High Mortality Rates in Medicare Patients After Peripheral Artery Disease Revascularization

Background: Cholesterol efflux is an important mechanism by which high-density lipoproteins (HDLs) protect against cardiovascular disease. As peripheral artery disease (PAD) is associated with high mortality rates, mainly due to cardiovascular causes, we investigated whether cholesterol efflux capacity (CEC) of apolipoprotein B (apoB)-depleted plasma, a widely used surrogate of HDL function, may serve as a predictive marker for mortality in this patient population. Methods: In this prospective single-center study (median follow-up time: 9.3 years), apoB-containing lipoproteins were precipitated from plasma of 95 patients with PAD and incubated with J744-macrophages, which were loaded with radiolabeled cholesterol. CEC was defined as the fractional radiolabel released during 4 h of incubation. Results: Baseline CEC was lower in PAD patients that currently smoked (p = 0.015) and had a history of myocardial infarction (p = 0.011). Moreover, CEC showed a significant correlation with HDL-cholesterol (p = 0.003) and apolipoprotein A-I levels (p = 0.001) as well as the ankle-brachial index (ABI, p = 0.018). However, CEC did not differ between survivors and non-survivors. Neither revealed Kaplan–Meier and Cox regression analyses any significant association of CEC with all-cause mortality rates. Conclusion: Taken together, CEC is associated with ABI but does not predict all-cause mortality in patients with PAD.

Download Full-text

INCIDENCE OF MAJOR ADVERSE CARDIOVASCULAR AND LIMB EVENTS IN MEDICARE PATIENTS WITH PERIPHERAL ARTERY DISEASE

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(18)32621-4 ◽

2018 ◽

Vol 71 (11) ◽

pp. A2080

Author(s):

Jeremy Van't Hof ◽

Marc P. Bonaca ◽

Eric Weinhandl ◽

Niki Oldenburg ◽

Monica Chase ◽

...

Keyword(s):

Peripheral Artery Disease ◽

Peripheral Artery ◽

Medicare Patients ◽

Artery Disease

Download Full-text

TCTAP A-126 Mortality Rates and Mortality Predictors in Patients with Symptomatic Peripheral Artery Disease Treated Endovascular Treatment

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2017.03.169 ◽

2017 ◽

Vol 69 (16) ◽

pp. S70-S71

Author(s):

Atsusuke Yatomi ◽

Hiroaki Nakamura ◽

Makoto Kadotani

Keyword(s):

Endovascular Treatment ◽

Peripheral Artery Disease ◽

Mortality Rates ◽

Peripheral Artery ◽

Artery Disease ◽

Mortality Predictors

Download Full-text

Analyses of serum and urinary metabolites in individuals with peripheral artery disease (PAD) consuming a bean-rich diet: Relationships with drug metabolites

Applied Physiology Nutrition and Metabolism ◽

10.1139/apnm-2021-0495 ◽

2021 ◽

Author(s):

Le Wang ◽

Erin M Goldberg ◽

Carla G Taylor ◽

Peter Zahradka ◽

Michel Aliani

Keyword(s):

Peripheral Artery Disease ◽

Urinary Metabolites ◽

Mortality Rates ◽

High Morbidity ◽

Metabolomic Profile ◽

Peripheral Artery ◽

Biochemical Pathways ◽

Urinary Levels ◽

Artery Disease ◽

Serum And Urine

Peripheral artery disease (PAD) has high morbidity and mortality rates. A metabolomics approach was employed to determine whether consumption of bean-rich diets for 8 weeks would impact the metabolomic profile of PAD individuals. Serum and urine, collected from 54 participants with clinical PAD at baseline and after 8 weeks on 0.3 cups beans/d (n=19), 0.6 cups beans/d (n= 20), or control (n=23) diet, and the beans were extracted and analyzed using LC-QTOF-MS. As a result, PGE2 p-acetamidophenyl ester, PGF2α diethyl amide and 5-L-glutamyl-L-alanine were significantly changed in the serum or urine of bean groups compared to control. Significant changes (P<0.05) in the profile and/or levels of 22 flavonoids present in bean extracts showed the potential importance of the mixture of beans used in this study. In a subset of participants taking metoprolol, after 8 weeks the bean-rich diets significantly elevated metoprolol in the serum while reducing it in urine compared to baseline. In addition, the diets significantly enhanced the urinary excretion of metformin. In conclusion, several biochemical pathways including prostaglandins and glutathione were affected by bean consumption. Significant changes in the metabolism of metoprolol and metformin with bean consumption suggested the presence of diet-drug interactions that may require adjustment of the prescribed dose. ClinicalTrials.gov Identifier: NCT01382056 Novelty: • Bean consumption by people with PAD alters the levels of certain metabolites in serum and urine • Different bean types (black, red kidney, pinto, navy) have unique flavonoid profiles • Metabolomics revealed potential diet-dug interactions as serum and/or urinary levels of metoprolol and metformin are modified by bean consumption

