Abstract P225: Calcification of the Splenic, Internal and External Iliac, and Breast Arteries and Risk of All-cause Mortality

Introduction: Prognostic consequences of and risk factors for coronary and aortic calcification are well known. Less is known about the consequences of and risk factors for calcification in other arteries. Hypothesis: We hypothesize that calcifications in the splenic, internal and external iliac, and breast arteries (in females) have different risk factor profiles, and that calcification in these beds is associated with mortality. Methods: We conducted a case cohort study from 5196 individuals who self-referred for whole body computed tomography (CT). We selected a random sub-cohort of 395 individuals. Our cases were 298 individuals who died during a median follow-up of 9.4 years. CT scans were scored for splenic, internal and external iliac, and, in females, breast artery calcification. The associations between risk factors and presence or absence of calcification in each vascular bed in the random sub-cohort was evaluated using logistic regression. Using both the sub-cohort and death cases, we used Prentice-weighted Cox proportional hazards models to assess associations of calcification in each bed with mortality. Results: Within the random sub-cohort, prevalence of calcification was 11.6% (46 of 395) in the splenic, 47.9% (187 of 390) in the internal iliac and 9.5% (37 of 390) in the external iliac arteries. Among the 163 women, 3.7% had breast artery calcification. In multivariable models, age (OR 1.62 [95%CI 1.04-2.54] per 10 years), diabetes (OR 5.80 [95%CI 1.37-24.61]), log-transformed abdominal aortic calcium (AAC) (OR 1.36 [95%CI 1.09-1.70]) and log-transformed CAC score (OR 1.38 [95%CI 1.13-1.68]) were independently associated with splenic artery calcification. Age (OR 1.60 [95%CI 1.09-2.33], male gender (OR 3.86 [95%CI 2.09-7.15]), AAC (OR 1.44 [95%CI 1.28-1.62]) and CAC score (OR 1.23 [95%CI 1.08-1.39]) were associated with internal iliac artery calcium. Smoking (current vs. never OR 9.87 [95%CI 2.24-43.61]) and AAC (OR 1.96 [95%CI 1.24-3.11]) were associated with external iliac artery calcium. For the breast arteries, numbers were too small to fit these multivariable models. Although calcification in the splenic, internal, and external iliac arteries were significantly associated with mortality in unadjusted models, these associations were attenuated and no longer statistically significant after adjusting for cardiovascular risk factors. Among women, breast artery calcification was associated with mortality independent of traditional CVD risk factors and a 0-5 score of the number of calcified vascular beds out of the carotids, coronaries, abdominal and thoracic aorta and common iliacs (HR 5.67 [95%CI 1.50-21.41]). Conclusions: Calcification in the splenic, internal and external iliac arteries was strongly associated with calcification in the abdominal aorta. In females, breast artery calcification was strongly and independently associated with mortality.

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Abstract P323: Pulse Pressure and Incident Acute Coronary Heart Disease Events in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study

Circulation ◽

10.1161/circ.127.suppl_12.ap323 ◽

2013 ◽

Vol 127 (suppl_12) ◽

Author(s):

Stephen P Glasser ◽

Daniel L Halberg ◽

Charles Sands ◽

Paul Muntner ◽

Monika Safford

Keyword(s):

