Digital Amputation in Systemic Sclerosis: Prevalence and Clinical Associations. A Retrospective Longitudinal Study

2012 ◽  
Vol 39 (8) ◽  
pp. 1648-1653 ◽  
Author(s):  
PAOLA CARAMASCHI ◽  
DOMENICO BIASI ◽  
CRISTIAN CAIMMI ◽  
GIOVANNI BARAUSSE ◽  
DANIA SABBAGH ◽  
...  
Keyword(s):  
Systemic Sclerosis ◽  
Peripheral Artery Disease ◽  
Disease Duration ◽  
Preventive Strategy ◽  
Digital Ulcers ◽  
Peripheral Artery ◽  
Rheumatology Unit ◽  
History Of ◽  
Artery Disease ◽  
Digital Amputation

Objective.To evaluate the prevalence of digital necrosis requiring surgical amputation in a single-center group of patients with systemic sclerosis (SSc) and to compare the characteristics of patients with and those without this severe complication.Methods.We reviewed the medical records of 188 patients with SSc [162 women, 26 men, mean age 59.2 yrs, mean disease duration 8.0 yrs, mean time from onset of Raynaud’s phenomenon (RP) 11.7 yrs, median followup duration 92 mo] enrolled in the Rheumatology Unit since 2004. Demographic and clinical features were collected, as well as the presence of the typical risk factors for atherosclerosis.Results.Nine patients (4.8%) underwent partial or total surgical digital amputation because of necrotic process; all these patients except 1 had a long history of multiple and persisting digital ulcers. All 9 patients had concomitant large-vessel involvement. Comparison of cases with and without digital amputation showed that this complication was associated with older age, long history of RP, long disease duration, presence of anticentromere antibody, and coexistence of peripheral artery disease and hypercholesterolemia.Discussion.We noted that 4.8% of patients with SSc underwent digital amputation. Our retrospective analysis suggests that peripheral artery disease is strongly associated with digital amputation. The preventive strategy for digital ulcers and amputation associated with SSc should include an extensive diagnostic and preventive investigation for peripheral atherosclerosis.

Time trends in use of cardioprotective medication in patients with peripheral artery disease between 1997 and 2016: a nationwide study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Kamil ◽  
T.S.G Sehested ◽  
K Houlind ◽  
J.F Lassen ◽  
G Gislason ◽  
...  
Keyword(s):  
Peripheral Artery Disease ◽  
Ace Inhibitors ◽  
Lifestyle Modification ◽  
Temporal Trends ◽  
Peripheral Artery ◽  
Nationwide Study ◽  
History Of ◽  
Artery Disease ◽  
First Time ◽  
Time Diagnosis

Abstract Background Peripheral artery disease (PAD) is associated with increased cardiovascular (CV) morbidity and mortality. Aggressive management of risk factors and lifestyle modification may improve outcomes for patients with PAD. The present study aims to investigate changes in use of cardioprotective medication after the incident diagnosis of PAD between 1997 and 2016. Methods By using Danish national healthcare registries, we identified all patients with first-time diagnosis of PAD between 1997 and 2016. These patients were classified into 2 main groups: PAD-all (n=167,762) that includes all PAD patients with or without a history of CVD, including myocardial infarction (MI), atrial fibrillation (AF), and stroke (n=167,761) and PAD-only (n=87,935) that comprise patients with PAD without a history of AF, MI, and stroke. We calculated temporal trends and assessed comparative use of cardioprotective medication in the first 12 months after the incident diagnosis of PAD. Results Our results showed an improved use of cardioprotective medication temporally in both groups. However, PAD-all were marginally better treated (Aspirin, 3.5% - 48.4%; Clopidogrel, 0% - 17.6%; VKA 0.9% - 7.8%; NOACs 0.0% - 10.1%; Statins, 1.9%- 58.1%; ACE-inhibitors, 1.2% - 20.6%), compared to PAD-only (Aspirin, 2.9% - 54.4%; Clopidogrel, 0% - 11.9%; VKA 0.9% - 2.4%; NOACs 0.0% - 3.4%; Statins, 1.5%- 56.9%; ACE-inhibitors, 0.9% - 17.2%), respectively. Proportion of PAD patients treated with any cardioprotective medication was greater among those with a history of MI or stroke. Whereas, PAD patients with a history of AF were substantially better treated with VKA and NOACs. Conclusion In this nationwide study, use of cardioprotective medication increased considerably with time, but there remains an underuse of guideline-recommended therapy in patients with PAD. Funding Acknowledgement Type of funding source: None

