Balancing Weight Loss and Sarcopenia in Elderly Patients With Peripheral Artery Disease

Abstract Peripheral artery disease (PAD) is a chronic disease which is associated with old age. PAD was known as an age-related chronic condition. Metabolic comorbid conditions which include hypertension, diabetes, and hyperlipidemia can have negative impacts on blood vessels aggravating PAD in elderly patients. Therefore, metabolic comorbidities need be considered in order to develop intervention for patients with PAD. The aim of this study is to find the characteristics of PAD patients with metabolic comorbidities. This is a retrospective study that used the national claim data of South Korea from 2009 to 2018. The inclusion criteria were adults (20+) and patients diagnosed with PAD as a primary or secondary diagnosis from 2011 to 2017. The frequency of hypertension, hyperlipidemia, diabetes, and metabolic comorbidities in PAD patients was examined. In addition, the difference in the number of metabolic comorbidities according to sex was identified using the chi-squared test. Among the total PAD adult patients(n=8,478,876), the number of elderly patients over 60 years old was 4,124,592(48.7%). Among the total patients, PAD patients with hypertension were the most common at 958,329 (11.30%). Sex was significantly related to having metabolic comorbidities and women showed higher proportion of metabolic comorbidities compared to men (χ2 =5.02, p<.001). As the frequency of PAD patients with hypertension were the highest, it is necessary to develop a health management program that considers metabolic comorbidities, especially hypertension, in order to manage PAD disease. In addition, there is a need for special interest in intervening metabolic conditions of female patients with PAD.

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Low-dose rivaroxaban plus aspirin for elderly patients with symptomatic peripheral artery disease: is it worth the bleeding risk?

European Heart Journal ◽

10.1093/eurheartj/ehab602 ◽

2021 ◽

Author(s):

Juqian Zhang ◽

S R Vallabhaneni ◽

Gregory Y H Lip

Keyword(s):

Elderly Patients ◽

Peripheral Artery Disease ◽

Low Dose ◽

Bleeding Risk ◽

Peripheral Artery ◽

Artery Disease

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Prevalence and risk factors associated with peripheral artery disease in elderly patients undergoing peritoneal dialysis

Vascular Health and Risk Management ◽

10.2147/vhrm.s37008 ◽

2012 ◽

pp. 581 ◽

Cited By ~ 3

Author(s):

Ding-Wei Kuang ◽

Chiu-Leong Li ◽

Un-I Kuok ◽

Kin Cheung ◽

Weng-In Lio ◽

...

Keyword(s):

Risk Factors ◽

Peritoneal Dialysis ◽

Elderly Patients ◽

Peripheral Artery Disease ◽

Peripheral Artery ◽

Factors Associated ◽

Artery Disease

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Rehabilitative Exercise Reduced the Impact of Peripheral Artery Disease on Vascular Outcomes in Elderly Patients with Claudication: A Three-Year Single Center Retrospective Study

Journal of Clinical Medicine ◽

10.3390/jcm8020210 ◽

2019 ◽

Vol 8 (2) ◽

pp. 210 ◽

Cited By ~ 4

Author(s):

Fabio Manfredini ◽

Nicola Lamberti ◽

Franco Guerzoni ◽

Nicola Napoli ◽

Vincenzo Gasbarro ◽

...

Keyword(s):

Elderly Patients ◽

Peripheral Artery Disease ◽

Ankle Brachial Index ◽

Rehabilitation Program ◽

Peripheral Artery ◽

Rehabilitation Outcomes ◽

Home Based ◽

Severe Group ◽

Artery Disease ◽

The Impact

The study retrospectively evaluated the association between rehabilitative outcomes and risk of peripheral revascularizations in elderly peripheral artery disease (PAD) patients with claudication. Eight-hundred thirty-five patients were enrolled. Ankle-brachial index (ABI) and maximal walking speed (Smax) were measured at baseline and at discharge from a structured home-based rehabilitation program. For the analysis, patients were divided according to a baseline ABI value (severe: ≤0.5; moderate: ≥0.5) and according to hemodynamic or functional rehabilitative response (responder: ABI ≥0.10 and/or Smax >0.5 km/h). Three-year outcomes were collected from the regional registry. According to the inclusion criteria (age 60–80, ABI <0.80; program completion) 457 patients, 146 severe and 311 moderate, were studied. The whole population showed significant functional and hemodynamic improvements at discharge, with 56 revascularizations and 69 deaths at follow-up. Compared to the moderate group, the severe group showed a higher rate of revascularizations (17% vs. 10%, p < 0.001) and deaths (29% and 8%, respectively; p < 0.001). However, patients with severe PAD who were ABI responders after rehabilitation showed less revascularizations than non-responders (13% vs. 21%; hazard ratio (HR): 0.52) and were not different from patients with moderate disease (9%). Superimposable rates were observed for Smax responders (13% vs. 21%; HR: 0.55; moderate 10%). In conclusion, elderly patients with severe PAD empowered by better rehabilitation outcomes showed lower rates of peripheral revascularizations and deaths that were comparable to patients with moderate PAD.

