Self-Reported History of Childhood Smoking Is Associated with an Increased Risk for Peripheral Arterial Disease Independent of Lifetime Smoking Burden

Abstract Introduction Antiplatelet therapy is the cornerstone of treatment for many atherosclerotic vascular pathologies including peripheral arterial disease (PAD). Patients with PAD often have comorbid conditions that require complex antithrombotic therapy, i.e. combined antiplatelet and anticoagulation. Methods All adult patients undergoing ankle brachial index (ABI) measurements were included in the study. ABI values between 1.00 and 1.40 were considered normal, and values below 1.00 or above 1.40 were considered PAD. Demographic, comorbidity and outcome data were obtained using diagnostic codes from the electronic health record. Three medication classes were analyzed: aspirin, non-aspirin oral antiplatelets (e.g. P2Y12 inhibitors) and oral anticoagulants (warfarin and the direct oral anticoagulants). Medication use was determined for patients who had been on a medication for at least one year. Cox proportional hazard analysis for the time to first bleeding event was analyzed. Bleeding was defined as any bleeding requiring medical evaluation (including clinically-relevant non-major bleeding and major bleeding). Results In all, 40,144 patients were included in the analysis (mean age 66±15, 43% female). Patients with PAD were more likely to be on double therapy (one antiplatelet with anticoagulation) (28% vs 19%) and triple therapy (dual antiplatelet with anticoagulation) (10% vs 4%). Unadjusted hazard ratios for bleeding risk showed increased risk of bleeding for patients with PAD (1.18, 95% confidence interval [CI]: 1.08–1.29), though the association is no longer present after adjustment for antithrombotic therapy. Adjusting for age, sex and PAD class, compared to no antithrombotic therapy, there was increased risk of bleeding for monotherapy (1.91, 95% CI: 1.61–2.26), double therapy (3.40, 95% CI: 2.89–4.00) and triple therapy (5.00, 95% CI: 4.21–5.96). Among medications, aspirin and anticoagulant use was independently associated with the greatest increase in risk of bleeding. Conclusion Patients in PAD are at increased risk of bleeding secondary to antithrombotic therapy. Complex antithrombotic therapy with double or triple therapy confer additional bleeding risk, particularly regimens containing aspirin and oral anticoagulants. Funding Acknowledgement Type of funding source: None

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Extremely elevated lipoprotein (a) as an independent risk factor for peripheral arterial disease in large patient cohort

European Heart Journal ◽

10.1093/ehjci/ehaa946.2397 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M.R Poudel ◽

S Kirana ◽

D Stoyanova ◽

K.P Mellwig ◽

D Hinse ◽

...

Keyword(s):

Peripheral Arterial Disease ◽

Low Density Lipoprotein ◽

Density Lipoprotein ◽

Arterial Disease ◽

P Value ◽

Lipoprotein A ◽

Large Patient ◽

Increased Risk ◽

Revascularization Therapy ◽

Peripheral Arterial

Abstract Background Elevated lipoprotein (a) [LP (a)] levels are an independent, genetic, and causal factor for cardiovascular disease and associated with myocardial infarction (MI). Although the association between circulating levels of lipoprotein(a) [Lp(a)] and risk of coronary artery disease (CAD) is well established, its role in risk of peripheral arterial disease (PAD) remains unclear. PAD affects over 236 million individuals and follows ischaemic heart disease (IHD) and cerebrovascular disease (CVD) as the third leading cause of atherosclerotic cardiovascular morbidity worldwide. LP (a) is genetically determined, stable throughout life and yet refractory to drug therapy. While 30 mg/dl is considered the upper normal value for LP (a) in central Europe, extremely high LP (a) levels (>150mg/dl) are rare in the general population. The aim of our study was to analyse the correlation between lipoprotein (a) [LP (a)] levels and an incidence of PAD in high-risk patients. Patients and methods We reviewed the LP (a) concentrations of 52.898 consecutive patients admitted to our cardiovascular center between January 2004 and December 2014. Of these, 579 patients had LP (a) levels above 150 mg/dl (mean 181.45±33.1mg/dl). In the control collective LP (a) was <30mg/dl (n=350). Other atherogenic risk factors in this group were HbA1c 6.58±1.65%, low density lipoprotein (LDL) 141.99±43.76 mg/dl, and body mass index 27.81±5.61. 54.40% were male, 26.07% were smokers, 93.2% had hypertension, and 24% had a family history of cardiovascular diseases. More than 82.6% were under statins. The mean glomerular filtration rate (GFR) was 69.13±24.8 ml/min [MDRD (Modification of Diet in Renal Disease)]. Results 45.00% (n=261) of the patients with LP (a) >150mg/dl had PAD. The prevalence of PAD in patients with LP (a) <30mg/dl in our control collective was 15.8%. (P- Value 0.001). Patients with LP (a) >150mg/dl had a significantly increased risk for PAD (Odds ratio 4.36, 95% CI 2.94–6.72, p: 0.001). 19.1% of patients were re-vascularized by percutaneous angioplasty (PTA) and 7.09% of patients had to undergo peripheral vascular bypass (PVB). Mean LP (a) level in patients with PAD was 182.6±31.61. Conclusion Elevated LP (a) levels above 150 mg/dl are associated with a significantly increased risk of PAD in our collective and it confirms our hypothesis. Over one fourth of these patients had severe PAD and requiring revascularization therapy. We need more prospective studies to confirm our findings. Funding Acknowledgement Type of funding source: None

