scholarly journals O72: SECONDARY PREVENTION OF CARDIOVASCULAR DISEASE IN PERIPHERAL ARTERY DISEASE PATIENTS

2021 ◽  
Vol 108 (Supplement_1) ◽  
Author(s):  
ST Rashid ◽  
S Bangee
Keyword(s):  
Cardiovascular Disease ◽  
Risk Factor ◽  
Secondary Prevention ◽  
Peripheral Artery Disease ◽  
Peripheral Artery ◽  
Nice Guidelines ◽  
Novel Treatments ◽  
Wide Range ◽  
Artery Disease ◽  
Prevention Of Cardiovascular Disease

Abstract Introduction Peripheral artery disease (PAD) is associated with significant cardiovascular morbidity and mortality which can be reduced by the treatment of atherosclerotic risk factors. Recent research demonstrates that novel drugs can significantly enhance PAD outcomes. However, the uptake of these drugs is uncertain. We wished to audit current atherosclerotic management in PAD patients as well as their eligibility for newer drugs - PCSK 9 inhibitors, SGLT2 inhibitors, and DOAC drugs – in accordance with relevant guidelines and trials. Method 100 PAD inpatients and outpatients seen at a teaching hospital in the UK within the month of March 2019 were assessed. Medications from PAD patients were recorded from hospital records and patient histories were assessed for secondary prevention of cardiovascular disease - lipids, blood pressure, diabetic control, and atherothrombotic prevention. Result showed that compliance with NICE guidelines had a wide range – from 19% of outpatients on correct lipid control to 89% of inpatients on optimal atherothrombotic management. Based on the best evidence of eligibility: 0 of 41 eligible patients were taking PCSK9 Inhibitors, 1 out of the 71 was on an SGLT 2 inhibitor and 6 of 98 patients were on Rivaroxaban. Conclusion This audit shows adherence to NICE guidelines is variable for secondary prevention of atherosclerosis in PAD patients. Furthermore, very few novel treatments had been prescribed for suitable patients. Overall, prescribing for PAD risk factor management can be significantly improved. A solution could be dedicating risk factor clinics led by nurses, pharmacists or physicians. Take-home message Steps need to be taken to prevent cardiovascular disease in peripheral arterial disease patients. Steps include improvements in the following of guidelines, exploration of novel treatments, and the introduction of special risk factor clinics focused on improving the prognosis of the patients.

scholarly journals Usability of a Digital Registry to Promote Secondary Prevention for Peripheral Artery Disease Patients

2020 ◽  
Author(s):  
Alisha P. Chaudhry ◽  
Ronald A. Hankey ◽  
Vinod C. Kaggal ◽  
Huzefa Bhopalwala ◽  
David A. Liedl ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Peripheral Artery Disease ◽  
Peripheral Artery ◽  
Artery Disease

scholarly journals Association between cholesterol efflux capacity and peripheral artery disease in coronary heart disease patients with and without type 2 diabetes: from the CORDIOPREV study

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Elena M. Yubero-Serrano ◽  
Juan F. Alcalá-Diaz ◽  
Francisco M. Gutierrez-Mariscal ◽  
Antonio P. Arenas-de Larriva ◽  
Patricia J. Peña-Orihuela ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Secondary Prevention ◽  
Peripheral Artery Disease ◽  
Cholesterol Efflux ◽  
Newly Diagnosed ◽  
Peripheral Artery ◽  
Cholesterol Efflux Capacity ◽  
Increased Risk ◽  
Artery Disease

