Complexity of lower extremity peripheral artery disease reflects the complexity of coronary artery disease

We investigated the relationship between peripheral artery disease complexity and coronary artery disease complexity in patients with peripheral artery disease. A total of 449 patients were enrolled. SYNTAX score, a marker of coronary artery disease complexity, was assessed by dedicated computer software and complexity of peripheral artery disease was determined by Trans Atlantic Inter-Society Consensus II classification. The SYNTAX score of patients with minimal peripheral artery disease, Trans Atlantic Inter-Society Consensus A, Trans Atlantic Inter-Society Consensus B, Trans Atlantic Inter-Society Consensus C and Trans Atlantic Inter-Society Consensus D were 5 (11), 12.5 (13.25), 20 (14), 20.5 (19) and 27.5 (19), respectively (values in brackets represent the interquartile range). SYNTAX score and Trans Atlantic Inter-Society Consensus class was moderately correlated (r = 0.495, p < 0.001). In multivariate regression analysis male sex (B = 0.169, p < 0.001, CI95% = 0.270–0.735), Log10 SYNTAX score (B = 0.282, p < 0.001, CI95% = 0.431–0.782), Log10 creatinine (B = 0.081, p = 0.036, CI95% = 0.043–1.239), low-density lipoprotein (B = 0.114, p = 0.003, CI95% = 0.001–0.006) and high-density lipoprotein (B = −0.360, p < 0.001, CI95% = −0.063 to −0.041) were the independent predictors of Trans Atlantic Inter-Society Consensus II class. We have shown that patients with complex peripheral artery disease had complex coronary artery disease.

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Metabolic biomarkers for peripheral artery disease compared with coronary artery disease: Lipoprotein and metabolite profiling of 31,657 individuals from five prospective cohorts

10.1101/2020.07.24.20158675 ◽

2020 ◽

Author(s):

Emmi Tikkanen ◽

Vilma Jägerroos ◽

Rodosthenis Rodosthenous ◽

Michael Holmes ◽

Naveed Sattar ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Peripheral Artery Disease ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Vascular Diseases ◽

Peripheral Artery ◽

Ldl Particles ◽

Increased Risk ◽

Artery Disease

Background: Peripheral artery disease (PAD) and coronary artery disease (CAD) represent atherosclerosis in different vascular beds. We conducted detailed metabolic profiling to identify biomarkers for the risk of developing PAD and compared with risk of CAD to explore common and unique risk factors for these different vascular diseases. Methods: We measured blood biomarkers using nuclear magnetic resonance metabolomics in five Finnish prospective general-population cohorts (FINRISK 1997, 2002, 2007, 2012, and Health 2000 studies, n = 31,657). We used Cox modelling to estimate associations between biomarkers and incident symptomatic PAD and CAD (498 and 2073 events, respectively) during median follow-up time of 14 years. Results: The pattern of biomarker associations for incident PAD deviated from that for CAD. Apolipoproteins and cholesterol measures were robustly associated with incident CAD (for example, age- and sex-adjusted hazard ratio per SD for higher apolipoprotein B/A 1 ratio: 1.30; 95% confidence interval 1.25-1.36), but not with incident PAD (1.04; 0.95-1.14; Pheterogeneity < 0.001). Low-density lipoprotein (LDL) particle concentrations were also associated with incident CAD (e.g. small LDL particles: 1.24; 1.19-1.29) but not with PAD (1.07; 0.98-1.17; Pheterogeneity < 0.001). In contrast, more consistent associations of smaller LDL particle size and higher triglyceride levels in LDL and HDL particles with increased risk for both CAD and PAD events were seen (Pheterogeneity > 0.05). Many non-traditional biomarkers, including fatty acids, amino acids, inflammation- and glycolysis-related metabolites were associated with future PAD events. Lower levels of linoleic acid, an omega-6 fatty acid, and higher concentrations of glucose, lactate, pyruvate, glycerol and glycoprotein acetyls were more strongly associated with incident PAD as compared to CAD (Pheterogeneity < 0.001). The differences in metabolic biomarker associations for PAD and CAD remained when adjusting for body mass index, smoking, prevalent diabetes, and medications. Conclusions: The metabolic biomarker profile for future PAD risk is largely distinct from that of CAD. This may represent pathophysiological differences and may facilitate risk prediction.