Risk Factors ◽

Coronary Heart Disease ◽

Heart Disease ◽

Racial Differences ◽

Pulse Pressure ◽

Proportional Hazards ◽

Linear Trend ◽

Cox Proportional Hazards ◽

Cvd Risk

Background: Increased attention has been given to pulse pressure (PP) as a potential independent risk factor of cardiovascular disease. We examined the relationship between PP and incident acute coronary heart disease (CHD). Methods: We used data from the REasons for Geographic And Racial Differences in Stroke (REGARDS) national cohort study of 30,239 black and white participants aged 45 years or older and enrolled between 2003 and 2007. Baseline data included a 45-minute interview and in-home visit during which blood pressure was assessed and recorded as the average of two measurements obtained after a 5 minute seated rest. PP (SBP-DBP) was classified into 4 groups (<45, 45-54, 54.1-64, >64.1 mmHg). Telephone follow-up occurred every six months for self or proxy-reported suspected events, triggering medical record retrieval and adjudication by experts. Cox-proportional hazards models examined the association of incident CHD with PP groups, adjusting for socio-demographic and clinical risk factors. Results: This analysis included 22,909 participants free of CHD at baseline, with mean age 64.7±9.4 years; 40.4%were black, 44.6% were male and they experienced a total of 515 incident CHD events over a mean 3.4 yrs of follow-up (maximum 6 years). In unadjusted analyses, compared with PP<45 mmHg, each higher PP group had incrementally higher hazard ratios (HR) for incident CHD (HR 1.28 {95% CI 1.02-1.60}, 2.05 {1.63-2.56}, 3.82 {3.08-4.74}, p<0.001 for linear trend). This relationship persisted after fully adjusting including SBP for the highest PP group (HR 0.96 {0.75-1.21}, 1.12 {0.86-1.46}, 1.51 {1.09-2.10}, p trend <0.0001). Conclusions: High PP was associated with incident CHD, even when accounting for SBP and numerous other CVD risk factors.

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Abstract 17: Association of Race and Sex with Cardiovascular Disease and Non-Cardiovascular Disease Mortality: The REasons for Geographic and Racial Differences in Stroke study

Circulation ◽

10.1161/circ.135.suppl_1.17 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Gabriel S Tajeu ◽

Monika M Safford ◽

George Howard ◽

Rikki M Tanner ◽

Paul Muntner

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Racial Differences ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Hazard Ratio ◽

Cvd Risk ◽

Hazard Ratios ◽

Stroke Study ◽

Cvd Mortality

Introduction: Black Americans have higher rates of cardiovascular disease (CVD) mortality compared with whites. Differences in sociodemographic, psychosocial, CVD, and other risk factors may explain increased mortality risk. Methods: We analyzed data from 29,015 REasons for Geographic and Racial Differences in Stroke study participants to determine factors that may explain the higher hazard ratio for CVD and non-CVD mortality in blacks compared with whites. Cause of death was adjudicated by trained investigators. Within age-sex sub-groups, we used Cox proportional hazards regression with progressive adjustment to estimate black:white hazard ratios. Results: Overall, 41.0% of participants were black, and 54.9% were women. Over a mean follow-up of 7.1 years (maximum 12.3 years), 5,299 participants died (1,797 CVD and 3,502 non-CVD deaths). Among participants < 65 years of age, the age and region adjusted black:white hazard ratio for CVD mortality was 2.28 (95% CI: 1.68-3.10) and 2.32 (95% CI: 1.80-3.00) for women and men, respectively, and for participants ≥ 65 was 1.54 (95% CI: 1.30-1.82) and 1.35 (95% CI: 1.16-1.57) for women and men, respectively ( Table ). The higher black:white hazard ratios for CVD mortality were no longer statistically significant after multivariable adjustment, with the largest attenuation occurring with sociodemographic and CVD risk factor adjustment. Among participants < 65 years of age, the age and region adjusted black:white hazard ratios for non-CVD mortality were 1.51 (95% CI: 1.24-1.85) and 1.76 (95% CI: 1.46-2.13) for women and men, respectively, and for participants ≥ 65 was 1.12 (95% CI: 1.00-1.26) and 1.34 (95% CI: 1.20-1.49) for women and men, respectively. The higher black:white hazard ratios for non-CVD mortality were attenuated after adjustment for sociodemographics. Conclusions: Black:white differences are larger for CVD than non-CVD causes of death. The increased CVD mortality for blacks compared with whites is primarily explained by sociodemographic and CVD risk factors.

