scholarly journals One‐Year Change in Walking Performance and Subsequent Mobility Loss and Mortality Rates in Peripheral Artery Disease: Longitudinal Data From the WALCS

2021 ◽  
Author(s):  
Michael M. Hammond ◽  
Lu Tian ◽  
Lihui Zhao ◽  
Dongxue Zhang ◽  
Mary M. McDermott
Keyword(s):  
Peripheral Artery Disease ◽  
Proportional Hazards ◽  
Functional Performance ◽  
Performance Measure ◽  
Cox Proportional Hazards ◽  
Peripheral Artery ◽  
Cox Proportional Hazards Models ◽  
Walking Velocity ◽  
Artery Disease ◽  
Minute Walk

Background Associations of 1‐year change in functional performance measures with subsequent mobility loss and mortality in people with lower extremity peripheral artery disease are unknown. Methods and Results Six‐minute walk and 4‐meter walking velocity (usual and fastest pace) were measured at baseline and 1 year later in 612 people with peripheral artery disease (mean age 71±9 years, 37% women). Participants were categorized into tertiles, based on 1‐year changes in walking measures. Cox proportional hazards models were used to examine associations between 1‐year change in each walking measure and subsequent mobility loss and mortality, respectively, adjusting for potential confounders. Compared with the best tertile, the worst tertile (ie, greatest decline) in 1‐year change in each performance measure was associated with higher rates of mobility loss: 6‐minute walk (Tertile 1 [T1] cumulative incidence rate [IR], 72/160; Tertile 3 [T3] IR, 47/160; hazard ratio [HR], 2.35; 95% CI, 1.47–3.74), usual‐paced 4‐meter walking velocity (T1 IR, 54/162; T3 IR, 57/162; HR, 2.21; 95% CI, 1.41–3.47), and fast‐paced 4‐meter walking velocity (T1 IR, 61/162; T3 IR, 58/162; HR, 1.81; 95% CI, 1.16–2.84). Compared with the best tertile, the worst tertiles in 1‐year change in 6‐minute walk (T1 IR, 66/163; T3 IR, 54/163; HR, 1.61; 95% CI, 1.07–2.43) and fast‐paced 4‐meter walking velocity (T1 IR, 63/166; T3 IR, 44/166; HR, 1.75; 95% CI, 1.16, 2.64) were associated with higher mortality. Conclusions In people with peripheral artery disease, greater 1‐year decline in 6‐minute walk or 4‐meter walking velocity may help identify people with peripheral artery disease at highest risk for mobility loss and mortality.

Abstract P144: One-year Change In Walking Performance And Mobility Loss In People With Peripheral Artery Disease: The Walking And Leg Circulation Study (walcs)

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Michael M Hammond ◽  
Mary M McDermott ◽  
Lu Tian ◽  
Dongxue Zhang ◽  
Lihui Zhao
Keyword(s):  
Peripheral Artery Disease ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Peripheral Artery ◽  
Cox Proportional Hazards Models ◽  
Walking Performance ◽  
Artery Disease ◽  
One Year ◽  
Minute Walk