Download Full-text

Abstract P363: Regional And Racial Variation In The Prevalence Of Concomitant Diabetes And Peripheral Artery Disease

Circulation ◽

10.1161/circ.141.suppl_1.p363 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

J Aaron Barnes ◽

Mark A Eid ◽

Zachary J Wanken ◽

Richard J Powell ◽

David H Stone ◽

...

Keyword(s):

Peripheral Artery Disease ◽

Relative Reduction ◽

Peripheral Artery ◽

Racial Variation ◽

Entire Cohort ◽

Black Patients ◽

Hospital Referral ◽

Medicare Patients ◽

Artery Disease ◽

Absolute Decrease

Introduction and Objectives: Prior research has demonstrated regional and racial variation in the prevalence of concomitant diabetes and peripheral artery disease (PAD). However, trends in prevalence of diabetes and PAD across races has not been well explored in recent patient cohorts. Methods: Using data from the Centers for Medicare and Medicaid Services from 2003-2016, we identified patients concurrently diagnosed with both diabetes and PAD (n=10,506,254). Overall prevalence of concomitant diabetes and PAD was determined. Regional variation at the state and hospital referral region (HRR) level was then identified using zip code data. Racial demographics within Medicare data were used to stratify prevalence by race. Results: The overall prevalence of diabetes and PAD across the entire cohort was 15.3 per 1,000 Medicare patients. When stratified by HRR, prevalence of patients with concomitant diabetes and PAD varied by nearly 7-fold with a low of 5.0 and a high of 33.2 per 1,000 Medicare patients. When stratified by race, the number of new patients concomitantly diagnosed with diabetes and PAD decreased across all races, with the greatest decline seen in the Hispanic population (absolute decrease 1.84%, relative reduction 63%). The number of new black patients decreased as well (absolute decrease 1.40%, relative reduction 52%), but blacks continue to comprise the highest proportion of newly diagnosed patients at 1.29% (Figure 1). Conclusion: Significant regional and racial variation exists in the prevalence of concomitant diabetes and PAD diagnoses among Medicare patients with black patients remaining disproportionately affected. Efforts to improve prevention and care management should target these endemic regions and populations.

Download Full-text

Racial and Regional Disparities in the Prevalence of Peripheral Artery Disease and Diabetes and Amputation Rates Among Medicare Patients

Journal of Vascular Surgery ◽

10.1016/j.jvs.2020.04.446 ◽

2020 ◽

Vol 72 (1) ◽

pp. e268

Author(s):

Mark A. Eid ◽

J. Aaron Barnes ◽

Zachary Wanken ◽

Bjoern D. Suckow ◽

David H. Stone ◽

...

Keyword(s):

Peripheral Artery Disease ◽

Regional Disparities ◽

Peripheral Artery ◽

Medicare Patients ◽

Artery Disease

Download Full-text

Diabetic foot ulcer carries high amputation and mortality rates, particularly in the presence of advanced age, peripheral artery disease and anemia

Diabetes & Metabolic Syndrome Clinical Research & Reviews ◽

10.1016/j.dsx.2017.04.008 ◽

2017 ◽

Vol 11 ◽

pp. S583-S587 ◽

Cited By ~ 18

Author(s):

Rafael Henrique Rodrigues Costa ◽

Natália Anício Cardoso ◽

Ricardo Jayme Procópio ◽

Túlio Pinho Navarro ◽

Alan Dardik ◽

...