Abstract Background Peripheral artery disease (PAD) is recognized as a significant predictor of mortality and adverse cardiovascular outcomes in patients with coronary heart disease (CHD). In fact, coexisting PAD and CHD is strongly associated with a greater coronary event recurrence compared with either one of them alone. High-density lipoprotein (HDL)-mediated cholesterol efflux capacity (CEC) is found to be inversely associated with an increased risk of incident CHD. However, this association is not established in patients with PAD in the context of secondary prevention. In this sense, our main aim was to evaluate the association between CEC and PAD in patients with CHD and whether the concurrent presence of PAD and T2DM influences this association. Methods CHD patients (n = 1002) from the CORDIOPREV study were classified according to the presence or absence of PAD (ankle-brachial index, ABI ≤ 0.9 and ABI > 0.9 and < 1.4, respectively) and T2DM status. CEC was quantified by incubation of cholesterol-loaded THP-1 cells with the participants' apoB-depleted plasma was performed. Results The presence of PAD determined low CEC in non-T2DM and newly-diagnosed T2DM patients. Coexisting PAD and newly-diagnosed T2DM provided and additive effect providing an impaired CEC compared to non-T2DM patients with PAD. In established T2DM patients, the presence of PAD did not determine differences in CEC, compared to those without PAD, which may be restored by glucose-lowering treatment. Conclusions Our findings suggest an inverse relationship between CEC and PAD in CHD patients. These results support the importance of identifying underlying mechanisms of PAD, in the context of secondary prevention, that provide potential therapeutic targets, that is the case of CEC, and establishing strategies to prevent or reduce the high risk of cardiovascular events of these patients. Trial registrationhttps://clinicaltrials.gov/ct2/show/NCT00924937. Unique Identifier: NCT00924937

scholarly journals Risk factors and clinical outcomes in chronic coronary and peripheral artery disease: An analysis of the randomized, double-blind COMPASS trial

2019 ◽  
Vol 27 (3) ◽  
pp. 296-307 ◽  
Author(s):  
Thomas Vanassche ◽  
Peter Verhamme ◽  
Sonia S Anand ◽  
Olga Shestakovska ◽  
Keith AA Fox ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Peripheral Artery Disease ◽  
Low Dose ◽  
Cardiovascular Death ◽  
Peripheral Artery ◽  
Double Blind ◽  
Artery Disease ◽  
Risk Factor Status ◽  
Ischemic Events

Aims Secondary prevention in patients with coronary artery disease and peripheral artery disease involves antithrombotic therapy and optimal control of cardiovascular risk factors. In the Cardiovascular Outcomes for People Using Anticoagulation Strategies (COMPASS) study, adding low-dose rivaroxaban on top of aspirin lowered cardiovascular events, but there is limited data about risk factor control in secondary prevention. We studied the association between risk factor status and outcomes, and the impact of risk factor status on the treatment effect of rivaroxaban, in a large contemporary population of patients with coronary artery disease or peripheral artery disease. Methods and results We reported ischemic events (cardiovascular death, stroke, or myocardial infarction) in participants from the randomized, double-blind COMPASS study by individual risk factor (blood pressure, smoking status, cholesterol level, presence of diabetes, body mass index, and level of physical activity), and by number of risk factors. We compared rates and hazard ratios of patients treated with rivaroxaban plus aspirin vs aspirin alone within each risk factor category and tested for interaction between risk factor status and antithrombotic regimen. Complete baseline risk factor status was available in 27,117 (99%) patients. Status and number of risk factors were both associated with increased risk of ischemic events. Rates of ischemic events (hazard ratio 2.2; 95% confidence interval 1.8–2.6) and cardiovascular death (hazard ratio 2.0; 1.5–2.7) were more than twofold higher in patients with 4–6 compared with 0–1 risk factors ( p < 0.0001 for both). Rivaroxaban reduced event rates independently of the number of risk factors ( p interaction 0.93), with the largest absolute benefit in patients with the highest number of risk factors. Conclusion More favorable risk factor status and low-dose rivaroxaban were independently associated with lower risk of cardiovascular events.

P938Extensive formation of atherosclerotic cardiovascular disease in subjects with severe familial hypercholesterolemia defined by the international atherosclerosis society criteria

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Funabashi ◽  
Y Kataoka ◽  
M Harada-Shiba ◽  
M Hori ◽  
T Doi ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
High Risk ◽  
Familial Hypercholesterolemia ◽  
Peripheral Artery Disease ◽  
Cardiac Death ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Peripheral Artery ◽  
Lowering Therapy ◽  
Artery Disease

