Using ankle-brachial index to detect peripheral arterial disease: Prevalence and associated risk factors in a random population sample

2007 ◽  
Vol 17 (1) ◽  
pp. 41-49 ◽  
Author(s):  
Julio A. Carbayo ◽  
Juan A. Divisón ◽  
Julio Escribano ◽  
Juan López-Abril ◽  
Enrique López de Coca ◽  
...  
Author(s):  
Kim Smolderen ◽  
Jan-Willem Elshof ◽  
Moniek van Zitteren ◽  
John A Spertus ◽  
Johan Denollet ◽  
...  

Background: Obtaining adequate lipid control (LDL-Cholesterol [LDL] <100 mg/dL) in patients with peripheral arterial disease (PAD) is a critical, guideline-directed secondary prevention target. Current compliance with this recommendation is unknown. Methods: A total of 616 patients had their LDL levels measured at 2 vascular specialty clinics in the Netherlands (March 2006-November 2011) during the evaluation of new PAD symptoms. A year following this evaluation, 417 (68%) patients had their LDL levels re-assessed. Information about patients’ demographic and clinical factors was systematically abstracted from medical records. Categories of patients were created based on the attainment of the recommended LDL target (<100 mg/dL [on target] vs. ≥100 mg/dL [off target]). Predictors of being off target at initial evaluation and at 1-year follow-up were identified through multivariable logistic regression analyses. Results: Of the total group, 57% (351/616) were off target at initial evaluation and 81% (496/616) were on lipid-lowering drugs after the initial evaluation at the PAD specialty clinic. One year later, only 25% (103/417) got on target, while 35% (147/417) patients remained off target, and an additional 10% (43/417) saw an increase in LDL to become off target. A total of 30% (124/417) remained on target. Patients with hypertension, diabetes, a history of myocardial infarction, and a lower ankle-brachial index were less likely to be off target at initial evaluation. Predictors of being off target at 1-year follow-up were male sex, and having a higher ankle-brachial index ( Table ). Conclusion: About half of patients with PAD seen at vascular specialty clinics had above-target LDL levels both upon entry and 1 year later. Patients with existing cardiovascular risk factors were much better controlled, as compared with patients without such risk factors. Males and those with higher ankle-brachial indices were less likely to be on target 1 year following management at the specialty clinic. Reasons for poorly regulated lipids need to be further explored, and appropriate quality-of-care improvement strategies will likely be needed to optimize secondary prevention.


2020 ◽  
Vol 17 (6) ◽  
pp. 147916412096699
Author(s):  
Preaw Suwannasrisuk ◽  
Sarinya Sattanon ◽  
Watcharaporn Taburee ◽  
Pantitra Singkheaw ◽  
Non Sowanna ◽  
...  

In diabetes patients, urban lifestyle has been concerned as one of the risk factors for peripheral arterial disease (PAD). The aims of this study were to find out the prevalence and associated risk factors of PAD in type 2 diabetes patients who live in a non-urban community area. A total of 885 participants with type 2 diabetes mellitus were enrolled from six primary care units in the health network centered at Naresuan University Hospital, Phitsanulok, between May and June 2018. Ankle-brachial index (ABI) was performed in all subjects using a vascular screening device. PAD was defined by an ABI value of 0.9 or lesser at least on one leg. The predictors of PAD were analyzed using multiple logistic regression. The prevalence of PAD was 7.2% among 884 evaluable patients. Diabetic neuropathy and a history of macrovascular complications were significant predictors of PAD.


2005 ◽  
Vol 67 ◽  
pp. S44-S47 ◽  
Author(s):  
Soledad Garcia de Vinuesa ◽  
Mayra Ortega ◽  
Patricia Martinez ◽  
Marian Goicoechea ◽  
Francisco Gomez Campdera ◽  
...  

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Monica L Bertoia ◽  
Jennifer K Pai ◽  
Sotirios Tsimikas ◽  
Michel M Joosten ◽  
Murray A Mittleman ◽  
...  