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Increased risk of peripheral arterial disease in polymyalgia rheumatica: a population-based cohort study

Arthritis Research & Therapy ◽

10.1186/ar2664 ◽

2009 ◽

Vol 11 (2) ◽

pp. R50 ◽

Cited By ~ 25

Author(s):

Kenneth J Warrington ◽

Elena P Jarpa ◽

Cynthia S Crowson ◽

Leslie T Cooper ◽

Gene G Hunder ◽

...

Keyword(s):

Cohort Study ◽

Peripheral Arterial Disease ◽

Polymyalgia Rheumatica ◽

Arterial Disease ◽

Population Based ◽

Increased Risk ◽

Peripheral Arterial

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TCTAP C-027 Transbrachial Intra-aortic Balloon in Patient with Acute Coronary Syndrome and History of Peripheral Arterial Disease

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2018.03.472 ◽

2018 ◽

Vol 71 (16) ◽

pp. S94

Author(s):

Osama Mamdouh Shoeib ◽

Francesco Burzotta ◽

Cristina Aurigemma ◽

Carlo Trani

Keyword(s):

Acute Coronary Syndrome ◽

Peripheral Arterial Disease ◽

Arterial Disease ◽

Coronary Syndrome ◽

History Of ◽

Peripheral Arterial

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Abstract P081: Markers of Endothelial Function and Peripheral Arterial Disease among Women

Circulation ◽

10.1161/circ.127.suppl_12.ap081 ◽

2013 ◽

Vol 127 (suppl_12) ◽

Author(s):

Sona Rivas-Tumanyan ◽

Kenneth J Mukamal ◽

Jennifer K Pai ◽

Kaumudi J Joshipura

Keyword(s):

Myocardial Infarction ◽

Peripheral Arterial Disease ◽

Endothelial Function ◽

Conditional Logistic Regression ◽

Relative Weight ◽

Serum Levels ◽

Arterial Disease ◽

Blood Draw ◽

Increased Risk ◽

Peripheral Arterial

Introduction: Markers of endothelial function may be associated with increased risk for cardiovascular disease; however, prospective data for peripheral arterial disease (PAD) are limited. We evaluated the hypothesis that serum markers of endothelial dysfunction are associated with an increased risk of PAD among women. Methods: We conducted a nested case-control study within an ongoing prospective cohort of U.S. female nurses (Nurses’ Health Study). Among 32,826 NHS participants who provided blood samples in 1989-1990, after excluding those who had myocardial infarction, coronary heart disease, stroke, or carotid artery surgery prior to the PAD diagnosis, we included all incident PAD cases that occurred between 1990 and 2008 and were confirmed by medical records. Each case was individually matched with three eligible controls using risk-set sampling, by age, smoking, date of blood draw, and fasting status. We evaluated the association between serum levels of soluble intercellular adhesion molecule (ICAM-1), E-selectin, and the risk of PAD, using conditional logistic regression analysis. Results: Complete biomarker data from 1990 was available for 144 cases and 431 controls. After accounting for matching factors, baseline ICAM-1 levels were associated with higher risk of PAD (RR for highest (T3) vs. lowest (T1) tertile=1.75, 95% CI: 1.05-2.90). The association was attenuated and no longer significant (RR T3 vs. T1=1.37, 95% CI: 0.75-2.49) after adjusting for serum levels of HDL and LDL-cholesterol, family history of myocardial infarction, relative weight, reported aspirin and cholesterol-lowering medication use, hypertension and diabetes diagnoses, physical activity, and pack-years of smoking. Additional adjustment for CRP levels further attenuated the relative risk (RR T3 vs. T1= 1.24, 95% CI: 0.67-2.29). We did not observe any significant association between baseline E-selectin levels and the risk of PAD (multivariate- and CRP-adjusted RR T3 vs. T1=0.93, 95% CI: 0.54-1.59). Conclusions: There was no association between ICAM-1 and E-selectin and subsequent PAD in this cohort of U.S women.

