scholarly journals Non-Persistence With Antiplatelet Medications Among Older Patients With Peripheral Arterial Disease

2021 ◽  
Vol 12 ◽  
Author(s):  
Martin Wawruch ◽  
Jan Murin ◽  
Tomas Tesar ◽  
Martina Paduchova ◽  
Miriam Petrova ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Cox Regression ◽  
Arterial Disease ◽  
Study Data ◽  
Chronic Obstructive ◽  
Study Cohort ◽  
Antiarrhythmic Agents ◽  
Insurance Company ◽  
Antiplatelet Medication ◽  
Peripheral Arterial

Introduction: Antiplatelet therapy needs to be administered life-long in patients with peripheral arterial disease (PAD). Our study was aimed at 1) the analysis of non-persistence with antiplatelet medication in older PAD patients and 2) identification of patient- and medication-related characteristics associated with non-persistence.Methods: The study data was retrieved from the database of the General Health Insurance Company. The study cohort of 9,178 patients aged ≥ 65 years and treated with antiplatelet medications was selected from 21,433 patients in whom PAD was newly diagnosed between 01/2012 and 12/2012. Patients with a 6 months treatment gap without antiplatelet medication prescription were classified as non-persistent. Characteristics associated with non-persistence were identified using the Cox regression.Results: At the end of the 5 years follow-up, 3,032 (33.0%) patients were non-persistent. Age, history of ischemic stroke or myocardial infarction, clopidogrel or combination of aspirin with clopidogrel used at the index date, higher co-payment, general practitioner as index prescriber and higher overall number of medications were associated with persistence, whereas female sex, atrial fibrillation, anxiety disorders, bronchial asthma/chronic obstructive pulmonary disease, being a new antiplatelet medication user (therapy initiated in association with PAD diagnosis), and use of anticoagulants or antiarrhythmic agents were associated with non-persistence.Conclusion: In patients with an increased probability of non-persistence, an increased attention should be paid to improvement of persistence.

scholarly journals Reinitiation and Subsequent Discontinuation of Antiplatelet Treatment in Nonpersistent Older Patients with Peripheral Arterial Disease

Biomedicines ◽  
2021 ◽  
Vol 9 (9) ◽  
pp. 1280
Author(s):  
Martin Wawruch ◽  
Jan Murin ◽  
Tomas Tesar ◽  
Martina Paduchova ◽  
Miriam Petrova ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Antiplatelet Therapy ◽  
Cox Regression ◽  
Antiplatelet Agents ◽  
Arterial Disease ◽  
University Education ◽  
Chronic Obstructive ◽  
Factors Associated ◽  
Antiplatelet Medication ◽  
Peripheral Arterial

The successful treatment of peripheral arterial disease (PAD) depends on adequate adherence to medications including antiplatelet agents. The aims of this study were (a) to identify the proportion of nonpersistent patients who reinitiated antiplatelet therapy and how many of them discontinued therapy after reinitiation, and (b) to identify patient- and medication-related characteristics associated with the likelihood of reinitiation and discontinuation among reinitiators. The analysis of reinitiation was conducted on 3032 nonpersistent users of antiplatelet agents aged ≥65 years, with PAD newly diagnosed in 2012. Discontinuation (i.e., a treatment gap of ≥6 months without antiplatelet medication prescription) was analysed in 2006 reinitiating patients. To identify factors associated with the likelihood of reinitiation and discontinuation, Cox regression with time-dependent covariates was used. Reinitiation was recorded in 2006 (66.2%) of 3032 patients who had discontinued antiplatelet medication. Among these 2006 reinitiators, 1078 (53.7%) patients discontinued antiplatelet therapy again. Ischemic stroke and myocardial infarction during nonpersistence and bronchial asthma/chronic obstructive pulmonary disease were associated with an increased likelihood of reinitiation. University education was associated with discontinuation among reinitiators. Factors associated with the probability of reinitiation and discontinuation in reinitiators make it possible to identify older PAD patients in whom “stop-starting” behaviour may be expected.

scholarly journals Adherence to Antiplatelet Medications among Persistent and Non-Persistent Older Patients with Peripheral Arterial Disease