Abstract Introduction The International Atherosclerosis Society (IAS) has proposed “severe familial hypercholesterolemia (FH)” as a FH phenotype with the highest cardiovascular risk. Coronary artery disease (CAD) represents a major atherosclerotic change in FH patients. Given their higher LDL-C level and atherogenic clinical features, more extensive formation of atherosclerosis cardiovascular disease including not only CAD but stroke/peripheral artery disease (PAD) may more frequently occur in severe FH. Methods 481 clinically-diagnosed heterozygous FH subjects were analyzed. Severe FH was defined as untreated LDL-C>10.3 mmol/l, LDL-C>8.0 mmol/l+ 1 high-risk feature, LDL-C>4.9 mmol/l + 2 high-risk features or presence of clinical ASCVD according to IAS proposed statement. Cardiac (cardiac death and ACS) and non-cardiac (stroke and peripheral artery disease) events were compared in severe and non-severe FH subjects. Results Severe FH was identified in 50.1% of study subjects. They exhibit increased levels of LDL-C and Lipoprotein (a) with a higher frequency of LDLR mutation. Furthermore, a proportion of %LDL-C reduction>50% was greater in severe FH under more lipid-lowering therapy (Table). However, during the observational period (median=6.3 years), severe FH was associated with a 5.9-fold (95% CI, 2.05–25.2; p=0.004) and 5.8-fold (95% CI, 2.02–24.7; p=0.004) greater likelihood of experiencing cardiac-death/ACS and stroke/PAD, respectively (picture). Multivariate analysis demonstrated severe FH as an independent predictor of both cardiac-death/ACS (hazard ratio=3.39, 95% CI=1.12–14.7, p=0.02) and stroke/PAD (hazard ratio=3.38, 95% CI=1.16–14.3, p=0.02) events. Clinical characteristics of severe FH Non-severe FH Severe FH P-value Baseline LDL-C (mmol/l) 5.3±1.5 6.6±2.0 <0.0001 Lp(a) (mg/dl) 15 [8–28] 21 [10–49] <0.0001 LDLR mutation (%) 49.6% 58.9% 0.00398 On-treatment LDL-C (mmol) 133 [106–165] 135 [103–169] 0.9856 %LDL-C reduction>50% 21.3% 49.8% <0.0001 High-intensity statin (%) 13.3% 42.3% <0.0001 PCSK9 inhibitor (%) 6.3% 21.2% <0.0001 Clinical outcome Conclusions Severe FH subjects exhibit substantial atherosclerotic risks for coronary, carotid and peripheral arteries despite lipid lowering therapy. Our finding underscore the screening of systemic arteries and the adoption of further stringent lipid management in severe FH patients.

The relation between apolipoprotein E (APOE) genotype and peripheral artery disease in patients at high risk for cardiovascular disease

2016 ◽  
Vol 246 ◽  
pp. 187-192 ◽  
Author(s):  
Charlotte Koopal ◽  
Mirjam I. Geerlings ◽  
Majon Muller ◽  
G.J. de Borst ◽  
Ale Algra ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
High Risk ◽  
Apolipoprotein E ◽  
Peripheral Artery Disease ◽  
Apoe Genotype ◽  
Peripheral Artery ◽  
Artery Disease

scholarly journals Association between AST to ALT ratio and peripheral artery disease in Chinese adults with hypertension：a cross-sectional study

2020 ◽  
Author(s):  
Hui Liu ◽  
Xiaoyuan Zha ◽  
Congcong Ding ◽  
Lihua Hu ◽  
Minghui Li ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Peripheral Artery Disease ◽  
Reference Group ◽  
Final Analysis ◽  
Multivariate Logistic Regression Model ◽  
Peripheral Artery ◽  
Chinese Adults ◽  
Cross Sectional ◽  
Increased Risk ◽  
Artery Disease

Abstract Background: Previous studies had shown that aspartate aminotransferase to alanine aminotransferase (AST/ALT ratio) plays a role in cardiovascular disease. Peripheral artery disease (PAD) is an important risk factor for cardiovascular disease. However, there are a little research on the association between the AST/ALT ratio and Peripheral artery disease (PAD). Methods: A total of 10, 900 hypertensive patients from the Chinese Hypertension Registry Study were included in the final analysis. The association between AST / ALT and peripheral arterial disease (PAD), which was defined as ABI ≤ 0.9 in either leg, was estimated by a multivariate logistic regression model.Results: Overall, the prevalence of PAD was 3.21%. After adjusting for potential confounders, AST / ALT ratio was independently and positively associated with the risk of PAD (OR: 1.31, 95% CI: 1.13 to 1.59), and a statistically significant increased risk of PAD for the third tertile (T3) of AST / ALT ratio compared to the first tertile (T1) (OR:1.49, 95% CI: 1.09 to 2.04, P-trend= 0.005) was found. Moreover, when the T1-T2 group was combined into one group and used it as a reference group, the risk of PAD increased with the increase of AST/ALT and the risk ratio was 1.52 (95% CI :1.20 to 1.95). Conclusion: A higher AST/ALT ratio (≥1.65) was associated with PAD risk in Chinese adults with hypertension. The presented results suggested that AST / ALT may help us highlight patients who are at high risk of vascular endpoints.Trial registration: CHICTR, CHiCTR1800017274. Registered 20 July 2018.