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Activation Products of the Haemostatic System in Coronary, Cerebrovascular and Peripheral Arterial Disease

Thrombosis and Haemostasis ◽

10.1055/s-0037-1615700 ◽

2001 ◽

Vol 85 (02) ◽

pp. 234-239 ◽

Cited By ~ 32

Author(s):

M. L. Bots ◽

F. Haverkate ◽

P. Meijer ◽

A. Hofman ◽

C. Kluft ◽

...

Keyword(s):

Peripheral Arterial Disease ◽

Transient Ischemic Attack ◽

Pressure Ratio ◽

Arterial Disease ◽

Population Based ◽

Control Subjects ◽

History Of ◽

Ischemic Attack ◽

Peripheral Arterial ◽

D Dimer

SummaryTo determine the presence of a ‘hypercoagulable state’ as assessed by indices of thrombin and plasmin generation and of the amount of fibrin that is lysed, in patients with stable coronary, cerebral and peripheral arterial disease a population-based cross-sectional study was performed. From a population-based cohort comprising 7983 men and women aged 55 years and over, we randomly selected 127 subjects with a history of myocardial infarction, 124 with a history of stroke and/or transient ischemic attack, 131 patients with peripheral arterial disease and 263 control subjects in the same age group without arterial disease. Subjects using anticoagulant drugs were not selected. F1+2, TAT, and PAP were not associated with a history of cardiovascular events, nor with peripheral arterial disease. In contrast, positive associations were found for D-Dimer. Mean D-Dimer level was 40 μg/l (95% CI 35,44) in control subjects; 53 μg/l (47, 61) in those with a history of myocar-dial infarction and 51 μg/l (45, 58) in those with a history of stroke and or transient ischemic attack. D-Dimer increased gradually with increasing severity of peripheral atherosclerosis; a decrease in ankle/arm systolic blood pressure ratio of 0.1 was associated with an increase in D-Dimer of 3.9 μg/l (p<0.01). This was more pronounced in subjects with higher F1+2, TAT and PAP concentration. In conclusion, the markers of onset of coagulation F1+2, TAT and PAP are not associated with the presence of arterial disease, but increased levels of these markers are necessary for the positive association between D-Dimer and arterial disease.

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Increased Risk of Peripheral Arterial Disease After Hip Replacement

Medicine ◽

10.1097/md.0000000000000870 ◽

2015 ◽

Vol 94 (19) ◽

pp. e870 ◽

Cited By ~ 7

Author(s):

Tzu-Yi Chou ◽

Ta-Wei Su ◽

Herng-Jeng Jou ◽

Pei-Yu Yang ◽

Hsuan-Ju Chen ◽

...