scholarly journals Family History of Peripheral Artery Disease Is Associated With Prevalence and Severity of Peripheral Artery Disease

2011 ◽  
Vol 58 (13) ◽  
pp. 1386-1392 ◽  
Author(s):  
Christina L. Wassel ◽  
Rohit Loomba ◽  
Joachim H. Ix ◽  
Matthew A. Allison ◽  
Julie O. Denenberg ◽  
...  
Keyword(s):  
Family History ◽  
Peripheral Artery Disease ◽  
Peripheral Artery ◽  
History Of ◽  
Artery Disease

Peripheral artery disease in outpatients with a recent history of acute coronary syndrome or at high atherothrombotic risk

Vascular ◽  
2020 ◽  
pp. 170853812093892 ◽  
Author(s):  
Carlos Cantú-Brito ◽  
Erwin Chiquete ◽  
Javier F Antezana-Castro ◽  
Liz Toapanta-Yanchapaxi ◽  
Ana Ochoa-Guzmán ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Peripheral Artery Disease ◽  
Case Fatality ◽  
Coronary Risk ◽  
Vascular Risk ◽  
Peripheral Artery ◽  
Coronary Syndrome ◽  
History Of ◽  
Artery Disease

Objectives The frequency and implications of peripheral artery disease (PAD) in some risk groups are not entirely characterized in Latin America. We studied PAD prevalence, risk factors, and six-month outcomes in stable outpatients with a history of a recent acute coronary syndrome (ACS), or at high coronary risk. Methods We recruited 830 outpatients in 43 Mexican sites (median age: 64.8 years; 57.8% men). Inclusion criteria were age >18 years, and ACS within 30 days, or age <55 years plus ≥2 major vascular risk factors, or age ≥55 years plus ≥1 vascular risk factors. Patients received standardized assessments at baseline and six-month follow-up for medical history, ankle-brachial index (ABI), and the Edinburgh Claudication Questionnaire (ECQ). Results ABI <0.8 was found in 10.5%, <0.9 in 22.5%, >1.3 in 4.8%, and >1.4 in 3.6%, without differences according to sex or selection criteria. Positive ECQ was found in 7.6%. ABI <0.9 was directly associated with age, diabetes, ACS, and chronic kidney disease, but inversely associated with BMI >27. The six-month case-fatality and atherothrombotic events rates were 1.6% and 3.6%, respectively. In patients with ABI <0.9 and ABI <0.8, the six-month case-fatality rates were 2.5% ( p =  0.27) and 5.4% ( p =  0.03), respectively. In a Cox proportional-hazards model, baseline factors associated with death were age ≥65, ABI <0.8, and ACS. Conclusions Subclinical PAD is more common than symptomatic claudication in high-risk coronary outpatients. Low ABI is associated with reduced short-term survival in patients with recent ACS or at high coronary risk.

scholarly journals Association of sleep apnea with outcomes in peripheral artery disease: Insights from the PORTRAIT study

PLoS ONE ◽  
2021 ◽  
Vol 16 (9) ◽  
pp. e0256933
Author(s):  
Qurat-ul-ain Jelani ◽  
Carlos Mena-Hurtado ◽  
Kensey Gosch ◽  
Moghniuddin Mohammed ◽  
Clementine Labrosciano ◽  
...  
Keyword(s):  
Health Status ◽  
Sleep Apnea ◽  
Peripheral Artery Disease ◽  
Rank Test ◽  
Peripheral Artery ◽  
Clinical Trial Registration ◽  
The Us ◽  
History Of ◽  
Artery Disease