Keyword(s):

Peripheral Artery Disease ◽

Diabetic Foot ◽

Foot Ulcer ◽

Diabetic Foot Ulcer ◽

Mortality Rates ◽

Advanced Age ◽

Peripheral Artery ◽

Artery Disease

Download Full-text

Abstract P152: Racial Disparities In The Prevalence Of Peripheral Artery Disease And Diabetes And Amputation Rates Among Medicare Patients

Circulation ◽

10.1161/circ.141.suppl_1.p152 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Mark A Eid ◽

J Aaron Barnes ◽

Zachary Wanken ◽

David H Stone ◽

Bjoern Suckow ◽

...

Keyword(s):

Peripheral Artery Disease ◽

Average Rate ◽

Peripheral Artery ◽

Black Patients ◽

Hospital Referral ◽

Increased Risk ◽

Patients With Diabetes ◽

Medicare Patients ◽

Artery Disease ◽

Using Data

Background: Patients with peripheral artery disease (PAD) and diabetes are at increased risk for nontraumatic amputations. The associations of race with amputation risk among patients with both PAD and diabetes is not well understood in recent national patient cohorts. Methods: Using data from the Centers for Medicare and Medicaid Services from 2007-2016, we identified a cohort of patients concurrently diagnosed with both PAD and diabetes (N= 10,506,254). Patients were followed from time of diagnosis to identify major and minor amputation events, and stratified by race (Black, White, Hispanic) in order to determine differences in outcomes. We examined associations between the regional prevalence of PAD and diabetes and amputation rates, at the level of the state and the hospital referral region (HRR). Results: The average rate of amputation between 2007 and 2016 was 0.3 amputations per 1000 Medicare patients. When analyzed by race, Black patients had an almost 3-fold higher rate of amputation as compared to White patients (0.89 v 0.36 per 1000 patients, P<0.001) and a 2-fold higher rate as compared to Hispanic patients (0.89 v 0.39 per 1000 patients, P<0.001). States with larger populations of Black patients with diabetes and PAD had higher rates of amputation. We also observed a direct and significant association between regional prevalence of PAD and diabetes and amputation risk for both White and Black patients (R 2 =0.36 and 0.25 respectively); some states such as Mississippi had disproportionately higher amputations rates among Black patients for a given prevalence of PAD and diabetes (Figure 1). Conclusion: Black patients with PAD and diabetes are at disproportionally higher risk for amputation. Moreover, regional prevalence of concomitant PAD and diabetes is closely related to amputation risk across races.

Download Full-text

Anemia and Outcome in Outpatients With Peripheral Artery Disease

Angiology ◽

10.1177/0003319715599864 ◽

2015 ◽

Vol 67 (5) ◽

pp. 484-489 ◽

Cited By ~ 8

Author(s):

Paulina Perez ◽

Carlos Esteban ◽

Pedro Enrique Jiménez Caballero ◽

Juan Francisco Sánchez Muñoz-Torrero ◽

María Teresa Pascual Soria ◽

...

Keyword(s):

Peripheral Artery Disease ◽

Major Bleeding ◽

Multivariable Analysis ◽

Mortality Rates ◽

Limb Amputation ◽

Peripheral Artery ◽

Increased Risk ◽

Factores De Riesgo ◽

Artery Disease ◽

Ischemic Events

The influence of anemia on outcome in stable outpatients with peripheral artery disease (PAD) has not been consistently investigated. We used data from the Factores de Riesgo y ENfermedad Arterial (FRENA) Registry to compare ischemic events and mortality rates in stable outpatients with symptomatic PAD and anemia. Of 1663 patients with PAD, 208 (12.5%) had anemia. Over 18 months, patients with anemia had a higher rate of myocardial infarction (MI; rate ratio [RR]: 2.10; 95% confidence interval [CI]: 1.04-3.99), limb amputation (RR: 2.98; 95%CI: 1.70-5.05), and higher mortality (RR: 3.58; 95%CI: 2.39-5.28) than those without anemia. The rates of ischemic stroke (RR: 0.75; 95%CI: 0.23-1.93) and major bleeding (RR: 0.93; 95%CI: 0.15-3.51) were similar. On multivariable analysis, anemia was associated with an increased risk to die (hazard ratio [HR]: 2.32; 95%CI: 1.53-3.50) but not to develop MI (HR: 1.49; 95%CI: 0.73-3.05) or to have limb amputation (HR: 1.49; 95%CI: 0.86-2.59). In stable outpatients with PAD, anemia was associated with increased mortality but not with an increased rate of subsequent ischemic events or major bleeding.

Download Full-text