Keyword(s):

Peripheral Arterial Disease ◽

Hip Replacement ◽

Arterial Disease ◽

Increased Risk ◽

Peripheral Arterial

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Case Report: ENDOVASCULAR STENTING IN PERIPHERAL ARTERIAL DISEASE OF LOWER EXTREMITY

Folia Medica Indonesiana ◽

10.20473/fmi.v52i2.5231 ◽

2017 ◽

Vol 52 (2) ◽

pp. 140

Author(s):

Yudi Her Oktaviono

Keyword(s):

Peripheral Arterial Disease ◽

Arterial Disease ◽

Transluminal Angioplasty ◽

Focal Lesions ◽

First Choice ◽

History Of ◽

Arterial Insufficiency ◽

Artery Disease ◽

Peripheral Arterial

Peripheral arterial disease (PAD) is usually caused by multilevel atherosclerotic disease, typically in patients with a history of cigarette smoking, diabetes mellitus, or both. Intermittent claudication (IC), an early manifestation of PAD, commonly leads to reduced quality of life for patients who are limited in their ambulation. Percutaneous intervention for peripheral artery disease has evolved from balloon angioplasty for simple focal lesions to multimodality techniques that enable treatment of severe arterial insufficiency. Especially for high-grade stenoses or short arterial occlusions, percutaneous transluminal angioplasty (PTA) should be the method of first choice followed by the best surgical procedure later on. To achieve good long-term efficacy, a close follow-up including objective tests of both the arterial lesion and hemodynamic status, surveillance of secondary preventive measures and risk factor control is mandatory.

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The Association Between Pleural Empyema and Peripheral Arterial Disease in Younger Patients: A Retrospective National Population-Based Cohort Study

Frontiers in Medicine ◽

10.3389/fmed.2021.621330 ◽

2021 ◽

Vol 8 ◽

Author(s):

Tzu-Yuan Wang ◽

Hsin-Hung Chen ◽

Chun-Hung Su ◽

Sheng-Pang Hsu ◽

Chun-Wei Ho ◽

...

Keyword(s):

Cohort Study ◽

Peripheral Arterial Disease ◽

Pleural Empyema ◽

Arterial Disease ◽

Population Based ◽

Rank Test ◽

Research Database ◽

Increased Risk ◽

Using Data ◽

Peripheral Arterial

Background: To investigate the relationship between pleural empyema (PE) and peripheral arterial disease (PAD).Methods: We conducted a retrospective cohort study using data from the National Health Institute Research Database. Univariable and multivariable Cox's proportional hazard regressions were performed to investigate the association between PE and the risk of PAD. Kaplan–Meier method and the differences were assessed using a log-rank test.Results: The overall incidence of PAD was higher in the PE cohort than in the non-PE cohort (2.76 vs. 1.72 per 1,000 person-years) with a crude hazard ratio (HR) of 1.61 [95% confidence interval (CI) = 1.41–1.83]. After adjustment for age, gender, and comorbidities, patients with PE were noted to be associated with an increased risk of PAD compared with those without PE [adjusted HR (aHR) = 1.18, 95% CI = 1.03–1.35]. Regarding the age-specific comparison between the PE and non-PE cohorts, PAD was noted to be significantly high in the ≤ 49 years age group (aHR = 5.34, 95% CI = 2.34–10.1). The incidence of PAD was higher in the first 2 years, with an aHR of 1.35 (95% CI = 1.09–1.68) for patients with PE compared with those without PE.Conclusion: The risk of PAD was higher if patients with PE were younger than 49 years and within the 2-year diagnosis of PE.

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The Role of Tobacco Cessation, Antiplatelet and Lipid-Lowering Therapies in the Treatment of Peripheral Arterial Disease

Vascular Medicine ◽

10.1177/1358863x9700200314 ◽

1997 ◽

Vol 2 (3) ◽

pp. 243-251 ◽

Cited By ~ 81

Author(s):

Alan T Hirsch ◽

Diane Treat-Jacobson ◽

Harry A Lando ◽

Dorothy K Hatsukami

Keyword(s):

Peripheral Arterial Disease ◽

Arterial Disease ◽

Pharmacological Therapy ◽

Current Data ◽

Lipid Lowering ◽

History Of ◽

Medical Therapies ◽

Peripheral Arterial ◽

Interventional Therapies

Despite the widely held belief that there are no effective medical therapies for peripheral arterial disease (PAD), current data suggest that medical therapies can effectively modify the natural history of atherosclerotic lower extremity arterial occlusive disease. The ideal medical therapy would improve claudication, forestall the onset of limb-threatening events, decrease rates of invasive interventional therapies and improve long-term patient survival. These ideal outcomes might be achieved through the use of smoking cessation interventions, including behavioral and pharmacological therapy, and the administration of antiplatelet and lipid-lowering medications in patients with PAD.

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