Chang Jiang Zhi Lu, Yuzhong District, Chongqing, 400042, China
| | - Hongbo He
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, 10 Chang Jiang Zhi Lu, Yuzhong District, Chongqing, 400042, China
| | - Qing Zhou
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, 10 Chang Jiang Zhi Lu, Yuzhong District, Chongqing, 400042, China
| | - Tingbing Cao
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, 10 Chang Jiang Zhi Lu, Yuzhong District, Chongqing, 400042, China
| | - Lijuan Wang
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, 10 Chang Jiang Zhi Lu, Yuzhong District, Chongqing, 400042, China
| | - Zhigang Zhao
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, 10 Chang Jiang Zhi Lu, Yuzhong District, Chongqing, 400042, China
| | - Zhiming Zhu
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, 10 Chang Jiang Zhi Lu, Yuzhong District, Chongqing, 400042, China.
| | - Peng Gao
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, 10 Chang Jiang Zhi Lu, Yuzhong District, Chongqing, 400042, China.
| | - Zhencheng Yan
- Department of Hypertension and Endocrinology, Center for Hypertension and Metabolic Diseases, Daping Hospital, Army Medical University, Chongqing Institute of Hypertension, 10 Chang Jiang Zhi Lu, Yuzhong District, Chongqing, 400042, China.
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