scholarly journals Midlife Cardiorespiratory Fitness and the Development of Peripheral Artery Disease in Later Life

2021 ◽  
Author(s):  
Neil Keshvani ◽  
Benjamin Willis ◽  
David Leonard ◽  
Ang Gao ◽  
Laura DeFina ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Cardiorespiratory Fitness ◽  
Peripheral Artery Disease ◽  
Lower Risk ◽  
Later Life ◽  
Peripheral Artery ◽  
Metabolic Equivalent ◽  
Metabolic Equivalent Task ◽  
Artery Disease

Background Data are sparse on the prospective associations between physical activity and incidence of lower extremity peripheral artery disease (PAD). Methods and Results Linking participant data from the CCLS (Cooper Center Longitudinal Study) to Medicare claims files, we studied 19 023 participants with objectively measured midlife cardiorespiratory fitness through maximal effort on the Balke protocol who survived to receive Medicare coverage between 1999 and 2009. The study aimed to determine the association between midlife cardiorespiratory fitness and incident PAD with proportional hazards intensity models, adjusted for age, sex, body mass index, and other covariates, to PAD failure time data. During 121 288 person‐years of Medicare follow‐up, we observed 805 PAD‐related hospitalizations/procedures among 19 023 participants (21% women, median age 50 years). Lower midlife fitness was associated with a higher rate of incident PAD in patients aged 65 years and older (low fit [quintile 1]: 11.4, moderate fit [quintile 2 to 3]: 7.8, and high fit [quintile 4 to 5]: 5.7 per 1000 person years). After multivariable adjustment for common predictors of incident PAD such as age, body mass index, hypertension, and diabetes, these findings persisted. Lower risk for PAD per greater metabolic equivalent task of fitness was observed (hazard ratio [HR], 0.93 [95% CI, 0.90–0.97]; P <0.001). Among a subset of patients with an additional fitness assessment, each 1 metabolic equivalent task increase from baseline fitness was associated with decreased risk of incident PAD (HR, 0.90 [95% CI, 0.82–0.99]; P =0.03). Conclusions Cardiorespiratory fitness in healthy, middle‐aged adults is associated with lower risk of incident PAD in later life, independent of other predictors of incident PAD.

Body mass index and outcome in patients with coronary, cerebrovascular, or peripheral artery disease: findings from the FRENA registry

2009 ◽  
Vol 16 (4) ◽  
pp. 457-463 ◽  
Author(s):  
Raquel Barba ◽  
Josep Bisbe ◽  
José Nicolas Alcalá Pedrajas ◽  
Jesús Toril ◽  
Rafael Monte ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Cerebrovascular Disease ◽  
Body Mass ◽  
Peripheral Artery Disease ◽  
Cardiovascular Mortality ◽  
Inverse Correlation ◽  
Limb Ischemia ◽  
Arterial Disease ◽  
Peripheral Artery ◽  
Artery Disease

Background The relationship between body mass index (BMI) and mortality in patients with established arterial disease remains controversial. Methods FRENA is an ongoing, observational registry of consecutive outpatients with coronary artery disease (CAD), cerebrovascular disease, or peripheral artery disease (PAD). We examined the prognostic importance of accepted BMI categories on outcome among patients in the FRENA registry. Results In April 2008, 2274 patients (mean age, 66 years) had been enrolled, of whom 14 (0.6%) were underweight; 533 (23%) normal; 1051 (46%) overweight; and 676 (30%) were obese. Over a mean follow-up of 14 months, the incidence of major cardiovascular events (myocardial infarction, ischemic stroke, or critical limb ischemia) per 100 patient-years was: 7.1 [95% confidence interval (CI): 0.4–35]; 11 (95% CI: 8.4–14); 6.9 (95% CI: 5.6–8.5); and 8.5 (95% CI: 6.6–11), respectively. Their cardiovascular mortality was: 7.1 (95% CI: 0.4–35); 4.1 (95% CI: 5.9–11); 1.3 (95% CI: 0.9–2.3); and 1.5 (95% CI: 1.4–3.5), respectively. On multivariate analysis, the hazard ratio for cardiovascular mortality was: 2.2 (95% CI: 0.3–17); 1.0 (reference); 0.37 (95% CI: 0.20–0.69); and 0.37 (95% CI: 0.18–0.73), respectively. Survival benefit was only found in patients with CAD or PAD. Weight loss had little influence on outcome. Conclusion Patients with CAD or PAD (not those with cerebrovascular disease) have an inverse correlation between BMI and cardiovascular mortality, even after adjusting for confounding variables.

scholarly journals Body mass index and peripheral artery disease

2020 ◽  
Vol 292 ◽  
pp. 31-36 ◽  
Author(s):  
Sean P. Heffron ◽  
Aeshita Dwivedi ◽  
Caron B. Rockman ◽  
Yuhe Xia ◽  
Yu Guo ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Mass ◽  
Peripheral Artery Disease ◽  
Peripheral Artery ◽  
Artery Disease