Biomedicines ◽  
2021 ◽  
Vol 9 (12) ◽  
pp. 1800
Author(s):  
Martin Wawruch ◽  
Jan Murin ◽  
Tomas Tesar ◽  
Martina Paduchova ◽  
Miriam Petrova ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Antiplatelet Agents ◽  
Arterial Disease ◽  
Medication Administration ◽  
Study Cohort ◽  
Binary Logistic Regression Model ◽  
Adherence To Medication ◽  
Antiplatelet Medication ◽  
Patient Groups ◽  
Peripheral Arterial

Secondary prevention of peripheral arterial disease (PAD) includes administration of antiplatelet agents, and adherence to medication is a requirement for an effective treatment. The aim of this study was to analyse adherence measured using the proportion of days covered (PDC) index separately in persistent and non-persistent patients, and to identify patient- and medication-related characteristics associated with non-adherence in these patient groups. The study cohort of 9178 patients aged ≥ 65 years in whom PAD was diagnosed in 1/–12/2012 included 6146 persistent and 3032 non-persistent patients. Non-adherence was identified as PDC < 80%. Characteristics associated with non-adherence were determined using the binary logistic regression model. In the group of persistent patients, 15.3% of subjects were identified as non-adherent, while among non-persistent patients, 26.9% of subjects were non-adherent to antiplatelet medication. Administration of dual antiplatelet therapy (aspirin and clopidogrel) and a general practitioner as index prescriber were associated with adherence in both patient groups. Our study revealed a relatively high proportion of adherent patients not only in the group of persistent patients but also in the group of non-persistent patients before discontinuation. These results indicate that most non-persistent PAD patients discontinue antiplatelet treatment rapidly after a certain period of adherence.

Association between Chronic Obstructive Pulmonary Disease and Peripheral Arterial Disease in Construction Workers-A Cross-Sectional Study

2021 ◽  
Vol 15 (9) ◽  
pp. 2989-2994
Author(s):  
U. Sivakumar ◽  
Rinku Garg ◽  
Sunita Nighute
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Peripheral Arterial Disease ◽  
Pulmonary Disease ◽  
Arterial Disease ◽  
Cross Sectional Study ◽  
Chronic Obstructive ◽  
Sectional Study ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease ◽  
Peripheral Arterial

Objective: COPD has been recognized not only as a lung but also a systemic disease. Smoking is a major cause of COPD, cardiovascular disease, stroke and peripheral arterial disease (PAD). Methods: This was a cross-sectional study conducted at the Department of Physiology, Santosh Medical College diagnosed with COPD using Spirometry was recruited for the study with a sample size of 130 patients. Results: Of the 130 participants, the mean age was 51.73 years of all COPD patients. Thirty-seven (28.46%) were diagnosed to have PAD. Twenty-five patients (19.23%) were overweight, 10 (7.69%) were obese. All the patients included in the study had history of smoking, including current (n= 67, 51.5%) and former (n= 35, 26.9%) smokers. There was no patient with severe respiratory failure in our study. The most common cardiovascular co-morbidity was hypertension (n= 67, 51.5%), followed by diabetes mellitus (n =28, 21.5%), and dyslipidaemia (n= 35, 26.92%). PAD seen in different stages of COPD stage I –IV were 2.94%, 55.88%, 61.76%, 20.58% respectively. Conclusion: The diagnosis of peripheral arterial disease in COPD is important because this is an entity that limits the patient’s physical activity and impairs their quality of life. Lung function was not associated with PAD in patients with COPD. Abnormal ABI results were associated with a higher prevalence of risk factors and more severe lung disease. Keywords: Peripheral Arterial Disease, Smoking, Chronic Obstructive Pulmonary Disease.