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A Meta-analysis of Vitamin K Status and Cardiovascular Disease (OR33-01-19)

Current Developments in Nutrition ◽

10.1093/cdn/nzz039.or33-01-19 ◽

2019 ◽

Vol 3 (Supplement_1) ◽

Author(s):

M Kyla Shea ◽

Daniel Weiner ◽

Gregory Matuszek ◽

Sarah Booth ◽

Kathryn Barger

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Vitamin K ◽

Cardiovascular Health ◽

Proportional Hazards ◽

Meta Analysis ◽

Cox Proportional Hazards ◽

Community Dwelling ◽

Cvd Risk Factors ◽

Cvd Risk

Abstract Objectives Evidence suggests low vitamin K status may be associated with an increased cardiovascular disease (CVD) risk in people with CVD risk factors. The objective of this study was to summarize the association between vitamin K status and CVD, overall and according to baseline CVD risk, by conducting a participant-level meta-analysis using data from the Framingham Offspring Study, the Health, Aging, and Body Composition Study (Health ABC), and the Multi-ethnic Study of Atherosclerosis (MESA). Methods Circulating phylloquinone (vitamin K1), measured from baseline fasting blood samples, was categorized as ≤0.5 nM, >0.5 - ≤1.0 nM and >1.0 nM. CVD was defined as confirmed ischemic heart disease, angina, resuscitated cardiac arrest, fatal or non-fatal myocardial infarction or stroke. Multivariable Cox proportional hazards models were used to evaluate the association between circulating phylloquinone and incident CVD overall and stratified according to baseline CVD risk factors. Results Among the 3622 participants (mean (SD) baseline age 65 (11), 45% men, 65% white), there were 785 CVD events over a median of 13.0 years. Overall the risk for CVD did not differ significantly according to circulating phylloquinone categories [HR(95%CI) for CVD, compared to plasma phylloquinone >1.0 nM: ≤0.5 nM = 1.15 (0.96–1.38); >0.5 - ≤1.0 nM = 0.99 (0.84–1.18)]. However, lower circulating phylloquinone was associated with higher incident CVD risk in those with diabetes, with a normal BMI, and in women (Table). Conclusions Overall, we did not detect any significant differences in CVD risk across circulating phylloquinone categories in community-dwelling adults. However, low circulating phylloquinone was associated with a higher CVD risk among certain sub-groups, but additional studies are needed to clarify if improving vitamin K status will benefit the cardiovascular health of certain segments of the population. Funding Sources Supported by NHLBI R21HL133421 and the USDA ARS Cooperative Agreement (58‐1950‐7‐707). Supporting Tables, Images and/or Graphs

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Abstract P007: Ankle-brachial Index And Cardiovascular Outcomes In Older Adults: The Atherosclerosis Risk In Communities Study

Circulation ◽

10.1161/circ.143.suppl_1.p007 ◽

2021 ◽

Vol 143 (Suppl_1) ◽

Author(s):

Frances M Wang ◽

Chao Yang ◽

Shoshana Ballew ◽

Corey A Kalbaugh ◽

Michelle L Meyer ◽

...

Keyword(s):