Association Between Underweight Body Mass Index and In-Hospital Outcome in Patients Undergoing Endovascular Interventions for Peripheral Artery Disease: A Propensity Score Matching Analysis

2019 ◽  
Vol 26 (3) ◽  
pp. 411-417 ◽  
Author(s):  
Homam Moussa Pacha ◽  
Yasser Al-khadra ◽  
Fahed Darmoch ◽  
Mohamad Soud ◽  
Amir Kaki ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Propensity Score ◽  
Propensity Score Matching ◽  
Body Mass ◽  
Peripheral Artery Disease ◽  
Peripheral Artery ◽  
Propensity Score Matching Analysis ◽  
Significant Difference ◽  
Low Bmi ◽  
Artery Disease

Purpose: To investigate in-hospital outcomes after endovascular therapy (EVT) in patients with severe peripheral artery disease (PAD) who had a low body mass index (BMI, kg/m2) compared to those with normal BMI. Materials and Methods: Using weighted data from the National Inpatient Sample (NIS) database between 2002 and 2014 and ICD-9 codes, 2614 patients were identified who were aged ≥18 years and underwent EVT for PAD in the lower limb vessels. EVT was defined as angioplasty, atherectomy, and/or stenting. After excluding individuals with BMI >24, there were 807 (31%) normal-weight (BMI 19–24) patients and 1807 (69%) underweight (BMI <19) individuals. All patients in both groups were matched for baseline demographic and clinical characteristics and critical limb ischemia in a 1:1 propensity score matching analysis using the nearest neighbor method. Results: Propensity score matching produced 2 groups of 685 patients that differed only in the incidence of chronic lung disease, which was more frequent in low-BMI patients (p=0.04). Patients with low BMI had a higher incidence of in-hospital mortality (4.8% vs 1.2%, p<0.001), major adverse cardiovascular events (composite of death, myocardial infarction, or stroke) (7.9% vs 4.1%, p=0.003), open bypass surgery (9.1% vs 6.0%, p=0.03), and infection (14.6% vs 10.5%, p=0.02) compared with the normal-BMI group. There was no significant difference in the incidence of vascular complications (p=0.31), major bleeding (p=0.17), major amputation (p=0.35), or acute kidney injury (p=0.09) between the low- and normal-BMI groups. Conclusion: Low-BMI patients with PAD have worse in-hospital survival and more adverse outcomes after EVT.

scholarly journals Body composition and mortality in patients undergoing endovascular treatment for peripheral artery disease

2021 ◽  
Author(s):  
Tadashi Itagaki ◽  
Soichiro Ebisawa ◽  
Kyuhachi Otagiri ◽  
Tamon Kato ◽  
Takashi Miura ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Body Composition ◽  
Endovascular Treatment ◽  
Body Mass ◽  
Peripheral Artery Disease ◽  
Major Amputation ◽  
Amputation Rate ◽  
Peripheral Artery ◽  
Artery Disease ◽  
The Impact

AbstractAn inverse correlation between body mass index and mortality in patients with peripheral artery disease (PAD) has been reported. However, little information is available regarding the impact of body composition on the clinical outcomes in patients with PAD. This study evaluated the relationships between the lean body mass index (LBMI), body fat % (BF%), and mortality and major amputation rate in patients with PAD. We evaluated 320 patients with PAD after endovascular treatment (EVT) enrolled from August 2015 to July 2016 and divided them into low and high LBMI and BF% groups based on their median values (17.47 kg/m2 and 22.07%, respectively). We assessed 3-year mortality and major amputation for the following patient groups: Low LBMI/Low BF%, Low LBMI/High BF%, High LBMI/Low BF%, and High LBMI/High BF%. During the median 3.1-year follow-up period, 70 (21.9%) patients died and 9 (2.9%) patients experienced major amputation. The survival rate was lower in the Low LBMI than in the High LBMI group, and was not significantly different between the Low and High BF% groups. Survival rates were lowest in the Low LBMI/Low BF% group (57.5%) and highest in the High LBMI/High BF% group (94.4%). There were no significant differences in major amputation rate between the Low LBMI and High LBMI groups, and between the Low BF% and High BF% groups. The Low LBMI and Low BF% groups were associated with an increased risk of mortality after adjustment for age, sex, frailty and conventional risk factors [hazard ratio (HR): 4.02; 95% confidence interval (CI) 2.10–7.70; p < 0.001 and HR: 4.48; 95% CI 1.58–12.68, p = 0.005, respectively], for age, sex, hemodialysis, and prior cerebral cardiovascular disease (HR: 3.63; 95% CI 1.93–6.82; p < 0.001 and HR: 4.03; 95% CI 1.43–11.42, p = 0.009, respectively) and for age, sex, and laboratory date (HR: 3.97; 95% CI 1.88–8.37; p < 0.001 and HR: 3.31; 95% CI 1.15–9.53, p = 0.026, respectively). In conclusion, Low LBMI and Low BF% were associated with poor prognosis in patients undergoing EVT for PAD, and mortality was the lowest in the High LBMI/High BF% group compared with other body composition groups.