Background Sleep apnea is a predictor of adverse cardiovascular outcome in many cardiovascular diseases but whether it is associated with worse health status outcomes or mortality in peripheral artery disease (PAD) is unknown. Methods PORTRAIT is an international (US, Netherlands, Australia) prospective PAD registry that consecutively enrolled patients who presented with new-onset or recent exacerbations of PAD symptoms to any of 16 vascular specialty clinics. Health status was assessed upon presentation and at 12 months with the disease-specific Peripheral Artery Questionnaire (PAQ). Higher PAQ scores indicate better health status. A sequentially-adjusted hierarchical linear regression model examined the association between sleep apnea and 1-year PAQ symptoms, quality of life, and summary scores. Five-year survival curves by comorbid sleep apnea status for US patients were compared using the log-rank test. Results The mean age of the 1204 PORTRAIT participants was 67.6 ± 9.4 years with 37.5% women and 8.3% (n = 100) having sleep apnea. Patients with sleep apnea were more likely to be from the US, more sedentary, and to have diabetes, obesity, coronary disease, more depressive symptoms and a history of prior peripheral interventions. Paradoxically, they also had higher ankle-brachial indices, but lower PAQ Summary scores at presentation and 12 months (41.2 ± 22.0 vs. 49. 9± 21.6 and 58.6 ± 27.9 vs. 71.3 ± 24.9, respectively, p = <0.05). The association between sleep apnea and 1-year health status persisted after multivariable adjustment, but there were no differences in all-cause mortality over 5 years (28.0% vs. 23.4%, p = 0.76). Conclusion In patients presenting with PAD, comorbid sleep apnea is independently associated with worse health status over time. Future studies should test whether better treatment of sleep apnea can improve the health status of patients with PAD. Clinical trial registration NCT01419080

scholarly journals Vorapaxar in the treatment of cardiovascular diseases

2020 ◽  
Vol 16 (5) ◽  
pp. 373-384
Author(s):  
Udaya S Tantry ◽  
Kevin P Bliden ◽  
Rahul Chaudhary ◽  
Marko Novakovic ◽  
Amit Rout ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Peripheral Artery Disease ◽  
Coronary Revascularization ◽  
Bleeding Risk ◽  
Cardiovascular Death ◽  
Severe Bleeding ◽  
Peripheral Artery ◽  
Primary Hemostasis ◽  
History Of ◽  
Artery Disease

Vorapaxar specifically and effectively inhibits protease activated receptor-1 and may reduce thrombin-mediated ischemic events without interfering primary hemostasis. In the TRA-2P-TIMI 50 trial, vorapaxar reduced the risk of primary ischemic outcome but with increased bleeding risk. In the post hoc analysis, in patients with a history of myocardial infarction, peripheral artery disease, the net clinical outcome favored vorapaxar therapy with 10% reduction in cardiovascular death, myocardial infarction, stroke, urgent coronary revascularization and moderate or severe bleeding. Based on these favorable results, vorapaxar was approved for the reduction of thrombotic cardiovascular events in patients with prior myocardial infarction or with peripheral artery disease on top of standard antiplatelet therapy. A careful patient selection is needed to balance efficacy versus safety.

P652Lower use of statins among patients with peripheral artery disease compared with those with coronary heart disease

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L D Colantonio ◽  
Y Dai ◽  
D Hubbard ◽  
R S Rosenson ◽  
T M Brown ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Peripheral Artery Disease ◽  
High Intensity ◽  
Prevalence Ratio ◽  
Peripheral Artery ◽  
History Of ◽  
Artery Disease ◽  
Multivariable Adjustment ◽  
Statin Use