Risk Factors ◽

Older Adults ◽

Primary Prevention ◽

Proportional Hazards ◽

Ankle Brachial Index ◽

Cox Proportional Hazards ◽

Atherosclerotic Cardiovascular Disease ◽

Cvd Risk ◽

Atherosclerosis Risk In Communities ◽

Cox Proportional Hazards Models

Introduction: The ankle-brachial index (ABI) is a representative diagnostic indicator of peripheral artery disease (PAD) and recognized as a risk enhancer in the ACC/AHA guidelines for primary prevention of atherosclerotic cardiovascular disease (ASCVD). However, our understanding of the association between ABI and cardiovascular (CVD) risk in older adults is limited. Additionally, the prognostic value of ABI among individuals with prior ASCVD is not well understood. Hypothesis: In a contemporary cohort of older adults, low ABI is independently associated with higher risk of CVD events, regardless of prevalent ASCVD at baseline (coronary heart disease [CHD], stroke, and/or symptomatic PAD). Methods: At ARIC Visit 5 (2011-2013), we studied 5,005 participants (4,160 without prior ASCVD [median age 74 years, 38% male], and 843 with ASCVD [median age 76 years, 65% male]). We quantified the association between ABI categories and subsequent risk of heart failure (HF) and composite CHD/stroke using multivariable Cox proportional hazards models. Results: Over a median follow-up of 5.5 years, we observed 400 CHD/stroke and 338 HF cases (242 CHD/stroke and 199 HF cases in those without prior ASCVD). After adjustment for CVD risk factors, in those without ASCVD history, ABI ≤0.9 was associated with a higher risk of both CHD/stroke and HF ( Table ). In those with a history of ASCVD, low ABI was not significantly associated with CHD/stroke, but was associated with HF (hazard ratio 7.1, 95% CI: 2.5-20.5); ABI categories of 0.9-1.1 and >1.3 were also significantly associated with HF. Addition of ABI to traditional risk factors improved prediction of CHD/stroke risk in those without prior ASCVD and prediction of HF, regardless of baseline ASCVD ( Table ). Conclusions: Low ABI (≤0.9) was associated with incident CHD/stroke in those without prior ASCVD and HF regardless of baseline ASCVD status. These results support ABI as a risk enhancer for guiding primary prevention of ASCVD and suggest its potential value in HF risk assessment for older adults.

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Importance of Both Internal and External Iliac Artery Interrogation in Pelvic Trauma as Evidenced by Hemorrhage from Bilateral Corona Mortis with Unilateral Aberrant Origin off the External Iliac Artery

Case Reports in Radiology ◽

10.1155/2019/6734816 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4

Author(s):

Michael Herskowitz ◽

James Walsh ◽

Meghan Lilly ◽

Kimberly McFarland

Keyword(s):

Iliac Artery ◽

External Iliac Artery ◽

Hemodynamic Instability ◽

Pelvic Trauma ◽

Obturator Artery ◽

Iliac Arteries ◽

Corona Mortis ◽

Internal Iliac ◽

Blunt Pelvic Trauma ◽

Internal Iliac Arteries

Transcatheter angiography and embolization has long been recognized as the gold standard for patients with hemodynamic instability secondary to blunt pelvic trauma. While often the bleeding source can be readily localized based on the distribution of extravasation on preprocedural Computed Tomographic Angiography, one should be cautious in assessment for aberrant anatomy. A variant obturator artery originating from the inferior epigastric branch of the external iliac artery is commonly referred to as the corona mortis. We present a case of blunt pelvic trauma in which a patient demonstrated extravasation in the anterior distributions of both internal iliac arteries. Following embolization of bilateral internal iliac arteries, identification and embolization of bilateral corona mortis branches was crucial to achieving hemodynamic stability in this patient.

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Rare origin of the obturator artery from the external iliac artery with two obturator veins

Jornal Vascular Brasileiro ◽

10.1590/1677-5449.005116 ◽

2016 ◽

Vol 15 (3) ◽

pp. 250-253 ◽

Cited By ~ 2

Author(s):

Kiyoshi Goke ◽

Lucas Alves Sarmento Pires ◽

Tulio Fabiano de Oliveira Leite ◽

Carlos Alberto Araujo Chagas

Keyword(s):

Iliac Artery ◽

Internal Iliac Artery ◽

External Iliac Artery ◽

Lateral Wall ◽

Iliac Vein ◽

Obturator Foramen ◽

Obturator Artery ◽

Iliac Arteries ◽

Internal Iliac ◽

The Common

Abstract The obturator artery is a branch of the internal iliac artery, although there are reports documenting variations, with origin from neighboring vessels such as the common iliac and external iliac arteries or from any branch of the internal iliac artery. It normally runs anteroinferiorly along the lateral wall of the pelvis to the upper part of the obturator foramen where it exits the pelvis by passing through said foramen. Along its course, the artery is accompanied by the obturator nerve and one obturator vein. It supplies the muscles of the medial compartment of the thigh and anastomoses with branches of the femoral artery on the hip joint. We report a rare arterial variation in a Brazilian cadaver in which the obturator artery arose from the external iliac artery, passing beyond the external iliac vein toward the obturator foramen, and was accompanied by two obturator veins with distinct paths. We also discuss its clinical significance.