scholarly journals Intensity-dependent effects of exercise therapy on walking performance and aerobic fitness in symptomatic patients with lower-extremity peripheral artery disease: A systematic review and meta-analysis

2021 ◽  
pp. 1358863X2110345
Author(s):  
Mattia Fassora ◽  
Luca Calanca ◽  
Cécile Jaques ◽  
Lucia Mazzolai ◽  
Bengt Kayser ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Cardiorespiratory Fitness ◽  
Peripheral Artery Disease ◽  
Exercise Intensity ◽  
Moderate Intensity ◽  
Peripheral Artery ◽  
Walking Performance ◽  
Vigorous Intensity ◽  
Artery Disease ◽  
Training Modalities

We investigated how nonpain-based exercise therapy intensity (light-to-moderate or vigorous) affects improvements in walking performance and cardiorespiratory fitness of patients with symptomatic lower-extremity peripheral artery disease (PAD). We searched the Embase, MEDLINE, Cochrane, Web of Science, and Google Scholar databases up to April 2021 and included randomized controlled trials reporting training therapies targeting exercise intensity (heart rate, oxygen consumption, or perceived exertion). The main outcomes were walking performance (pain-free [PFWD] and maximal [MWD] walking distance) and cardiorespiratory fitness (V̇O2peak). Secondary subanalyses examined the training modality (walking or other modalities) and the approach (high-intensity interval or moderate-intensity training). A total of 1132 patients were included. Light-to-moderate was superior to vigorous exercise intensity in improving MWD (223 m [95% CI 174 to 271], p < 0.00001; 153 m [95% CI 113 to 193], p < 0.00001; respectively) and PFWD (130 m [95% CI 87 to 173], p < 0.00001; 83 m [95% CI 61 to 104], p < 0.00001; respectively). When training modalities were considered, walking at a vigorous intensity (272 m [95% CI 207 to 337], p < 0.00001) showed the largest improvement in MWD compared to other exercise modalities. A larger increase in V̇O2peak was observed following vigorous (3.0 mL O2·kg−1·min−1 [95% CI 2.4 to 3.6], p < 0.00001) compared to light-to-moderate (1.1 mL O2·kg−1·min−1 [95% CI 0.4 to 1.7], p = 0.001) exercise intensity. These results indicate that vigorous was less effective than light-to-moderate intensity in improving walking performance, whereas it was more effective in improving V̇O2peak. When the training modalities were considered, walking at a vigorous intensity showed the greatest improvement in MWD. (PROSPERO Registration No.: CRD42020199469)

Outcomes with cilostazol after endovascular therapy of peripheral artery disease

2019 ◽  
Vol 24 (4) ◽  
pp. 313-323 ◽  
Author(s):  
Michael Megaly ◽  
Bishoy Abraham ◽  
Marwan Saad ◽  
Andrew Mekaiel ◽  
Peter Soukas ◽  
...  
Keyword(s):  
Peripheral Artery Disease ◽  
Endovascular Therapy ◽  
Lower Risk ◽  
Observational Studies ◽  
Meta Analysis ◽  
Target Lesion ◽  
Major Amputation ◽  
Primary Patency ◽  
Peripheral Artery ◽  
Artery Disease

The role of cilostazol after endovascular therapy (EVT) of peripheral artery disease (PAD) remains unclear. We conducted a meta-analysis for all studies reporting the outcomes of cilostazol after EVT of PAD from January 2000 through November 2018 with the outcomes of interest including primary patency, major adverse limb events (MALE), target lesion revascularization (TLR), and major amputation. We included eight studies (three randomized controlled trials (RCTs) and five observational studies) with a total of 3846 patients (4713 lesions). During a mean follow-up duration of 12.5 ± 5 months, the use of cilostazol was associated with higher primary patency (OR 2.28, 95% CI (1.77, 2.94), p < 0.001, I2 = 24%), lower risk of TLR (OR 0.37, 95% CI (0.26, 0.52), p < 0.001, I2 = 0%), and lower risk of major amputation (OR 0.15, 95% CI (0.04, 0.62), p = 0.008, I2 = 0%). The use of cilostazol in RCTs was associated with significantly higher odds of primary patency compared with observational studies (OR 3.37 vs 2.28, p-interaction = 0.03). After further subgroup analysis, cilostazol remained associated with higher primary patency regardless of the use of anticoagulants (warfarin) ( p-interaction = 0.49). We conclude that the use of cilostazol after EVT of femoropopliteal and iliac lesions is associated with improved primary patency and lower risk of major amputation and TLR. The favorable impact of cilostazol is independent of the use of warfarin. PROSPERO identifier: CRD42018092715.

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