Relation between Chronic Obstructive Pulmonary Disease and Peripheral Arterial Disease among Construction Workers

2021 ◽  
Vol 15 (10) ◽  
pp. 3473-3475
Author(s):  
U. Sivakumar ◽  
Rinku Garg ◽  
Sunita Nighute
Keyword(s):  
Chronic Obstructive Pulmonary Disease ◽  
Peripheral Arterial Disease ◽  
Pulmonary Disease ◽  
Arterial Disease ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Risk Of Death ◽  
Increased Risk ◽  
Peripheral Arterial

Introduction: PAD was asymptomatic in a large proportion of COPD patients and was associated with more severe lung disease than in COPD subjects without PAD. Materials and Methods: This was a Cross-sectional study conducted at Department of Physiology, Santosh Medical College diagnosed with COPD using Spirometry was recruited for the study with a Sample size of 130 patients. Results: The characteristics of the population for follow-up (n=130) are presented in table 1. The mean Mean±SD was 51.73±6.1 years. The prevalence of never smokers was 21.5%, former smokers were 51.5% and current smokers were 26.9%. In total, 41 out of 130 individuals (31.5%) had PAD based on an ABI of less than 0.6. A statistically significant association was found between COPD and newly diagnosed PAD during follow-up. The association between COPD and incident PAD was stronger (adjusted OR 1.91, 95% CI 1.14–3.21). Stratified analysis by smoking status revealed that the overall association between COPD and newly developed PAD was driven by the ever smoker group. Conclusion: Subjects with COPD have a higher risk of developing PAD. People with both COPD and PAD have a substantially increased risk of death. Consequently, early detection of PAD and preventive actions in people with COPD should receive more attention in clinical respiratory care. Keywords: Peripheral Arterial Disease, Chronic Obstructive Pulmonary Disease, Ankle-brachial index.

scholarly journals COPD is associated with an increased risk of peripheral artery disease and mortality

2018 ◽  
Vol 4 (4) ◽  
pp. 00086-2018 ◽  
Author(s):  
Natalie Terzikhan ◽  
Lies Lahousse ◽  
Katia M.C. Verhamme ◽  
Oscar H. Franco ◽  
M. Arfan Ikram ◽  
...  
Keyword(s):  
Cox Regression ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Mortality Rates ◽  
Population Based ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Interaction Terms ◽  
Increased Risk ◽  
Peripheral Arterial

Patients with chronic obstructive pulmonary disease (COPD) commonly present with multimorbidity. We aimed to investigate the association between COPD and the development of peripheral arterial disease (PAD) in the general population, and how this might affect mortality among individuals with COPD.We included 3123 participants of the population-based Rotterdam Study without PAD at baseline (mean age 65 years; 57.4% female). The association between COPD at baseline and PAD during follow-up was studied using logistic regression (PAD being indicated by an ankle–brachial index (ABI) of 0.9 or less). Cox regression was used for mortality analysis and interaction terms were used to investigate mortality risk modification by PAD.The presence of COPD was associated with incident PAD (adjusted odds ratio 1.9, 95% CI 1.1–3.2). Mortality rates per 100 000 person-years were as follows: 10.0 in individuals without COPD or PAD, 18.4 in those with COPD only, 16.1 in those with PAD only and 30.1 in individuals with both COPD and PAD. No statistical interaction was found between PAD and COPD on risk of dying.Individuals with COPD have an almost doubled risk of developing PAD. Although PAD does not modify the association between COPD and mortality, people suffering from both diseases have substantially higher mortality rates.

Abstract 11471: Peripheral Arterial Disease and Risk of Atrial Fibrillation and Stroke: The Multi-Ethnic Study of Atherosclerosis

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Wesley T O’Neal ◽  
Jimmy T Efird ◽  
Saman Nazarian ◽  
Alvaro Alonso ◽  
Susan R Heckbert ◽  
...  
Keyword(s):  
Risk Factors ◽  
Atrial Fibrillation ◽  
Peripheral Arterial Disease ◽  
Cox Regression ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Ethnic Study ◽  
Hazard Ratios ◽  
Increased Risk ◽  
Peripheral Arterial

