Abstract P081: Markers of Endothelial Function and Peripheral Arterial Disease among Women

Introduction: Markers of endothelial function may be associated with increased risk for cardiovascular disease; however, prospective data for peripheral arterial disease (PAD) are limited. We evaluated the hypothesis that serum markers of endothelial dysfunction are associated with an increased risk of PAD among women. Methods: We conducted a nested case-control study within an ongoing prospective cohort of U.S. female nurses (Nurses’ Health Study). Among 32,826 NHS participants who provided blood samples in 1989-1990, after excluding those who had myocardial infarction, coronary heart disease, stroke, or carotid artery surgery prior to the PAD diagnosis, we included all incident PAD cases that occurred between 1990 and 2008 and were confirmed by medical records. Each case was individually matched with three eligible controls using risk-set sampling, by age, smoking, date of blood draw, and fasting status. We evaluated the association between serum levels of soluble intercellular adhesion molecule (ICAM-1), E-selectin, and the risk of PAD, using conditional logistic regression analysis. Results: Complete biomarker data from 1990 was available for 144 cases and 431 controls. After accounting for matching factors, baseline ICAM-1 levels were associated with higher risk of PAD (RR for highest (T3) vs. lowest (T1) tertile=1.75, 95% CI: 1.05-2.90). The association was attenuated and no longer significant (RR T3 vs. T1=1.37, 95% CI: 0.75-2.49) after adjusting for serum levels of HDL and LDL-cholesterol, family history of myocardial infarction, relative weight, reported aspirin and cholesterol-lowering medication use, hypertension and diabetes diagnoses, physical activity, and pack-years of smoking. Additional adjustment for CRP levels further attenuated the relative risk (RR T3 vs. T1= 1.24, 95% CI: 0.67-2.29). We did not observe any significant association between baseline E-selectin levels and the risk of PAD (multivariate- and CRP-adjusted RR T3 vs. T1=0.93, 95% CI: 0.54-1.59). Conclusions: There was no association between ICAM-1 and E-selectin and subsequent PAD in this cohort of U.S women.

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Abstract P248: Oxidized Phospholipids and Risk of Peripheral Arterial Disease in Men

Circulation ◽

10.1161/circ.125.suppl_10.ap248 ◽

2012 ◽

Vol 125 (suppl_10) ◽

Author(s):

Monica L Bertoia ◽

Jennifer K Pai ◽

Sotirios Tsimikas ◽

Michel M Joosten ◽

Murray A Mittleman ◽

...

Keyword(s):

Risk Factors ◽

Peripheral Arterial Disease ◽

Conditional Logistic Regression ◽

Ankle Brachial Index ◽

Arterial Disease ◽

Population Based ◽

Oxidized Phospholipids ◽

Blood Draw ◽

Peripheral Arterial ◽

Conventional Risk Factors

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.

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Erectile Dysfunction and Cardiovascular Risk in Men with Rheumatoid Arthritis: A Population- Based Cohort Study

The Journal of Rheumatology ◽

10.3899/jrheum.201226 ◽

2021 ◽

pp. jrheum.201226

Author(s):

Katelynn M. Wilton ◽

Sara J. Achenbach ◽

John M. Davis ◽

Elena Myasoedova ◽

Eric L. Matteson ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Myocardial Infarction ◽

Heart Failure ◽

Erectile Dysfunction ◽

Cardiovascular Risk ◽

Peripheral Arterial Disease ◽

Arterial Disease ◽

Risk Of Death ◽

Increased Risk ◽

Peripheral Arterial

Objective Both erectile dysfunction (ED) and rheumatoid arthritis (RA) are associated with increased cardiovascular risk. It is unknown if these diagnoses are associated or if their combination confers additional cardiovascular risk. We aim to define the incidence of ED in RA, and determine if ED correlates with increased cardiovascular risk in RA. Methods Medical information concerning RA, ED and cardiovascular diagnoses for men with RA (n=260) diagnosed in Olmsted county, Minnesota and age-matched male comparators was extracted from a comprehensive medical record system. Results ED incidence was similar between the RA cohort and comparators (HR 0.80; 95% CI 0.55-1.16). In men with RA, ED diagnosis was associated with a trend toward an increase in peripheral arterial disease (HR 2.22; 95% CI 0.98-5.03) and a significantly decreased rate of myocardial infarction (HR 0.26; 95% CI 0.07-0.90), heart failure (HR 0.49; 95% CI 0.25-0.94) and death (HR 0.56; 95% CI 0.36-0.87). In men with RA and ED, phosphodiesterase-5 inhibitor use was associated with a decreased risk of death (HR 0.35; 95% CI 0.16-0.79), with a trending decreased risk of some cardiovascular diagnoses. Conclusion Incidence of ED was not statistically increased in RA. Although patients with both RA and ED had a similar overall cardiovascular risk to those with RA alone, men with both RA and ED had decreased risk of heart failure, myocardial infarction and death, as well as an increased risk of peripheral arterial disease. Further studies are needed to clarify these associations and their implications for pathogenesis and therapeutics.

