Comparison of field questionnaires with the ankle-brachial index for the detection of peripheral artery disease. A population-based study in rural Ecuador

Background. Information on the association between earlobe crease (ELC) and peripheral artery disease is limited. We assessed this association in community-dwelling older adults. Study Design. A total of 294 Atahualpa residents aged ≥60 years were enrolled. ELC were visually identified by two raters. The ankle-brachial index (ABI), used as a surrogate of peripheral artery disease, was categorized using American Heart Association criteria. Using logistic regression and probability models, adjusted for demographics and cardiovascular risk factors, we assessed the relationship between ELC and abnormal ABI determinations, as well as the influence of age on this association. Results. ELC was identified in 141 (48%) individuals, and abnormal ABI determination was carried out in 56 (19%). The association between ELC and abnormal ABI was nonsignificant in logistic regression and probability models with individuals stratified according to their median age. Conclusions. The association between ELC and abnormal ABI determinations is probably attenuated by the high prevalence of both conditions in older persons. ELC might not be useful for identifying candidates for ABI determination.

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Prevalence, Correlates, and Prognosis of Peripheral Artery Disease in Rural Ecuador—Rationale, Protocol, andPhase IResults of a Population-Based Survey: An Atahualpa Project-Ancillary Study

International Journal of Vascular Medicine ◽

10.1155/2014/643589 ◽

2014 ◽

Vol 2014 ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Oscar H. Del Brutto ◽

Mark J. Sedler ◽

Robertino M. Mera ◽

Pablo R. Castillo ◽

Elizabeth H. Cusick ◽

...

Keyword(s):

Phase I ◽

Peripheral Artery Disease ◽

Cardiovascular Health ◽

Ankle Brachial Index ◽

Vascular Diseases ◽

Population Based ◽

Test Reliability ◽

Phase Iii ◽

Peripheral Artery ◽

Artery Disease

Background. Little is known on the prevalence of peripheral artery disease (PAD) in developing countries.Study design. Population-based study in Atahualpa. InPhase I, the Edinburgh claudication questionnaire (ECQ) was used for detection of suspected symptomatic PAD; persons with a negative ECQ but a pulse pressure ≥65 mmHg were suspected of asymptomatic PAD. InPhase II, the ankle-brachial index will be used to test reliability of screening instruments and to determine PAD prevalence. InPhase III, participants will be followed up to estimate the relevance of PAD as a predictor of vascular outcomes.Results. DuringPhase I, 665 Atahualpa residents aged ≥40 years were enrolled (mean age: 59.5 ± 12.6 years, 58% women). A poor cardiovascular health status was noticed in 464 (70%) persons of which 27 (4%) had a stroke and 14 (2%) had ischemic heart disease. Forty-four subjects (7%) had suspected symptomatic PAD and 170 (26%) had suspected asymptomatic PAD. Individuals with suspected PAD were older, more often women, and had a worse cardiovascular profile than those with nonsuspected PAD.Conclusions. Prevalence of suspected PAD in this underserved population is high. Subsequent phases of this study will determine whether prompt detection of PAD is useful to reduce the incidence of catastrophic vascular diseases in the region.

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The Relationship Between High Pulse Pressure and Low Ankle-Brachial Index. Potential Utility in Screening for Peripheral Artery Disease in Population-Based Studies

High Blood Pressure & Cardiovascular Prevention ◽

10.1007/s40292-015-0103-6 ◽

2015 ◽

Vol 22 (3) ◽

pp. 275-280 ◽

Cited By ~ 2

Author(s):

Oscar H. Del Brutto ◽

Robertino M. Mera ◽

Mark J. Sedler ◽

Jadry A. Gruen ◽

Kelsie J. Phelan ◽

...

Keyword(s):

Peripheral Artery Disease ◽

Pulse Pressure ◽

Ankle Brachial Index ◽

Population Based ◽

Potential Utility ◽

Peripheral Artery ◽

High Pulse Pressure ◽

High Pulse ◽

Artery Disease ◽

The Relationship

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Angiogenin—A Proposed Biomarker for Cardiovascular Disease—Is Not Associated With Long-Term Survival in Patients With Peripheral Artery Disease

Angiology ◽

10.1177/00033197211004393 ◽

2021 ◽

pp. 000331972110043

Author(s):

Clemens Höbaus ◽

Gerfried Pesau ◽

Bernhard Zierfuss ◽

Renate Koppensteiner ◽

Gerit-Holger Schernthaner

Keyword(s):

Peripheral Artery Disease ◽

Cox Regression ◽

Ankle Brachial Index ◽

Limb Ischemia ◽

Cross Sectional Study ◽

Enzyme Linked Immunosorbent Assay ◽

Peripheral Artery ◽

Cross Sectional ◽

Term Survival ◽

Artery Disease

We evaluated angiogenin as a prospective biomarker in peripheral artery disease (PAD) patients with and without claudication symptoms. A pilot study suggested an elevation of angiogenin in critical limb ischemia. However, in PAD patients, the predictive value of angiogenin has not yet been evaluated. For this purpose, 342 patients with PAD (age: 69 ± 10 years, 34.5% women) were followed-up for 7 years in a cross-sectional study. Angiogenin was measured by enzyme-linked immunosorbent assay. All-cause and cardiovascular mortality were analyzed by Cox regression. Angiogenin levels were higher in men ( P = .001) and were associated with patient waist-to-hip ratio ( P < .001), fasting triglycerides ( P = .011), and inversely with estimated glomerular filtration rate ( P = .009). However, angiogenin showed no association with age, characteristics of diabetes, markers of lipid metabolism, or C-reactive protein. Angiogenin did not correlate with markers of angiogenesis such as vascular endothelial growth factor, angiopoietin-2, or tie-2. Furthermore, angiogenin was not associated with PAD Fontaine stages or with patient ankle-brachial index in addition to all-cause mortality (hazard ratio [HR] = 1.09 [95% CI: 0.89-1.34]) or cardiovascular morality (HR = 1.05 [0.82-1.35]). These results suggest that angiogenin does not provide further information regarding outcome prediction in patients with PAD.

