Peripheral vascular disease: consequence for survival and association with risk factors in the Speedwell prospective heart disease study

AbstractBackgroundLipoprotein (a) (Lp(a)) is a CVD risk factor amenable to intervention and might help guide risk prediction.ObjectivesTo investigate the population attributable fraction due to elevated Lp(a) and its utility in risk prediction.MethodsUsing a prospective cohort study, 413,724 participants from UK Biobank, associations of serum Lp(a) with composite fatal/nonfatal CVD (n=10,065 events), fatal CVD (n=3247), coronary heart disease (n=16,649), ischaemic stroke (n=3191), and peripheral vascular disease (n=2716) were compared using Cox models. Predictive utility was determined by C-index changes. The population attributable fraction was estimated.ResultsMedian Lp(a) was 19.7nmol/L (interquartile interval 7.6-75.3nmol/L). 20.8% had Lp(a) values >100nmol/L; 9.2% had values >175nmol/L. After adjustment for classical risk factors, in participants with no baseline CVD and not taking a statin, 1 standard deviation increment in log Lp(a) was associated with a HR for fatal/nonfatal CVD of 1.09 (95%CI 1.07-1.11). Associations were similar for fatal CVD, coronary heart disease, and peripheral vascular disease. Adding Lp(a) to a prediction model containing traditional CVD risk factors improved the C-index by +0.0017 (95% CI 0.0009, 0.0026). We estimated that having Lp(a) values >100nmol/L accounts for 5.7% of CVD events in the whole cohort. We modelled that an ongoing trial to lower Lp(a) in patients with CVD and Lp(a) above ∼175nmol/L may reduce CVD risk by 20.3%, assuming causality, and an achieved Lp(a) reduction of 80%.ConclusionsPopulation screening for elevated Lp(a) may help to predict CVD and target Lp(a) lowering drugs, if such drugs prove efficacious, to those with markedly elevated levels.

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Lipoprotein(a) and cardiovascular disease: prediction, attributable risk fraction and estimating benefits from novel interventions

European Heart Journal ◽

10.1093/ehjci/ehaa946.2833 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

P Welsh ◽

C Welsh ◽

C.A.C Celis-Morales ◽

R Brown ◽

L.D Ferguson ◽

...

Keyword(s):

Risk Factors ◽

Coronary Heart Disease ◽

Heart Disease ◽

Vascular Disease ◽

Peripheral Vascular Disease ◽

Population Attributable Fraction ◽

Attributable Fraction ◽

Funding Source ◽

Peripheral Vascular ◽

Cvd Risk

Abstract Background Lipoprotein (a) (Lp(a)) measurement may help guide CVD risk prediction, is thought to be causal in several CVD outcomes, and phase 3 intervention trials of Lp(a) lowering agents are underway. We aimed to investigate the population attributable fraction due to elevated Lp(a) and its utility in CVD risk prediction. Methods In 413,724 participants from UK Biobank, associations of serum Lp(a) with composite fatal/nonfatal CVD (n=10,065 events), fatal CVD (n=3247), coronary heart disease (n=16,649), ischaemic stroke (n=3191), and peripheral vascular disease (n=2716) were compared using Cox models. Predictive utility was determined by C-index changes. The population attributable fraction was estimated. Results Median Lp(a) was 19.7nmol/L (interquartile interval 7.6–75.3nmol/L). 20.8% had Lp(a) values >100nmol/L; 9.2% had values >175nmol/L. After adjustment for classical risk factors, in participants with no baseline CVD and not taking a statin, 1 standard deviation increment in log Lp(a) was associated with a HR for fatal/nonfatal CVD of 1.09 (95% CI 1.07–1.11). Associations were similar for fatal CVD, coronary heart disease, and peripheral vascular disease. Adding Lp(a) to a prediction model containing traditional CVD risk factors improved the C-index by +0.0017 (95% CI 0.0009, 0.0026). We estimated that having Lp(a) values >100nmol/L accounts for 5.7% of CVD events in the whole cohort. We modelled that an ongoing trial to lower Lp(a) in patients with CVD and Lp(a) above ∼175nmol/L may be expected to reduce CVD risk by 20.3%, assuming causality, and an achieved Lp(a) reduction of 80%. Conclusions Population screening for elevated Lp(a) may help to predict CVD and target Lp(a) lowering drugs to those with markedly elevated levels, if such drugs prove efficacious. Population attributable fractions: Lp(a) Funding Acknowledgement Type of funding source: Other. Main funding source(s): Chest, Heart, and Stroke Association Scotland and British Heart Foundation

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Cardiovascular disease after renal transplantation.

Journal of the American Society of Nephrology ◽

10.1681/asn.v71158 ◽

1996 ◽

Vol 7 (1) ◽

pp. 158-165 ◽

Cited By ~ 16

Author(s):