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Complex antithrombotic therapy and bleeding risk in patients with peripheral arterial disease

European Heart Journal ◽

10.1093/ehjci/ehaa946.2396 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Tseng ◽

S Bhatt ◽

M Girardo ◽

D Liedl ◽

P Wennberg ◽

...

Keyword(s):

Peripheral Arterial Disease ◽

Triple Therapy ◽

Major Bleeding ◽

Antithrombotic Therapy ◽

Oral Anticoagulants ◽

Bleeding Risk ◽

Arterial Disease ◽

Risk Of Bleeding ◽

Increased Risk ◽

Peripheral Arterial

Abstract Introduction Antiplatelet therapy is the cornerstone of treatment for many atherosclerotic vascular pathologies including peripheral arterial disease (PAD). Patients with PAD often have comorbid conditions that require complex antithrombotic therapy, i.e. combined antiplatelet and anticoagulation. Methods All adult patients undergoing ankle brachial index (ABI) measurements were included in the study. ABI values between 1.00 and 1.40 were considered normal, and values below 1.00 or above 1.40 were considered PAD. Demographic, comorbidity and outcome data were obtained using diagnostic codes from the electronic health record. Three medication classes were analyzed: aspirin, non-aspirin oral antiplatelets (e.g. P2Y12 inhibitors) and oral anticoagulants (warfarin and the direct oral anticoagulants). Medication use was determined for patients who had been on a medication for at least one year. Cox proportional hazard analysis for the time to first bleeding event was analyzed. Bleeding was defined as any bleeding requiring medical evaluation (including clinically-relevant non-major bleeding and major bleeding). Results In all, 40,144 patients were included in the analysis (mean age 66±15, 43% female). Patients with PAD were more likely to be on double therapy (one antiplatelet with anticoagulation) (28% vs 19%) and triple therapy (dual antiplatelet with anticoagulation) (10% vs 4%). Unadjusted hazard ratios for bleeding risk showed increased risk of bleeding for patients with PAD (1.18, 95% confidence interval [CI]: 1.08–1.29), though the association is no longer present after adjustment for antithrombotic therapy. Adjusting for age, sex and PAD class, compared to no antithrombotic therapy, there was increased risk of bleeding for monotherapy (1.91, 95% CI: 1.61–2.26), double therapy (3.40, 95% CI: 2.89–4.00) and triple therapy (5.00, 95% CI: 4.21–5.96). Among medications, aspirin and anticoagulant use was independently associated with the greatest increase in risk of bleeding. Conclusion Patients in PAD are at increased risk of bleeding secondary to antithrombotic therapy. Complex antithrombotic therapy with double or triple therapy confer additional bleeding risk, particularly regimens containing aspirin and oral anticoagulants. Funding Acknowledgement Type of funding source: None

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Extremely elevated lipoprotein (a) as an independent risk factor for peripheral arterial disease in large patient cohort

European Heart Journal ◽

10.1093/ehjci/ehaa946.2397 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M.R Poudel ◽

S Kirana ◽

D Stoyanova ◽

K.P Mellwig ◽

D Hinse ◽

...

Keyword(s):

Peripheral Arterial Disease ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Arterial Disease ◽