Background: Peripheral arterial disease (PAD) is highly prevalent, found in 25% of adults ≥70 years, but its risk factors are less well studied than coronary and carotid atherosclerosis. Proinflammatory oxidized phospholipids (OxPL) are a novel cardiovascular risk factor produced by oxidative stress and are preferentially bound and transported by lipoprotein (a) [Lp(a)] in plasma. Previous studies have shown an association between OxPL on apolipoprotein B-100 (OxPL/apoB) and carotid and femoral atherosclerosis. However, no previous studies have specifically examined the prospective association between OxPL/apoB and risk of PAD in a population-based cohort. Methods: We conducted a nested case-control study among men free of cardiovascular disease within the Health Professionals Follow-up Study (1994–2008) including 143 men with PAD and 429 controls matched on age, month of blood draw, and smoking. OxPL/apoB and Lp(a) were measured in stored baseline plasma. We identified cases of clinically significant PAD based on at least one of the following: (1) amputation, bypass, or other revascularization procedure for occlusive arterial disease, (2) angiogram/ultrasound confirming at least 50% stenosis of at least one artery with congruent symptoms in the ipsilateral limb, (3) ankle-brachial index < 0.9, or (4) physician's diagnosis. We used conditional logistic regression to estimate odds ratios (OR) for PAD according to level of OxPL/apoB. Results: The OR for PAD was 1.24 (95% CI 1.05–1.46) for each 1-standard deviation (SD) increase in OxPL/apoB after adjusting for matching factors. Additional adjustment for family history of MI, triglycerides, HDL-C, LDL-C, C-reactive protein, hemoglobin A1c, pack-years of smoking, physical activity, hypertension, diabetes, hypercholesterolemia, body-mass index, and aspirin use did not change this estimate: 1.24 (95% CI 1.00–1.54). OxPL/apoB was not correlated with any conventional risk factors: Spearman correlation coefficients ranged from 0.0 to 0.13. We observed no interaction with age or LDL-C. Similarly, the OR for PAD was 1.25 (95% CI 0.95–1.63) for each 1- SD increase in ln[Lp(a)] after adjusting for all of the above covariates. Conclusion: OxPL/apoB is positively associated with risk of PAD in men with no appreciable attenuation after adjustment for conventional risk factors.


2014 ◽  
Vol 41 (2) ◽  
pp. 310-317 ◽  
Author(s):  
Jose Gabriel Erdozain ◽  
Irama Villar ◽  
Javier Nieto ◽  
Guillermo Ruiz-Irastorza

Objective.To analyze the prevalence of peripheral arterial disease (PAD) and cardiovascular (CV) risk factors in a cohort of patients with systemic lupus erythematosus (SLE) and to identify variables potentially related to PAD.Methods.The study included 216 patients with SLE from the Lupus-Cruces prospective observational cohort. The ankle brachial index (ABI) was determined in each patient, with values < 0.9 considered diagnostic of PAD. Demographic and clinical variables, presence of traditional risk factors and CV events, cardiovascular risk calculated by Systematic Coronary Risk Evaluation (SCORE), and treatments received by each patient were analyzed.Results.Ninety-two percent of patients were women. The mean age (SD) was 49 years (15), with a mean followup (SD) of 12 years (9). The prevalence of low ABI was 21%. CV risk factors were frequent: smoking, 30% of patients; high blood pressure, 32.7%; diabetes mellitus, 3.2%; hypercholesterolemia, 34.1%; and metabolic syndrome, 9.7%. The following variables were associated with low ABI in the univariate analysis: age (p < 0.001), hypertension (p = 0.002), diabetes (p = 0.018), hypercholesterolemia (p = 0.018), CV events (p < 0.001), SCORE (p = 0.004), cumulative dose of cyclophosphamide (p = 0.03), and fibrinogen levels (p = 0.002). In the multivariate analysis, the only independent variable in the final model was age (OR 1.04, 95% CI 1.02–1.07, p < 0.001), with a tendency for the presence of any vascular risk factor (diabetes, hypertension, hypercholesterolemia, or current smoking; OR 2.3, 95% CI 0.99–5.1, p = 0.053).Conclusion.The prevalence of low ABI in patients with SLE is higher than expected. While the association with CV risk factors and vascular disease in other territories was strong, we could not identify SLE-specific variables independently associated with PAD.


Author(s):  
Amaraporn Rerkasem ◽  
Patumrat Sripan ◽  
Sasinat Pongtam ◽  
Sakaewan Ounjaijean ◽  
Kanokwan Kulprachakarn ◽  
...  