Introduction: Peripheral artery disease (PAD) affects 10-15% of people age 65 and older, and the prevalence is expected to rise as the population ages. People with PAD have greater functional impairment and faster decline in walking performance than people without PAD. Objectives: To determine the association between 1-year change in walking performance and mobility loss. We hypothesized that greater declines in walking performance over one year would be associated with higher rates of mobility loss. Methods: Participants underwent measurement of 6-minute walk and 4-meter walking velocity at baseline, and returned yearly for repeat measurement of walking performance and assessment of mobility. Participants were categorized into tertiles based on their 1-year change in walking performance (Tertile 1: greatest decline). Mobility loss was defined as becoming newly unable to walk one-quarter mile or walk up and down 1 flight of stairs without assistance after the 1-year follow-up. We used Cox proportional hazards models to examine the association between 1-year change in walking performance and mobility loss, adjusting for potential confounders. Results: 907 participants with PAD (mean age 71 +/- 9 years, 40% female, 23% black) were included. Median follow-up time was 38 months. Participants in Tertile 1 were older (mean 73 ± 9 years compared to 71 ± 9 in Tertile 2, and 70 ± 9 in Tertile 3; p=0.0004), had lower ABI (p=0.001), and included a higher prevalence of female (42% vs. 40% in Tertile 2, and 37% in Tertile 3; p=0.36). Participants with greater decline in 6-minute walk at 1-year follow-up had higher rates of mobility loss than participants with less decline. No significant associations of change in 4-meter walking speed and mobility loss were observed (Table). Conclusion: Among people with PAD, greater 1-year declines in six-minute walk distance are associated with higher rates of mobility loss. Further study is needed to determine whether interventions that prevent decline in six-minute walk can also prevent mobility loss.

Abstract MP14: Proteinuria is Associated With a Greater Risk of Lower Limb Amputation in Patients With Peripheral Artery Disease

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Jung-Im Shin ◽  
Morgan Grams ◽  
Josef Coresh ◽  
Alex Chang ◽  
Kunihiro Matsushita
Keyword(s):  
Peripheral Artery Disease ◽  
Lower Limb ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Lower Limb Amputation ◽  
Limb Amputation ◽  
Antiplatelet Drug ◽  
Peripheral Artery ◽  
Increased Risk ◽  
Artery Disease

Introduction: Proteinuria is shown to be associated with increased risk of peripheral artery disease (PAD). However, its association with the risk of lower limb amputation in patients with PAD is unknown. Hypothesis: We hypothesized that proteinuria is associated with the risk of amputation in patients with PAD in a graded fashion. Methods: We identified 3,388 PAD patients with data on urine dipstick proteinuria within two years prior to PAD diagnosis between 1997 and 2017 in the Geisinger Health System (mean age 69.7 years, 44.8% female, 97.4% non-Hispanic White, 57.8% diabetic). We quantified the association of proteinuria with the risk of amputation using Cox proportional hazards models, adjusting for demographics, calendar year, estimated glomerular filtration rate, HbA1c, comorbidities including diabetic retinopathy/neuropathy, and medication use (antiplatelet drug, statin, and renin-angiotensin system inhibitor). Results: There were 55.2% with negative dipstick proteinuria, 11.1% trace, 14.1% with 1+, and 19.5% with ≥2+. A total of 245 patients underwent amputations over a median follow-up of 3.4 years. Incidence rate of amputation was 1.15 per 100 person-years for dipstick negative, 1.47 for trace, 2.11 for 1+, and 3.78 for ≥2+. This dose-response relationship remained similar even after accounting for potential confounders (p-trend=0.015), with particularly evident association for ≥2+ of dipstick (an adjusted hazard ratio of 1.52 [95% confidence interval: 1.08-2.17, p=0.017) (Figure). When we added proteinuria to other covariates, the risk discrimination slightly improved (Δc-statistic 0.007 [0.001-0.014]). Conclusions: Higher proteinuria was associated with a greater risk of lower limb amputation among patients with newly diagnosed PAD. Our results suggest the importance of considering proteinuria in risk assessment of limb loss in PAD patients.

scholarly journals Indoxyl Sulfate and Incident Peripheral Artery Disease in Hemodialysis Patients

Toxins ◽  
2020 ◽  
Vol 12 (11) ◽  
pp. 696
Author(s):  
Ting-Yun Lin ◽  
Hsin-Hua Chou ◽  
Hsuan-Li Huang ◽  
Szu-Chun Hung
Keyword(s):  
Peripheral Artery Disease ◽  
Proportional Hazards ◽  
Ankle Brachial Index ◽  
Hemodialysis Patients ◽  
Cox Proportional Hazards ◽  
Indoxyl Sulfate ◽  
Major Adverse Cardiovascular Events ◽  
Peripheral Artery ◽  
All Cause Mortality ◽  
Artery Disease