P Value ◽

Lipoprotein A ◽

Large Patient ◽

Increased Risk ◽

Revascularization Therapy ◽

Peripheral Arterial

Abstract Background Elevated lipoprotein (a) [LP (a)] levels are an independent, genetic, and causal factor for cardiovascular disease and associated with myocardial infarction (MI). Although the association between circulating levels of lipoprotein(a) [Lp(a)] and risk of coronary artery disease (CAD) is well established, its role in risk of peripheral arterial disease (PAD) remains unclear. PAD affects over 236 million individuals and follows ischaemic heart disease (IHD) and cerebrovascular disease (CVD) as the third leading cause of atherosclerotic cardiovascular morbidity worldwide. LP (a) is genetically determined, stable throughout life and yet refractory to drug therapy. While 30 mg/dl is considered the upper normal value for LP (a) in central Europe, extremely high LP (a) levels (>150mg/dl) are rare in the general population. The aim of our study was to analyse the correlation between lipoprotein (a) [LP (a)] levels and an incidence of PAD in high-risk patients. Patients and methods We reviewed the LP (a) concentrations of 52.898 consecutive patients admitted to our cardiovascular center between January 2004 and December 2014. Of these, 579 patients had LP (a) levels above 150 mg/dl (mean 181.45±33.1mg/dl). In the control collective LP (a) was <30mg/dl (n=350). Other atherogenic risk factors in this group were HbA1c 6.58±1.65%, low density lipoprotein (LDL) 141.99±43.76 mg/dl, and body mass index 27.81±5.61. 54.40% were male, 26.07% were smokers, 93.2% had hypertension, and 24% had a family history of cardiovascular diseases. More than 82.6% were under statins. The mean glomerular filtration rate (GFR) was 69.13±24.8 ml/min [MDRD (Modification of Diet in Renal Disease)]. Results 45.00% (n=261) of the patients with LP (a) >150mg/dl had PAD. The prevalence of PAD in patients with LP (a) <30mg/dl in our control collective was 15.8%. (P- Value 0.001). Patients with LP (a) >150mg/dl had a significantly increased risk for PAD (Odds ratio 4.36, 95% CI 2.94–6.72, p: 0.001). 19.1% of patients were re-vascularized by percutaneous angioplasty (PTA) and 7.09% of patients had to undergo peripheral vascular bypass (PVB). Mean LP (a) level in patients with PAD was 182.6±31.61. Conclusion Elevated LP (a) levels above 150 mg/dl are associated with a significantly increased risk of PAD in our collective and it confirms our hypothesis. Over one fourth of these patients had severe PAD and requiring revascularization therapy. We need more prospective studies to confirm our findings. Funding Acknowledgement Type of funding source: None

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Increased risk of peripheral arterial disease in polymyalgia rheumatica: a population-based cohort study

Arthritis Research & Therapy ◽

10.1186/ar2664 ◽

2009 ◽

Vol 11 (2) ◽

pp. R50 ◽

Cited By ~ 25

Author(s):

Kenneth J Warrington ◽

Elena P Jarpa ◽

Cynthia S Crowson ◽

Leslie T Cooper ◽

Gene G Hunder ◽

...

Keyword(s):

Cohort Study ◽

Peripheral Arterial Disease ◽

Polymyalgia Rheumatica ◽

Arterial Disease ◽

Population Based ◽

Increased Risk ◽

Peripheral Arterial

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Increased Risk of Peripheral Arterial Disease After Hip Replacement

Medicine ◽

10.1097/md.0000000000000870 ◽

2015 ◽

Vol 94 (19) ◽

pp. e870 ◽

Cited By ~ 7

Author(s):

Tzu-Yi Chou ◽

Ta-Wei Su ◽

Herng-Jeng Jou ◽

Pei-Yu Yang ◽

Hsuan-Ju Chen ◽

...

Keyword(s):

Peripheral Arterial Disease ◽

Hip Replacement ◽

Arterial Disease ◽

Increased Risk ◽

Peripheral Arterial

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The Association Between Pleural Empyema and Peripheral Arterial Disease in Younger Patients: A Retrospective National Population-Based Cohort Study

Frontiers in Medicine ◽

10.3389/fmed.2021.621330 ◽

2021 ◽

Vol 8 ◽

Author(s):

Tzu-Yuan Wang ◽

Hsin-Hung Chen ◽

Chun-Hung Su ◽

Sheng-Pang Hsu ◽

Chun-Wei Ho ◽

...

Keyword(s):

Cohort Study ◽

Peripheral Arterial Disease ◽

Pleural Empyema ◽

Arterial Disease ◽

Population Based ◽

Rank Test ◽

Research Database ◽

Increased Risk ◽

Using Data ◽

Peripheral Arterial

Background: To investigate the relationship between pleural empyema (PE) and peripheral arterial disease (PAD).Methods: We conducted a retrospective cohort study using data from the National Health Institute Research Database. Univariable and multivariable Cox's proportional hazard regressions were performed to investigate the association between PE and the risk of PAD. Kaplan–Meier method and the differences were assessed using a log-rank test.Results: The overall incidence of PAD was higher in the PE cohort than in the non-PE cohort (2.76 vs. 1.72 per 1,000 person-years) with a crude hazard ratio (HR) of 1.61 [95% confidence interval (CI) = 1.41–1.83]. After adjustment for age, gender, and comorbidities, patients with PE were noted to be associated with an increased risk of PAD compared with those without PE [adjusted HR (aHR) = 1.18, 95% CI = 1.03–1.35]. Regarding the age-specific comparison between the PE and non-PE cohorts, PAD was noted to be significantly high in the ≤ 49 years age group (aHR = 5.34, 95% CI = 2.34–10.1). The incidence of PAD was higher in the first 2 years, with an aHR of 1.35 (95% CI = 1.09–1.68) for patients with PE compared with those without PE.Conclusion: The risk of PAD was higher if patients with PE were younger than 49 years and within the 2-year diagnosis of PE.