Adult patients with human immunodeficiency virus (HIV) appear to be at high risk of cardiovascular disease (CVD). Peripheral arterial disease (PAD) is particularly concerning as it is associated with myocardial infarction and stroke. Nevertheless, the incidence of PAD is still unknown. The authors prospectively recruited HIV-infected patients from the outpatient clinic of the Department of Internal Medicine in our center. We assessed ankle-brachial index (ABI) using the VaSera system™ (Fukuda Denshi Co., Ltd). Patients were grouped into 3 ABI levels: an ABI ≤0.90 was considered abnormal and evidence of PAD, an ABI 1.0 to 1.40 was considered normal, and 0.91 to 0.99 was considered borderline. Cardiovascular risk factors were compared across all 3 levels of ABI and were analyzed using multivariate ordinal logistic regression. Eight hundred ninety-two patients were recruited. The mean age was 42.9 ± 10.0 years and 458 (51.4%) were males. There were 704, 149, and 39 patients in the normal, borderline, and abnormal ABI groups, respectively. The latter group of 39 patients was considered to have PAD, yielding a prevalence of 4.37% (95% confidence interval [CI] 3.21-5.93). Sex ratio, age, education levels, smoking rate, body mass index (BMI), blood pressure, prevalence of comorbidities with hypertension and coronary heart disease, median triglyceride level, reduced kidney function and HIV-1 RNA undetectable ratio, duration of HIV diagnosis, and duration on antiretroviral treatment were significantly different among 3 ABI subgroups. Independent risk factors associated with PAD were being female (odds ratio [OR]: 2.86; 95% CI: 1.94-4.22), being <30 years of age (OR: 4.66; 95% CI: 2.78-7.81), being overweight (BMI 25-25.9; OR: 0.39; 95% CI: 0.20-0.76), being obese (BMI: 30; OR: 3.53; 95% CI: 1.51-8.22), having a diastolic blood pressure ≥80 mmHg (OR: 0.50; 95% CI: 0.35-0.71), and having detectable HIV-1 RNA ≥20 copies/mL (OR: 1.85; 95% CI: 1.13-3.03). In conclusion, the prevalence of PAD in HIV-infected Thais was 4.37% in infected patients on therapy attending outpatient clinics. For this population, PAD appears to be relatively poorly correlated with traditional risk factors of CVD.


Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Wesley T O’Neal ◽  
Jimmy T Efird ◽  
Saman Nazarian ◽  
Alvaro Alonso ◽  
Susan R Heckbert ◽  
...  

Introduction: Peripheral arterial disease (PAD) shares several risk factors with atrial fibrillation (AF) and persons with PAD have an increased risk of stroke. It is unclear if PAD is associated with an increased risk for AF and whether such an association explains the increased risk of stroke associated with PAD. Methods: We examined the association between PAD, as measured by the ankle-brachial index (ABI), and incident AF and incident stroke, separately, in 6,568 participants (mean age 62 ± 10; 53% women; 62% non-white) from the Multi-Ethnic Study of Atherosclerosis (MESA). ABI values <1.0 or >1.4 defined PAD in this analysis. Participants were free of baseline clinical cardiovascular disease and AF. AF was ascertained by review of hospital discharge records and from Medicare claims data until December 31, 2010. An independent adjudication committee ascertained stroke events. Cox regression was used to compute hazard ratios (HR) and 95% confidence intervals (95%CI) for the association between PAD and AF and stroke. Results: A total of 774 (12%) participants had baseline PAD. Over a median follow-up of 8.5 years, 301 (4.6%) participants developed AF and 140 (2.1%) developed stroke. In a model adjusted for socio-demographics, cardiovascular risk factors, and potential confounders, PAD was associated with an increased risk of AF (HR=1.5, 95%CI=1.1, 2.0). In a similar model, PAD was associated with incident stroke (HR=1.7, 95%CI=1.1, 2.5) and the magnitude of risk was not different after inclusion of AF as a time-dependent covariate (HR=1.7, 95%CI=1.1, 2.5). Similar results were obtained in subgroup analyses stratified by age, sex, and race/ethnicity. Conclusions: PAD is independently associated with an increased risk of AF and stroke in the MESA study. The relationship between PAD and stroke is not mediated by AF.


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