Peripheral artery disease (PAD) is highly prevalent among patients with chronic kidney disease (CKD) and portends a very poor prognosis. Indoxyl sulfate has been shown to induce atherothrombosis and impaired neovascularization in uremic mice. However, there is no clinical evidence regarding the role of indoxyl sulfate in PAD associated with CKD. We examined associations between indoxyl sulfate and incident symptomatic lower extremity PAD events as well as major adverse cardiovascular events (MACE) and all-cause mortality using Cox proportional hazards models in a prospective cohort of 200 hemodialysis patients free of PAD at baseline. Patients were considered as having PAD if they developed PAD symptoms confirmed by an ankle-brachial index with waveforms, duplex ultrasound or angiography, and/or major adverse limb events including revascularization and amputation. During a median follow-up of 6.5 years, 37 patients (18.5%) experienced incident symptomatic PAD. MACE occurred in 52 patients, and a total of 85 patients died. After adjusting for traditional risk factors for PAD, including age, current smoking, diabetes, and cardiovascular disease, indoxyl sulfate was significantly associated with the risk of PAD (hazard ratio (HR), 1.19 for every 10-μg/mL increase in indoxyl sulfate; 95% confidence interval (CI), 1.05–1.35). However, indoxyl sulfate was not associated with risk of MACE (HR, 1.00; 95% CI, 0.90–1.12) or death from any cause (HR, 0.98; 95% CI, 0.90–1.07). Indoxyl sulfate was associated with incident symptomatic PAD but not with MACE or all-cause mortality, suggesting that indoxyl sulfate toxicity may be unique to PAD among hemodialysis patients.

scholarly journals Prognostic Value of Functional Performance for Mortality in Patients With Peripheral Artery Disease

2008 ◽  
Vol 51 (15) ◽  
pp. 1482-1489 ◽  
Author(s):  
Mary M. McDermott ◽  
Lu Tian ◽  
Kiang Liu ◽  
Jack M. Guralnik ◽  
Luigi Ferrucci ◽  
...  
Keyword(s):  
Peripheral Artery Disease ◽  
Prognostic Value ◽  
Functional Performance ◽  
Peripheral Artery ◽  
Artery Disease

Abstract 3073: Metabolic Syndrome, Inflammation and Risk of Symptomatic Peripheral Artery Disease in Women: A Prospective Study

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
David Conen ◽  
Kathryn M Rexrode ◽  
Paul M Ridker ◽  
Aruna D Pradhan
Keyword(s):  
Metabolic Syndrome ◽  
Peripheral Artery Disease ◽  
Cox Proportional Hazards ◽  
Health Study ◽  
Intercellular Adhesion Molecule ◽  
Peripheral Artery ◽  
Risk Increase ◽  
Increased Risk ◽  
Multivariable Models ◽  
Artery Disease