Abstract Background Adults with atherosclerotic cardiovascular disease are recommended to take a statin to reduce their risk for future cardiovascular events. Prior studies suggest that statins are being taken by most adults with coronary heart disease (CHD). However, there are few data on the use of statins among adults with peripheral artery disease (PAD). Purpose To compare the use of statins among US adults with a history of PAD versus those with a history of CHD. Methods We conducted a retrospective cohort study among US adults ≥19 years of age with commercial or government health insurance who had a history of CHD or PAD as of December 31, 2014 (n=1,006,451, mean age 63 years, 47% male). We used pharmacy claims between January 1 and December 31, 2014 to identify use of any statin and of a high-intensity statin (i.e., atorvastatin 40–80 mg, rosuvastatin 20–40 mg, simvastatin 80 mg). Patients with a history of CHD without PAD (CHD only), both CHD and PAD, and PAD without CHD (PAD only) were analysed. Prevalence ratios for use of any statin and a high-intensity statin among those taking a statin were calculated after multivariable adjustment for sociodemographics and cardiovascular risk factors. Results Overall, 69.1% of patients included in the current analysis had CHD only, 21.4% had both CHD and PAD, and 9.5% had PAD only. Overall, 66.0%, 68.2% and 47.5% of patients with CHD only, CHD and PAD, and PAD only were taking a statin. After multivariable adjustment and compared to patients with CHD only, the prevalence ratio for statin use was 1.02 (95% CI 1.01, 1.02) for those with both CHD and PAD and 0.82 (95% CI 0.82, 0.83) for those with PAD only. Among patients taking a statin, 29.4% of those with CHD only, 28.6% of those with both CHD and PAD, and 17.3% of those with PAD only were taking a high-intensity dosage. Compared to patients with CHD only, the multivariable adjusted prevalence ratio for taking a high-intensity dosage was 1.05 (95% CI 1.04, 1.06) for those with both CHD and PAD and 0.71 (95% CI 0.70, 0.73) for those with PAD only. Conclusion Adults with PAD receive less intensive statin therapy compared with their counterparts who have CHD. Interventions aimed to increase statin use among patients with PAD are warranted. Acknowledgement/Funding This study was supported through a research grant from Amgen, Inc. (Thousand Oaks, CA, USA).

scholarly journals A 72-year-old man with intermittent fever, anemia and a history of coronary and peripheral artery disease

2010 ◽  
Vol 5 (5) ◽  
pp. 415-420
Author(s):  
Stefano Del Pace ◽  
Andrea Savino ◽  
Raffaele Rasoini ◽  
Camilla Alderighi ◽  
Manlio Acquafresca ◽  
...  
Keyword(s):  
Peripheral Artery Disease ◽  
Peripheral Artery ◽  
Intermittent Fever ◽  
History Of ◽  
Artery Disease

scholarly journals Association of Hypertension and Arterial Blood Pressure on Limb and Cardiovascular Outcomes in Symptomatic Peripheral Artery Disease

2020 ◽  
Vol 13 (9) ◽  
Author(s):  
Marat Fudim ◽  
Charles W. Hopley ◽  
Zhen Huang ◽  
Sarah Kavanagh ◽  
Frank W. Rockhold ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Lower Extremity ◽  
Peripheral Artery Disease ◽  
Hazard Ratio ◽  
Peripheral Artery ◽  
Increased Risk ◽  
History Of ◽  
Artery Disease ◽  
Lower Extremity Revascularization