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Association of Abdominal Adiposity with Cardiovascular Mortality in Incident Hemodialysis

American Journal of Nephrology ◽

10.1159/000494281 ◽

2018 ◽

Vol 48 (6) ◽

pp. 406-414 ◽

Cited By ~ 1

Author(s):

Jessica Fitzpatrick ◽

Stephen M. Sozio ◽

Bernard G. Jaar ◽

Mara A. McAdams-DeMarco ◽

Michelle M. Estrella ◽

...

Keyword(s):

Risk Factors ◽

Body Mass Index ◽

Body Mass ◽

Cardiovascular Mortality ◽

Proportional Hazards ◽

Cox Proportional Hazards ◽

Abdominal Adiposity ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Cvd Mortality

Background: The risk of cardiovascular mortality is high among adults with end-stage renal disease (ESRD) undergoing hemodialysis. Waist-to-hip ratio (WHR), a metric of abdominal adiposity, is a predictor of cardiovascular disease (CVD) and mortality in the general population; however, no studies have examined the association with CVD mortality, particularly sudden cardiac death (SCD), in incident hemodialysis. Methods: Among 379 participants incident (< 6 months) to hemodialysis enrolled in the Predictors of Arrhythmic and Cardiovascular Risk in ESRD study, we evaluated associations between WHR and risk of CVD mortality, SCD, and non-CVD mortality in Cox proportional hazards regression models. Results: At study enrollment, mean age was 55 years with 41% females, 73% African Americans, and 57% diabetics. Mean body mass index was 29.3 kg/m2, and mean WHR was 0.95. During a median follow-up time of 2.5 years, there were 35 CVD deaths, 15 SCDs, and 48 non-CVD deaths. Every 0.1 increase in WHR was associated with higher risk (hazard ratio [95% CI]) of CVD mortality (1.75 [1.06–2.86]) and SCD (2.45 [1.20–5.02]), but not non-CVD mortality (0.93 [0.59–1.45]), independently of demographics, body mass index, comorbidities, inflammation, and traditional CVD risk factors. Conclusions: WHR is significantly associated with CVD mortality including SCD, independently of other CVD risk factors in incident hemodialysis. This simple, easily obtained bedside metric may be useful in dialysis patients for CVD risk stratification.

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Endovascular reconstruction of iliac artery bifurcation atherosclerotic disease with the kissing technique

Vascular ◽

10.1177/1708538113478748 ◽

2013 ◽

Vol 21 (5) ◽

pp. 339-342

Author(s):

Georgios Vourliotakis ◽

Georgios Mantas ◽

Athanasios Katsargyris ◽

Christine Aivatidi ◽

Yannis Kandounakis

Keyword(s):

Lower Extremity ◽

Iliac Artery ◽

Endovascular Repair ◽

Internal Iliac Artery ◽

Balloon Catheter ◽

External Iliac Artery ◽

Atherosclerotic Disease ◽

Iliac Arteries ◽

Left Buttock ◽

Internal Iliac

A 71-year-old male patient with severe left buttock and lower-extremity claudication due to iliac artery bifurcation stenoses was referred to our institution for endovascular treatment. A ‘kissing’ technique was used in order to dilate the proximal parts of both internal and external iliac arteries and avoid compromization of the internal iliac artery during proximal external iliac artery stenting. A balloon expandable stent was inserted via a left ipsilateral retrograde access to the narrowed origin of the left external iliacartery and a balloon catheter via a right contralateral access inside the origin of the left internal iliac artery. Simultaneous balloons inflation restored full patency of both vessels. Twelve months later the patient is doing well, free of buttock or lower-extremity claudication symptoms. For iliac artery bifurcation atherosclerotic disease, endovascular repair with the ‘kissing’ technique can achieve a complete bifurcation reconstruction offering significant clinical benefit in selected patients.