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Is it possible to predict the complexity of peripheral artery disease with atherogenic index?

Vascular ◽

10.1177/1708538120923531 ◽

2020 ◽

Vol 28 (5) ◽

pp. 513-519

Author(s):

Engin Mesut ◽

Aydın Cihan ◽

Guvenc Orhan

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Peripheral Artery Disease ◽

Multivariate Logistic Regression Analysis ◽

Density Lipoprotein ◽

Atherogenic Index ◽

Peripheral Artery ◽

Group 2 ◽

Artery Disease ◽

Group 1

Objectives Lower extremity peripheral artery disease develops mainly due to atherosclerosis and occurs as a result of the systemic atherosclerotic process. Increased triglyceride (TG) and decreased high density lipoprotein cholesterol (HDL-C) values increase atherosclerosis risk. With regard to this information, TG/HDL-C ratio is used as the atherogenic index. The aim of the present study was to evaluate the role of TG/HDL-C ratio to predict the complexity of disease in patients with peripheral artery disease. Methods Patients who were diagnosed with peripheral artery disease and admitted to our clinic between August 2013 and August 2019 were included in this study retrospectively. Patients were divided into two groups based on angiographic evaluations with TransAtlantic Inter-Society Consensus-II classification. Those with TASC A-B lesions were included in Group 1 and those with TASC C-D lesions constituted Group 2. Results The mean ages of Group 1 ( n = 314) and Group 2 ( n = 98) patients were 56.1 ± 9.3 and 58.4.1 ± 8.1 years, respectively. The frequency of male gender and coronary artery disease was significantly higher in Group 2 ( p = 0.043, p = 0.001, respectively). In Group 2, triglyceride and TG/HDL-C ratios were significantly high, while HDL-C was significantly low ( p = 0.022, p < 0.001, p = 0.010, respectively). The multivariate logistic regression analysis performed to evaluate the parameters in predicting the angiographic complexity of peripheral artery disease showed that coronary artery disease (OR: 1.009 CI 95%: 1.003–1.021 p = 0.016) and TG/HDL-C ratio (OR: 5.385 CI 95%: 2.553–9.357 p = 0.001) were independent predictors for complexity. ROC analysis revealed that the cut-off value of TG/HDL-C was 2.9 (AUC = 0.670, p < 0.001) with 75.5% sensitivity and 56.7% specificity. Conclusions It is possible to predict the angiographic complexity of peripheral artery disease with TG/HDL-C ratio, also known as atherogenic index, which is easily obtained by routine biochemical parameters.

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The role of novel cytokines in inflammation: Defining peripheral artery disease among patients with coronary artery disease

Vascular Medicine ◽

10.1177/1358863x18763096 ◽

2018 ◽

Vol 23 (5) ◽

pp. 428-436 ◽

Cited By ~ 12

Author(s):