Background: Current guidelines recommend aggressive management of hypertension. Recent evidence suggested potential harm with low blood pressure targets in patients with peripheral artery disease. We investigated the association of a history of hypertension and office systolic blood pressure (SBP) with major adverse cardiovascular events (MACEs) and major adverse limb events (MALEs). Methods and Results: The EUCLID trial (Examining the Use of Ticagrelor in Peripheral Artery Disease) included 13 885 participants with symptomatic peripheral artery disease; median follow-up was 30 months. Cox proportional hazards regression was used to calculate hazard ratios (HRs) for any MACE, MALE, and MALE including lower extremity revascularization. A clinical history of arterial hypertension was present in 10 857 (78%) participants, and these participants were older and more likely to be female when compared with the 3026 (22%) patients without hypertension. In patients with a history of hypertension, the adjusted hazard ratio for MACE was 0.94, 95% CI, 0.82–1.08; P =0.39, and the adjusted hazard ratio for MALE was 1.08, 95% CI, 0.96–1.23; P =0.21. During follow-up, average SBP was 135 mm Hg (125–145). Every 10 mmHg increase in SBP>125 mmHg was associated with an increased risk of MACE (HR, 1.10 [95% CI, 1.06–1.14]; P <0.001), a marginally increased risk of MALE (HR, 1.07 [95% CI, 1.00–1.15]; P =0.062), and an increased risk of MALE/lower extremity revascularization (HR, 1.08 [95% CI, 1.04–1.11]; P <0.001). Every decrease in 10 mmHg SBP ≤125 mmHg was associated with an increased risk of MACE (HR, 1.19 [95% CI, 1.09–1.31]; P <0.001) but not MALE or MALE/lower extremity revascularization (HR, 1.02 [95% CI, 0.84–1.23], P =0.824; HR, 1.04 [95% CI, 0.95–1.13], P =0.392, respectively). Conclusions: History of hypertension was not associated with higher hazard for MACE or MALE in patients with peripheral artery disease. In contrast, there was a higher hazard of MACE in patients with out-of-target low and high SBP. High but not low SBP was associated with an increased risk of ischemic limb events. Registration: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT01732822.

scholarly journals Effect of cilostazol on platelet reactivity among patients with peripheral artery disease on clopidogrel therapy

2018 ◽  
Vol 33 (1) ◽  
pp. 49-55 ◽  
Author(s):  
Dagmar F. Hernandez-Suarez ◽  
Hector Núñez-Medina ◽  
Stuart A. Scott ◽  
Angel Lopez-Candales ◽  
Jose M. Wiley ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Puerto Rican ◽  
Peripheral Artery Disease ◽  
Ex Vivo ◽  
Platelet Reactivity ◽  
Quantitative Polymerase Chain Reaction ◽  
Peripheral Artery ◽  
History Of ◽  
Clopidogrel Therapy ◽  
Artery Disease

AbstractBackground:Antiplatelet therapy with clopidogrel is recommended to reduce cardiovascular events in patients with peripheral artery disease (PAD); however, clopidogrel efficacy has not been adequately studied in this patient population. Therefore, we aimed to determine the effects of cilostazol therapy on platelet reactivity among PAD patients on clopidogrel.Methods:We performed a cross-sectional pilot study of 46 Puerto Rican patients diagnosed with PAD. The cohort was divided based on use of clopidogrel and cilostazol (n=24) or clopidogrel alone (n=22). Platelet function was measuredex vivousing the VerifyNow P2Y12 assay. Genomic DNA was extracted from peripheral blood samples using the QIAamp DNA Blood Midi Kit, which was subjected to candidate variant genotyping (CYP2C19,ABCB1,PON1andP2RY12) using TaqMan quantitative polymerase chain reaction assays. All analyses were performed using SAS version 9.4 (SAS Institute).Results:Among all enrolled patients, 18 (39%) had high on-treatment platelet reactivity (HTPR). The mean platelet reactivity was 207±53 (range, 78–325) with higher P2Y12 reaction units in the non-cilostazol group, 224±45 vs. 191±55 on the cilostazol group (p=0.03). No significant differences were observed in the clinical or genetic variables between the two groups. A multiple regression analysis determined that history of diabetes mellitus (p=0.03), use of cilostazol (p=0.03) and hematocrit (p=0.02) were independent predictors of platelet reactivity.Conclusions:In Puerto Rican PAD patients on clopidogrel therapy, history of diabetes mellitus, use of cilostazol and hematocrit are independent predictors of platelet reactivity. Adjunctive cilostazol therapy may enhance clopidogrel efficacy among PAD patients with HTPR.

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