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Menopausal Vasomotor Symptoms and Risk of Incident Cardiovascular Disease Events in SWAN

Journal of the American Heart Association ◽

10.1161/jaha.120.017416 ◽

2021 ◽

Vol 10 (3) ◽

Author(s):

Rebecca C. Thurston ◽

Helen E. Aslanidou Vlachos ◽

Carol A. Derby ◽

Elizabeth A. Jackson ◽

Maria Mori Brooks ◽

...

Keyword(s):

Risk Factors ◽

Cardiovascular Disease ◽

Proportional Hazards ◽

Reproductive Factors ◽

Cox Proportional Hazards ◽

Vasomotor Symptoms ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Increased Risk

Background Cardiovascular disease (CVD) in women has unique features, including associations with reproductive factors that are incompletely understood. Vasomotor symptoms (VMS), the classic menopausal symptom, are linked to CVD risk factors and subclinical CVD. Evidence linking VMS to CVD events is limited. We tested whether frequent and/or persistent VMS were associated with increased risk for fatal and nonfatal CVD events in SWAN (Study of Women’s Health Across the Nation). Methods and Results A total of 3083 women, aged 42 to 52 years at baseline, underwent up to 16 in‐person visits over 22 years. Assessments included questionnaires on VMS frequency (0, 1–5, or ≥6 days/2 weeks), physical measures, phlebotomy, and reported CVD events (myocardial infarction, stroke, heart failure, and revascularization). A subset of events was adjudicated via medical record. Death certificates were obtained. Relationships between baseline VMS or persistent VMS over the follow‐up (proportion of visits with frequent VMS) with combined incident nonfatal and fatal CVD were tested in Cox proportional hazards models adjusted for demographics, medication use, and CVD risk factors. Participants experienced 231 CVD events over the follow‐up. Women with frequent baseline VMS had an elevated risk of subsequent CVD events (relative to no VMS; ≥6 days: hazard ratio [HR] [95% CI], 1.51 [1.05–2.17], P =0.03; 1–5 days: HR [95% CI], 1.02 [0.75–1.39], P =0.89, multivariable). Women with frequent VMS that persisted over time also had an increased CVD event risk (>33% versus ≤33% of visits: HR [95% CI], 1.77 [1.33–2.35], P <0.0001, multivariable). Conclusions Frequent and persistent VMS were associated with increased risk of later CVD events. VMS may represent a novel female‐specific CVD risk factor.

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Custom-Made Bifurcated Prosthetic Graft for Aortoiliac Aneurysm Repair

Aorta ◽

10.1055/s-0041-1725090 ◽

2021 ◽

Author(s):

Spyros Papadoulas ◽

Stavros K. Kakkos ◽

Ioannis Ntouvas ◽

Konstantinos Nikolakopoulos ◽

Polyzois Tsantrizos ◽

...

Keyword(s):

Iliac Artery ◽

External Iliac Artery ◽

Prosthetic Graft ◽

Aneurysmal Dilatation ◽

Iliac Arteries ◽

Aortic Neck ◽

Custom Made ◽

Internal Iliac ◽

Aneurysm Repair ◽

Significant Distance

AbstractRevascularization of the internal iliac artery during open repair of aortoiliac aneurysms can be challenging, especially if there is a significant distance between the orifices of the internal and external iliac arteries owing to common iliac aneurysmal dilatation. We describe a technique involving insertion of an 18-mm tube graft between the proximal aortic neck and aneurysmal common iliac artery bifurcation. Revascularization of the contralateral external iliac artery is accomplished through an 8-mm side arm graft.

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