Introduction: Peripheral arterial disease (PAD) shares several risk factors with atrial fibrillation (AF) and persons with PAD have an increased risk of stroke. It is unclear if PAD is associated with an increased risk for AF and whether such an association explains the increased risk of stroke associated with PAD. Methods: We examined the association between PAD, as measured by the ankle-brachial index (ABI), and incident AF and incident stroke, separately, in 6,568 participants (mean age 62 ± 10; 53% women; 62% non-white) from the Multi-Ethnic Study of Atherosclerosis (MESA). ABI values <1.0 or >1.4 defined PAD in this analysis. Participants were free of baseline clinical cardiovascular disease and AF. AF was ascertained by review of hospital discharge records and from Medicare claims data until December 31, 2010. An independent adjudication committee ascertained stroke events. Cox regression was used to compute hazard ratios (HR) and 95% confidence intervals (95%CI) for the association between PAD and AF and stroke. Results: A total of 774 (12%) participants had baseline PAD. Over a median follow-up of 8.5 years, 301 (4.6%) participants developed AF and 140 (2.1%) developed stroke. In a model adjusted for socio-demographics, cardiovascular risk factors, and potential confounders, PAD was associated with an increased risk of AF (HR=1.5, 95%CI=1.1, 2.0). In a similar model, PAD was associated with incident stroke (HR=1.7, 95%CI=1.1, 2.5) and the magnitude of risk was not different after inclusion of AF as a time-dependent covariate (HR=1.7, 95%CI=1.1, 2.5). Similar results were obtained in subgroup analyses stratified by age, sex, and race/ethnicity. Conclusions: PAD is independently associated with an increased risk of AF and stroke in the MESA study. The relationship between PAD and stroke is not mediated by AF.

Abstract 15880: Angiopoietin 2, a Pro-inflammatory Protein, is Associated With Major Adverse Cardiovascular Events in Patients With Peripheral Arterial Disease

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Carsten Thilo Herz ◽  
Clemens Hoebaus ◽  
Florian Obendorf ◽  
Gerfried Pesau ◽  
Renate Koppensteiner ◽  
...  
Keyword(s):  
Peripheral Arterial Disease ◽  
Cox Regression ◽  
Smoking Status ◽  
Area Under The Curve ◽  
Arterial Disease ◽  
Major Adverse Cardiovascular Events ◽  
Operating Characteristics ◽  
Inflammatory Protein ◽  
Peripheral Arterial ◽  
Angiopoietin 2

Introduction: Angiopoietin 2 (ANG2) is a pro-inflammatory protein which is elevated in several inflammatory conditions and associated with increased morbidity and mortality. Hypothesis: ANG2 is associated with the composite of death, non-fatal myocardial infarction and non-fatal stroke (MACE) in patients with peripheral arterial disease (PAD). Methods: We measured serum ANG2 levels at baseline in 363 consecutive PAD patients with using multiplex bead array technology. Follow-up was five years. In Cox regression, confounding was evaluated by examining the relative change in coefficients (delta-beta) for ANG2 after the omission of the respective potential confounder from the fully adjusted model. Significant Confounding was defined as a delta-beta > 10%. Results: Using receiver operating characteristics, ANG2 exhibited an area under the curve of 0.6 (95%CI: 0.522 - 0.678) for the proper discrimination between MACE and non-events. A cut-off of 3.74 ng/ml resulted in the highest possible combination of specifity (57.5%) and sensitivity (63.3%) leading to an unadjusted hazard ratio (HR) of 2.17 (95%CI: 1.28 - 3.67) in Cox regression (p=0.004). Adjusting for age, sex, diabetes, systolic blood pressure, smoking status and renal function lead to a HR of 1.89 (95%CI: 1.11 - 3.24) for ANG2 >3.74 ng/ml (p=0.020). The additional adjustment for c-reactive protein (CRP) resulted in a no more significant HR of 1.68 (95%CI: 0.97 - 2.92)for high ANG2 (p=0.067). Diabetes and CRP, both significant predictors of MACE in our cohort, proved to be significant confounders with concomitant delta-betas of 19.7% and 22.9%, respectively. Conclusions: We are the first to demonstrate that elevated ANG2 levels are interrelated with MACE in patients with PAD. Inflammation and glucose hemostasis seem to influence this association.

Sign in / Sign up

Export Citation Format

Share Document