Background Metabolic syndrome (MetS) includes a number of cardiovascular risk factors known to predict vascular disease. Little is known, however, about the interrelationships between MetS, inflammation and the risk of incident peripheral artery disease (PAD). Methods We conducted a prospective cohort study among 27111 women participating in the Women’s Health Study. Subjects were free of cardiovascular disease at baseline and followed for the incidence of symptomatic PAD (n=114) over a follow-up period of 13.3 years. We used Cox proportional-hazards models to compare the risk of PAD among women with and without the MetS. We also evaluated relationships between MetS and markers of subclinical inflammation including high sensitivity C-reactive protein (hsCRP) and soluble intercellular adhesion molecule-1 (sICAM-1) and adjusted for these biomarker levels in multivariable models. Results At study entry, 25.5% of participants had the MetS. Women with the MetS had a 62% increased risk of incident PAD (HR 1.62; 95% CI 1.10 –2.38). After multivariable adjustment, MetS remained significantly associated with incident PAD (Table ). Similar results were obtained when we assessed the risk of PAD according to the number of MetS defining traits (21% risk increase per additional trait) (Table ). Median plasma levels of hsCRP and sICAM-1 were 4.0 mg/L versus 1.53 mg/L (p<0.0001) and 374 ng/mL versus 333 ng/mL (p<0.0001) in women with and without MetS, respectively. From 0 to 5 MetS defining traits, median hsCRP levels gradually increased from 1.0 to 5.9 mg/L (p<0.0001) and median sICAM-1 levels increased from 321 to 413 ng/mL (p<0.0001). When hsCRP and sICAM-1 were added to multivariable models for incident PAD, risk estimates for the MetS were substantially attenuated and became non-significant (Table ). Conclusion Women with the MetS have an increased risk of incident PAD. This increased risk may be largely mediated by the effects of inflammation and/or endothelial activation. Metabolic Syndrome and Risk of PAD

scholarly journals Vitamin D status and functional performance in peripheral artery disease

2012 ◽  
Vol 17 (5) ◽  
pp. 294-302 ◽  
Author(s):  
Mary M McDermott ◽  
Kiang Liu ◽  
Luigi Ferrucci ◽  
Lu Tian ◽  
Jack Guralnik ◽  
...  
Keyword(s):  
Vitamin D ◽  
Peripheral Artery Disease ◽  
Functional Performance ◽  
Vitamin D Status ◽  
Peripheral Artery ◽  
Artery Disease

Associations of edge-detected and manual-traced common carotid artery intima-media thickness with incident peripheral artery disease: The Multi-Ethnic Study of Atherosclerosis

2019 ◽  
Vol 24 (4) ◽  
pp. 306-312
Author(s):  
Joseph F Polak ◽  
David Herrington ◽  
Daniel H O’Leary
Keyword(s):  
Carotid Artery ◽  
Peripheral Artery Disease ◽  
Common Carotid Artery ◽  
Intima Media Thickness ◽  
Cox Proportional Hazards ◽  
Ultrasound Images ◽  
Peripheral Artery ◽  
Ethnic Study ◽  
Media Thickness ◽  
Artery Disease

Common carotid artery (CCA) intima-media thickness (IMT) is associated with coronary heart disease and can be measured on ultrasound images either by hand or with an automated edge detector. The association of CCA IMT with incident peripheral artery disease (PAD) is poorly studied. We studied 5467 participants of the Multi-Ethnic Study of Atherosclerosis composed of non-Hispanic white, Chinese, Hispanic, and African American participants with a mean age of 61.9 years (47.8% men). Framingham Risk Factors, manual-traced IMT (mt-IMT), and edge-detected IMT (ed-IMT) were entered into multivariable Cox proportional hazards models with incident PAD as the outcome. There were 87 events during a median follow-up of 12.2 years. In fully adjusted models and expressing the hazard ratios (HR) as an increment in SD values, both mt-IMT and ed-IMT were significantly associated with incident PAD: HR 1.36 (95% CI: 1.15, 1.61) and 1.29 (95% CI: 1.04, 1.60), respectively. We conclude that ed- and mt-CCA IMT measurements are associated with incident PAD. ClinicalTrials.gov Identifier: NCT00063440

scholarly journals Progenitor cell release plus exercise to improve functional performance in peripheral artery disease: The PROPEL Study

2013 ◽  
Vol 36 (2) ◽  
pp. 502-509 ◽  
Author(s):  
Kathryn Domanchuk ◽  
Luigi Ferrucci ◽  
Jack M. Guralnik ◽  
Michael H. Criqui ◽  
Lu Tian ◽  
...  
Keyword(s):  
Peripheral Artery Disease ◽  
Progenitor Cell ◽  
Functional Performance ◽  
Peripheral Artery ◽  
Cell Release ◽  
Artery Disease
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