Demet Ozkaramanli Gur ◽

Savas Guzel ◽

Aydin Akyuz ◽

Seref Alpsoy ◽

Niyazi Guler

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Peripheral Artery Disease ◽

Ankle Brachial Index ◽

Vascular Involvement ◽

Future Research ◽

Syntax Score ◽

Peripheral Artery ◽

Artery Disease ◽

Distinct Features

Coronary artery disease (CAD) patients with concomitant peripheral artery disease (PAD) experience more extensive and calcified atherosclerosis, greater lesion progression and more common coronary events compared to patients with CAD only. To characterize the distinct features of this aggressive atherosclerotic disease, we studied novel cytokines that code different stages of atherogenesis. One hundred and eighty consecutive subjects (60 patients into each group of CAD+PAD, CAD and controls) were recruited among patients with stable angina pectoris scheduled for coronary angiography. An ankle–brachial index (ABI) ≤0.9 was determined as occlusive PAD. Fasting serum tumor necrosis factor (TNF)-like antigen 1A (TL1A) and its receptor death receptor 3 (DR3), NOGO-B (reticulon 4B) and its receptor NUS1, high-sensitivity C-reactive protein (hsCRP), A disintegrin and metalloproteinase with thrombospondin motifs (ADAMTS) 1, 4, 5 and interleukin (IL) 6 levels were determined. Serum hsCRP and DR3/TL1A concentrations were similar and higher than controls in the CAD and CAD+PAD groups. Levels of NOGO-B and its receptor NUS1 were increased and ADAMTS-5 was decreased in patients with CAD+PAD. Independent predictors of ABI in multivariate analysis were smoking (B = −0.13, p = 0.04), NUS1 (B = −0.88, p < 0.001), ADAMTS-5 (B = 0.63, p < 0.001) and SYNTAX score (B = −0.26, p < 0.001). Similarly, smoking (OR = 5.5, p = 0.019), SYNTAX score (OR = 1.2, p < 0.001), NUS1 (OR = 14.4, p < 0.001), ADAMTS-5 (OR = 1.1, p < 0.001) and age (OR = 1.1, p = 0.042) independently predicted the involvement of peripheral vasculature in logistic regression. The diagnostic performance of these cytokines to discriminate CAD+PAD were AUC 0.79 ( p < 0.001) for NUS1 and 0.37 ( p = 0.013) for ADAMTS-5. We report herein that circulating cytokines can give clues to the ongoing atherosclerotic process and the extent of vascular involvement in which distinct features of ADAMTS-5 and NUS1 make them promising cytokines for future research.

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Association Between Severity of Peripheral Artery Disease Angio CT-derived Coronary Syntax Score in Patients with Critical Limb Ischemia

Journal of Interdisciplinary Medicine ◽

10.1515/jim-2016-0009 ◽

2016 ◽

Vol 1 (1) ◽

pp. 42-45

Author(s):

Emese Rapolti ◽

Theodora Benedek ◽

István Kovács ◽

Szilamér Korodi ◽

Zsuzsanna Suciu ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Peripheral Artery Disease ◽

Calcium Score ◽

Left Ventricular ◽

Coronary Calcium ◽

Syntax Score ◽

Peripheral Artery ◽

Angio Ct ◽

Artery Disease

Abstract Introduction: Peripheral artery disease, a frequent consequence of atherosclerosis, is usually associated with concomitant ischaemic coronary artery disease and with a high rate of cardiovascular mortality. Material and methods: The study population consisted of 24 patients, admitted to our clinic with peripheral artery disease, 10 of them with critical limb ischaemia. In all cases, cardiovascular risk factors, left ventricular dysfunction and ejection fraction were analyzed. Peripheral Multislice Angio CT examination was used to determine the TASC class and to assess the peripheral arterial lesions. The Coronary Calcium Score and the Syntax Score were determined with angio CT of the coronary arteries. Results: Patients were between 39 and 84 years of age, and 54% were in Fontaine class 2B, 21% in Fontaine class 3 and 25% in Fontaine class 4. 12.5% of patients presented TASC class A, 33.3% TASC class B, and 54.2% TASC class C. Coronary Calcium Scores were between 0 and 100 in 16.6% of patients, between 100 and 400 in 41.8%, and >400 in 41.6% of patients. The SYNTAX Score was <22 in 54% of patients, between 22 and 32 in 37.5%, and >32 in 8.5% of patients. A significant correlation was found between the Coronary Calcium Score and the SYNTAX Score (r = 0.82, p = 0.03). The Syntax Score was 22.43 ± 3.2 in TASC A patients, 26.2 ± 5.4 in TASC B patients, 32.1 ± 2.3 in TASC C patients (p = 0.005). Conclusions: The severity of coronary artery disease characterized by the Syntax Score, by the presence of left main stenosis and segmental left ventricular hypokinesis presents significant correlation with the severity of peripheral artery disease, characterized by the TASC classification.

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