B L Kasiske ◽

C Guijarro ◽

Z A Massy ◽

M R Wiederkehr ◽

J Z Ma

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Heart Disease ◽

Renal Transplantation ◽

Ischemic Heart Disease ◽

Vascular Disease ◽

Peripheral Vascular Disease ◽

Density Lipoprotein ◽

Ischemic Heart ◽

Peripheral Vascular

Although cardiovascular disease is a major cause of morbidity and mortality after renal transplantation, its pathogenesis and treatment are poorly understood. We conducted separate analyses of risk factors for ischemic heart disease, cerebral, and peripheral vascular disease after 706 renal transplants, all of which functioned for at least 6 months. We used Cox proportional hazards analysis to examine the effects of multiple pretransplant and posttransplant risk factors and included time-dependent variables measured at 3, 6, and 12 months, and annually to last follow-up at 7.0 +/- 4.2 yr. The independent relative risk (RR) of diabetes was 3.25 for ischemic heart disease, 3.21 for cerebral vascular disease, and 28.18 peripheral vascular disease (P < 0.05). The RR of each acute rejection episode was 1.40 for ischemic heart disease and 1.24 for cerebral vascular disease. Among serum lipid levels, high-density lipoprotein cholesterol was the best predictor of ischemic heart disease (RR = 0.80 for each 10 mg/dL). Posttransplant ischemic heart disease was strongly predictive of cerebral (5.80) and peripheral vascular disease (5.22), whereas ischemic heart disease was predicted by posttransplant cerebral (8.25) and peripheral vascular disease (4.58). Other risk factors for vascular disease included age, gender, cigarette smoking, pretransplant splenectomy, and serum albumin. Hypertension and low-density lipoprotein cholesterol had no effect, perhaps because of aggressive pharmacologic treatment. Thus, the incidence of cardiovascular disease continues to be high after renal transplantation, and multiple risk factors suggest a number of possible strategies for more effective treatment and prevention.

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Comparative Histopathology of Radial Artery Versus Internal Thoracic Artery and Risk Factors for Development of Intimal Hyperplasia and Atherosclerosis

Circulation ◽

10.1161/circ.100.suppl_2.ii-139 ◽

1999 ◽

Vol 100 (suppl_2) ◽

Author(s):

Permyos Ruengsakulrach ◽

Roger Sinclair ◽

Masashi Komeda ◽

Jai Raman ◽

Ian Gordon ◽

...

Keyword(s):

Risk Factors ◽

Vascular Disease ◽

Peripheral Vascular Disease ◽

Radial Artery ◽

Morphometric Analysis ◽

Intimal Hyperplasia ◽

Internal Thoracic Artery ◽

Peripheral Vascular ◽

Luminal Narrowing ◽

Intimal Thickness

Background —In this study, we examined the comparative histopathology, morphometry, and risk factors for the development of intimal hyperplasia and atherosclerosis in the radial artery (RA) and the internal thoracic artery (ITA). Methods and Results —Paired specimens of RAs and ITAs, obtained from 150 patients who underwent CABG, were evaluated with histopathology; 110 pairs of arteries were suitable for morphometric analysis. The severity of disease was evaluated on the basis of percentage of luminal narrowing, intimal thickness index, and intima-to-media ratio. Risk factors were determined with stepwise linear regression. Intimal hyperplasia was seen in 141 RAs (94%) and 103 ITAs (69%) ( P <0.001). Atherosclerosis was seen in 5% of RAs and 0.7% of ITAs ( P =0.04). Medial calcification was found only in RAs (20 of 150, 13.3%) ( P <0.001). Morphometric analysis showed that compared with ITAs, RAs had a significantly higher intimal area, medial area, percentage of luminal narrowing, intimal thickness index, and intima-to-media ratio (all P <0.001) Factors found to be significant ( P <0.05) predictors of the 3 severity indices of intimal hyperplasia, including atherosclerosis, in RAs were peripheral vascular disease, smoking, age, and diabetes. Risk factors for intimal hyperplasia in ITAs were age and smoking. Conclusions —The RA is more likely to have atherosclerosis, intimal hyperplasia, and medial calcification than the ITA. Morphometric analysis indices showed marked differences between the RA and the ITA. Care should be taken when selecting the RA as a conduit in CABG, particularly in patients who are elderly, diabetic, smoke, or have peripheral vascular disease.

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Prevalence and risk factors of peripheral vascular disease in Taiwanese type 2 diabetic patients

Atherosclerosis Supplements ◽

10.1016/s1567-5688(02)80719-x ◽

2002 ◽

Vol 3 (2) ◽

pp. 221-222

Keyword(s):

Risk Factors ◽

Vascular Disease ◽

Peripheral Vascular Disease ◽

Diabetic Patients ◽

Peripheral Vascular ◽

Type 2 Diabetic Patients ◽

Type 2 Diabetic

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Macroangiopathy in type II diabetes

Acta Endocrinologica ◽

10.1530/acta.0.104s075 ◽

1983 ◽

Vol 104 (4_Suppl) ◽

pp. S75-S78

Author(s):

Antti Aro

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Vascular Disease ◽

Peripheral Vascular Disease ◽

Type Ii Diabetes ◽

Clinical Manifestations ◽

Diabetic Patients ◽

Type Ii ◽

Peripheral Vascular ◽

Middle Aged

ABSTRACT. Macroangiopathy is the most important cause of mortality and morbidity in type II diabetes. The atherosclerotic process in diabetes is similar to that found in non-diabetic subjects, but the laesions are more extensive and the clinical manifestations are more common in diabetic subjects than in the non-diabetic population. In diabetic patients from different populations, the prevalence of macroangiopathy is variable, and the relative frequency follows the pattern found in the respective non-diabetic populations. The relative risk of large vessel disease is in most populations higher for female than for male diabetics. Coronary heart disease is the most important manifestation of macroangiopathy while cerebrovascular disease and peripheral vascular disease are less frequent, although all these manifestations occur at increased frequency among middle-aged diabetic subjects. The incidence of peripheral vascular disease seems to increase with increasing duration of diabetes in middle-aged subjects, whereas coronary heart disease is particularly frequent in type II diabetes already at the time of the diagnosis. Key words: atherosclerosis, complications, diabetes mellitus, macroangiopathy, mortality.

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