The risk of peripheral artery disease in older adults - seven-year results of the getABI study

VASA ◽  
2016 ◽  
Vol 45 (5) ◽  
pp. 403-410 ◽  
Author(s):  
Dietmar Krause ◽  
Ina Burghaus ◽  
Ulrich Thiem ◽  
Ulrike S. Trampisch ◽  
Matthias Trampisch ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Risk Factor ◽  
Peripheral Artery Disease ◽  
Ankle Brachial Index ◽  
Density Lipoprotein ◽  
Current Smoker ◽  
Repeated Measurements ◽  
Peripheral Artery ◽  
Artery Disease

Abstract. Background: To assess the risk of peripheral artery disease (PAD) in older adults and the contribution of traditional and novel risk factors to the incidence of PAD. Patients and methods: 344 general practitioners (GPs), trained by vascular specialists all over Germany, enrolled 6,880 unselected participants aged 65 years or older (getABI study). The onset of PAD was determined by a regression method in the course of repeated measurements of the ankle brachial index (ABI) over seven years. PAD onset was defined by the declining linear regression ABI line reaching 0.9 or by PAD symptoms. Results: The cumulative PAD incidence over seven years was 12.9%, corresponding to an incidence rate of 20.3 per 1000 person years (95% confidence interval [95%CI] 18.8 to 21.7). Logistic regression analysis showed that traditional risk factors contributed significantly to the risk of PAD: current smoker status (odds ratio 2.65, 95%CI 2.08 to 3.37), diabetes (1.35, 95%CI 1.13 to 1.62), and low-density lipoprotein >130 mg/dl (1.26, 95%CI 1.07 to 1.48). Three novel risk factor candidates showed significant impact on PAD incidence: elevated sensitive C-reactive protein level (1.23, 95%CI 1.05 to 1.45), impaired estimated glomerular filtration rate (1.27, 95%CI 1.03 to 1.56), and elevated homocysteine level (1.19, 95%CI 1.01 to 1.41). Conclusions: Older adults in Germany have a PAD risk of 12.9% per seven years. Potentially modifiable traditional PAD risk factors yield high impact on PAD incidence. Novel risk factor candidates may contribute to the risk of PAD

Epidemiology of Peripheral Artery Disease and Polyvascular Disease

2021 ◽  
Vol 128 (12) ◽  
pp. 1818-1832
Author(s):  
Aaron W. Aday ◽  
Kunihiro Matsushita
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Coronary Artery Disease ◽  
Peripheral Artery Disease ◽  
Microvascular Disease ◽  
Adverse Outcomes ◽  
Peripheral Artery ◽  
Cardiovascular Morbidity And Mortality ◽  
Increase Risk ◽  
Artery Disease

Atherosclerotic lower extremity peripheral artery disease (PAD) is increasingly recognized as an important cause of cardiovascular morbidity and mortality that affects >230 million people worldwide. Traditional cardiovascular risk factors, including advanced age, smoking, and diabetes, are strongly linked to an increase risk of PAD. Although PAD has been historically underappreciated compared with coronary artery disease and stroke, greater attention on PAD in recent years has led to important new epidemiological insights in the areas of thrombosis, inflammation, dyslipidemia, and microvascular disease. In addition, the concept of polyvascular disease, or clinically evident atherosclerosis in multiple arterial beds, is increasingly identified as a particularly malignant cardiovascular disease worthy of special clinical attention and further study. It is noteworthy that PAD may increase the risk of adverse outcomes in similar or even greater magnitude than coronary disease or stroke. In this review, we highlight important new advances in the epidemiology of PAD with a particular focus on polyvascular disease, emerging biomarkers, and differential risk pathways for PAD compared with other atherosclerotic diseases.

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