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Impact of frailty on super elderly patients with peripheral artery disease from the I-PAD 3 year registry

European Heart Journal ◽

10.1093/ehjci/ehaa946.2391 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

K Nishikawa ◽

A Nagae ◽

T Miura ◽

T Katoh ◽

Y Kanzaki ◽

...

Keyword(s):

Elderly Patient ◽

Elderly Patients ◽

Peripheral Artery Disease ◽

Cardiovascular Death ◽

Major Amputation ◽

Peripheral Artery ◽

Clinical Frailty Scale ◽

Treatment Indications ◽

Artery Disease ◽

Patient Prognosis

Abstract Background Unlike age, frailty is often not taken into account in treatment indications of Endovascular treatment (EVT). One of the reason is that there was little known the relationship between frailty and the outcome of EVT for super elderly patients with peripheral artery disease (PAD). We investigate impacts of frailty on the super elderly patient prognosis who underwent EVT. Purpose To investigate impacts of frailty on the super elderly patient prognosis who underwent EVT. Methods From August 2015 to July 2016, 335 consecutive patients who underwent EVT were enrolled in the I-PAD registry from 7 institutes in Nagano prefecture. Among them, we selected and analyzed 91 super elderly PAD patients (≥80 years-old) and divided them into two groups:those with moderate or higher frailty (Clinical Frailty Scale (CFS) ≥6, n=28) and those without (CFS ≤5, n=63). The primary endpoints were cardiovascular death and major adverse cardiovascular and limb events (MACLE), defined as a composite of cardiovascular death, myocardial infarction, stroke, admission for heart failure, major amputation and revascularization. Results The median follow-up period was 2.7 years. Freedom rate from cardiovascular death and MACLE were significantly lower among patients with moderate or higher frailty than among those without (47.0% vs. 58.0%, P=0.03; 39.1% vs. 68.5%, P<0.01). Conclusion The prognosis of super elderly patients with moderate or higher frailty is worse than those without. Funding Acknowledgement Type of funding source: None

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P1957Impact of fraility on the super elderly patients with peripheral artery disease

European Heart Journal ◽

10.1093/eurheartj/ehz748.0704 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

K Nishigawa ◽

A Nagae ◽

T Miura ◽

T Katoh ◽

M Hirabayashi ◽

...

Keyword(s):

Overall Survival ◽

Elderly Patients ◽

Peripheral Artery Disease ◽

Major Amputation ◽

Peripheral Artery ◽

Clinical Frailty Scale ◽

Multicenter Observational Study ◽

Primary Endpoints ◽

Artery Disease

Abstract Background The current consensus is that frail patients have high risks of mortality. However, it remains unclear whether frailty is associated with mortality risks in super-elderly patients with peripheral artery disease (PAD). Methods The I-PAD registry was a prospective multicenter observational study involving 12 institutions in Nagano prefecture in Japan. From July 2015 to July 2016, the I-PAD registry enrolled 371 consecutive PAD patients who had undergone endovascular therapy (EVT). Among them, we selected and analysed 109 PAD patients who were >80 years old when they had undergone EVT and divided them into two groups: those with frailty (Clinical Frailty Scale≥5, n=47) and those without frailty (Clinical Frailty Scale≤4, n=62). The primary endpoints were overall survival and major adverse limb events (MALE), defined as a composite of all-cause death, major amputation and revascularization. Results The median follow-up period was 1.58±0.3 years. Overall, 109 patients with a mean age of 84.8±4.0 years, of whom 63.3% were men, were included. Overall survival and freedom from MALE were significantly lower among patients with frailty than among those without frailty (60.5% vs. 91.6%, P<0.001; 51.4% vs. 87.5%, P<0.001; respectively). Conclusion The prognosis of super-elderly patients with frailty is worse than that of patients without frailty.

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