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Positive correlation of serum indoxyl sulfate level with peripheral arterial disease in hemodialysis patients

Vascular ◽

10.1177/17085381211039941 ◽

2021 ◽

pp. 170853812110399

Author(s):

Liang-Te Chiu ◽

Lin Lin ◽

Huei-Jhen Lin ◽

Yu-Hsien Lai ◽

Bang-Gee Hsu

Keyword(s):

Peripheral Arterial Disease ◽

Ankle Brachial Index ◽

Serum Levels ◽

Arterial Disease ◽

Indoxyl Sulfate ◽

Maintenance Hemodialysis ◽

C Reactive Protein ◽

Reactive Protein ◽

Index Group ◽

Peripheral Arterial

Objectives Indoxyl sulfate, known for its cardiovascular toxicity, is associated with vascular and coronary artery diseases and increased mortality. Peripheral arterial disease, defined by low ankle–brachial index, is associated with increased mortality in patients on hemodialysis. The present study aimed to determine the relationship between the serum indoxyl sulfate level and peripheral arterial disease in patients on maintenance hemodialysis. Methods The present cross-sectional, single-center study included 75 patients on maintenance hemodialysis. Serum indoxyl sulfate levels were determined by high-performance liquid chromatography–mass spectrometry. Ankle–brachial index values were measured using an automated oscillometric device. Patients with ankle–brachial indexes of < 0.9 were categorized into the low ankle–brachial index group. Results In the study cohort, 12 of the 75 patients (16.0%) had low ankle–brachial indexes. The rates of diabetes mellitus ( p = 0.010) as well as the serum levels of C-reactive protein ( p < 0.001) and indoxyl sulfate ( p < 0.001) were higher in the low ankle–brachial index group than the normal ankle–brachial index group. The multivariable logistic regression analysis revealed that serum levels of indoxyl sulfate (odds ratio = 1.123, 95% confidence interval 1.011–1.249, p = 0.031) and C-reactive protein (each 0.1 mg/dL increase, odds ratio = 1.169, 95% confidence interval 1.018–1.343, p = 0.027) were independently associated with peripheral arterial disease in patients on maintenance hemodialysis. Conclusions Serum indoxyl sulfate levels were associated with peripheral arterial disease in patients on maintenance hemodialysis.

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Relation between Chronic Obstructive Pulmonary Disease and Peripheral Arterial Disease among Construction Workers

10.53350/pjmhs2115103473 ◽

2021 ◽

Vol 15 (10) ◽

pp. 3473-3475

Author(s):

U. Sivakumar ◽

Rinku Garg ◽

Sunita Nighute

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Peripheral Arterial Disease ◽

Pulmonary Disease ◽

Arterial Disease ◽

Chronic Obstructive ◽

Obstructive Pulmonary Disease ◽

Risk Of Death ◽

Increased Risk ◽

Peripheral Arterial

Introduction: PAD was asymptomatic in a large proportion of COPD patients and was associated with more severe lung disease than in COPD subjects without PAD. Materials and Methods: This was a Cross-sectional study conducted at Department of Physiology, Santosh Medical College diagnosed with COPD using Spirometry was recruited for the study with a Sample size of 130 patients. Results: The characteristics of the population for follow-up (n=130) are presented in table 1. The mean Mean±SD was 51.73±6.1 years. The prevalence of never smokers was 21.5%, former smokers were 51.5% and current smokers were 26.9%. In total, 41 out of 130 individuals (31.5%) had PAD based on an ABI of less than 0.6. A statistically significant association was found between COPD and newly diagnosed PAD during follow-up. The association between COPD and incident PAD was stronger (adjusted OR 1.91, 95% CI 1.14–3.21). Stratified analysis by smoking status revealed that the overall association between COPD and newly developed PAD was driven by the ever smoker group. Conclusion: Subjects with COPD have a higher risk of developing PAD. People with both COPD and PAD have a substantially increased risk of death. Consequently, early detection of PAD and preventive actions in people with COPD should receive more attention in clinical respiratory care. Keywords: Peripheral Arterial Disease, Chronic Obstructive Pulmonary Disease, Ankle-brachial index.

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