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Peripheral artery disease impairs myocardial perfusion through increasing pulse wave reflection: the Northern Shanghai study

European Heart Journal ◽

10.1093/ehjci/ehaa946.2352 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Yu ◽

J Teliewubai ◽

X Fan ◽

C Chi ◽

H Ji ◽

...

Keyword(s):

Myocardial Perfusion ◽

Peripheral Artery Disease ◽

Wave Reflection ◽

Pulse Wave ◽

Ankle Brachial Index ◽

Community Dwelling ◽

Peripheral Artery ◽

Cardiac Damage ◽

Pulse Wave Reflection ◽

Artery Disease

Abstract Background Peripheral artery disease (PAD) is prevalent and substantially contributes to cardiovascular mortality particularly in the elderly, although the pathophysiological impact of PAD on heart itself still needs further investigation. In theory, PAD can increase pulse wave reflection which is an important determinant of subendocardial viability ratio (SEVR), a valuable estimate of myocardial perfusion as indicated by previous invasive studies. Thus, we hypothesize that PAD impairs myocardial perfusion through increasing pulse wave reflection. In this study, we aim to test this hypothesis in a large cohort from the Northern Shanghai Study. Methods A total of 2947 community-dwelling elderly Chinese (43.6% male, mean age: 71.3±5.9 years) were recruited. Ankle-brachial index were measured with the VP1000 device and used to diagnose PAD. Pulse wave reflection was estimated as aortic augmentation pressure (AP). Aortic BP, AP and SEVR were assessed by radial applanation tonometry. Multiple linear regression with SEVR and AP as dependent variable and PAD as independent variable, meanwhile adjusted for other covariates, were performed, respectively. Results 375 (12.7%) participants presented PAD. Compared to subjects without PAD, those with PAD showed significantly lower SEVR (126 vs. 132, P<0.001) but higher AP (19 vs. 17 mmHg, P<0.001). Multiple regression analysis revealed that both SEVR (regression coefficient [B] = −1.69, P=0.04, R2=0.61) and AP (B=1.19, P=0.04, R2=0.56) significantly associated with PAD, respectively. However, the association between SEVR and PAD was abolished when further adjusted for AP (B=−0.49, P=0.52). Similar results were obtained when inter-leg systolic BP difference was used to diagnose PAD. Conclusions PAD significantly and independently associates with myocardial perfusion; moreover, this association is mediated by increased pulse wave reflection. These findings provide a new dimension for understanding the pathophysiological mechanisms of cardiac damage of PAD. Funding Acknowledgement Type of funding source: None

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Cholesterol Efflux Capacity Associates with the Ankle-Brachial Index but Not All-Cause Mortality in Patients with Peripheral Artery Disease

Diagnostics ◽

10.3390/diagnostics11081407 ◽

2021 ◽

Vol 11 (8) ◽

pp. 1407

Author(s):

Robert K. Clemens ◽

Monika Hunjadi ◽

Andreas Ritsch ◽

Lucia Rohrer ◽

Thomas O. Meier ◽

...

Keyword(s):

Peripheral Artery Disease ◽

Cholesterol Efflux ◽

Ankle Brachial Index ◽

Mortality Rates ◽

High Density Lipoproteins ◽

Peripheral Artery ◽

Cholesterol Efflux Capacity ◽

Hdl Function ◽

All Cause Mortality ◽

Artery Disease

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.

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A Targeted Literature Review of the Disease Burden in Patients With Symptomatic Peripheral Artery Disease

Angiology ◽

10.1177/0003319719896477 ◽

2019 ◽

Vol 71 (4) ◽

pp. 303-314

Author(s):

Rupert Bauersachs ◽

Sebastian Debus ◽

Mark Nehler ◽

Maria Huelsebeck ◽

Janita Balradj ◽

...

Keyword(s):

Peripheral Artery Disease ◽

Disease Burden ◽

Ankle Brachial Index ◽

Peripheral Artery ◽

Economic Burden Of Disease ◽

Surgical Interventions ◽

Treatment Practice ◽

Patient Profile ◽

Increased Risk ◽

Artery Disease

Patients with peripheral artery disease (PAD) have an increased risk of cardiovascular (CV) and limb events, but the disease is frequently underdiagnosed and treatment options are limited. This review examines the disease burden of symptomatic PAD as well as key guideline recommendations. Publications were identified using the ProQuest portal to access the Medline, Medline In-Process, and Embase databases. Search terms for symptomatic PAD were combined with terms relevant to epidemiology, burden, treatment practice, and physiopathology. Articles in English published between January 2001 and September 2016 were screened according to the population, interventions, comparator, outcomes, and study design criteria. Relevant publications (n = 200) were identified. The reported incidence and prevalence of PAD varied depending on the definitions used and the study populations. Patients generally had a poor prognosis, with an increased risk of mortality, CV, and limb events and decreased quality of life. Guideline recommendations included ankle–brachial index measurements, exercise testing, and angiography for diagnosis and risk factor modification, antiplatelets, cilostazol, exercise therapy, or surgical interventions for treatment, depending on the patient profile. The clinical, humanistic, and economic burden of disease in patients with symptomatic PAD is substantial and needs to be reduced through improved PAD management.

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