Impact of risk factors on serum levels of vasoactive substances in patients with peripheral arterial occlusive disease at different Fontaine’s stages

BACKGROUND: Mortality from cardiovascular disease has declined among men and increased among North American women. Recent studies have revealed differences between genders in the epidemiology of atherosclerotic disease. OBJECTIVE: To study possible differences between male and female patients with critical limb ischemia (CLI) according to risk factors of atherosclerosis and clinical characteristics of lower limbs with peripheral arterial occlusive disease (PAOD). METHODS: The study included 171 male and female patients treated for CLI due to infrainguinal PAOD and compared clinical characteristics (Rutherford category and PAOD territory), risk factors for atherosclerosis (diabetes, age, smoking and hypertension) and number of opacified arteries on digital angiograms of the leg. The EPI-INFO software was used for statistical analysis, and the level of significance was set at p<0.05. RESULTS: Mean age was 70 years, and 88 patients were men (52%). For most patients (both genders), Rutherford category was 5 (82 % of men and 70% of women; p=0.16). The group of women had higher mean age (73 vs. 67 years; p=0.0002) and greater prevalence of diabetes (66% vs. 45%; p=0.003) and hypertension (90% vs. 56%; p=0.0000001). Among men, the prevalence of smoking was higher (76% vs. 53%; p=0.0008). The analysis of digital angiograms revealed that opacification of only one artery in the leg was found for 74% of women (vs. 50% of men). CONCLUSION: The prevalence of risk factors for atherosclerosis and the characteristics of PAOD are different between male and female patients with CLI.

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Retrospective Cohort Analysis of Peripheral Arterial Occlusive Disease (PAOD) Events in Patients (pts) with Chronic Myeloid Leukemia in Chronic Phase (CML-CP)

Blood ◽

10.1182/blood.v118.21.2757.2757 ◽

2011 ◽

Vol 118 (21) ◽

pp. 2757-2757 ◽

Cited By ~ 4

Author(s):

Francis J. Giles ◽

Michael J. Mauro ◽

Frank Hong ◽

Christine-Elke Ortmann ◽

Richard C. Woodman ◽

...

Keyword(s):

Risk Factors ◽

Peripheral Arterial Occlusive Disease ◽

Research Funding ◽

Retrospective Cohort ◽

Cohort Analysis ◽

Arterial Occlusive Disease ◽

Occlusive Disease ◽

Arterial Stenosis ◽

Retrospective Cohort Analysis ◽

Peripheral Arterial

Abstract Abstract 2757 Background: Recently there have been reports of PAOD events in pts with CML-CP treated with tyrosine kinase inhibitors (TKI). Although asymptomatic PAOD is common, occurring in 12–20% of adults (55–70 years of age), the incidence of PAOD in pts with CML is unknown. Risk factors for PAOD include hypercholesterolemia, hypertension, diabetes, smoking, and vascular disease. It remains to be determined if PAOD may be related to CML and/or TKIs. These considerations are important as atherosclerotic disease has been observed with other pt populations (HIV and hemophilia) with improved survival similar to CML due to effective treatments. To investigate the association of PAOD in CML pts a retrospective cohort analysis was conducted with the objective of comparing TKI treated pts to a comparator arm of no TKI therapy. Methods: This analysis was based on a database of pooled randomized, multi-center, clinical trial data from ENESTnd, TOPS, and IRIS in pts with newly-diagnosed CML-CP. From this database (n = 2393), 3 cohorts of pts were generated: Cohort 1–No TKI exposure (IFN+Ara-C only, n = 533), Cohort 2–Nilotinib only (300 and 400 mg BID, n = 556) and Cohort 3–Imatinib only (400 mg QD or BID, n = 1304). Exclusion criteria for cardiovascular disease varied across cohorts and pts with risk factors for PAOD were not excluded in any cohorts. The case definition for PAOD included atherosclerotic and thrombotic events, excluding the functional (vasoreactive), embolic, or aneurysmal disorders, in the arteries of lower and upper extremities according to ACC/AHA guidelines. Events indicative of PAOD were represented by a group of broad terms including: arterial disorder, arteriosclerosis, peripheral ischaemia, arterial insufficiency, arteriosclerosis obliterans, peripheral vascular disorder, arterial occlusive disease, femoral arterial stenosis, arterial stenosis, femoral artery occlusion, peripheral artery angioplasty, arterial stenosis limb, intermittent claudication, peripheral revascularization, arterial thrombosis limb, peripheral arterial occlusive disease, and poor peripheral circulation. The cumulative incidence of PAOD cases reported represents the crude rate without accounting for duration of exposure; exposure adjusted incidence rate was also provided since the duration of therapy differed substantially among cohorts. Relative risks (RR) with 95% confidence intervals (CI) are presented for Cohorts 2 (nilotinib only) and 3 (imatinib only) compared with Cohort 1 (no TKIs). Results: As shown in the table, when using Cohort 1 (no TKIs) as the control for TKI therapies the RR for Cohort 2 (nilotinib only) was 1.9 (95% CI 0.5, 7.6) and the RR for Cohort 3 (imatinib only) was 0.8 (95% CI 0.2, 3.3). When accounting for exposure using pt-years, the exposure adjusted RR was 1.0 (95% CI 0.2, 4.0) for Cohort 2 (nilotinib only), and 0.2 (95% CI 0.1, 1.0) for Cohort 3 (imatinib only). The CIs for these RRs overlap 1.0 suggesting no significant increased risk. Conclusions: Based on the large cohort of pts in this analysis, the results demonstrate a low incidence of PAOD cases for pts on either nilotinib or imatinib. In comparison with the no-TKI control, the risk and causality of PAOD due to nilotinib or imatinib could not be established with current available data. However, caution should be exercised when interpreting retrospective comparisons and further investigation is required to better understand whether PAOD events are increased in CML pts treated with TKIs. Disclosures: Giles: Novartis: Consultancy, Honoraria, Research Funding. Mauro:Novartis: Research Funding; Bristol Myers Squibb: Research Funding; Ariad: Research Funding. Hong:Novartis: Employment. Ortmann:Novartis: Employment. Woodman:Novartis: Employment, Equity Ownership. LeCoutre:Bristol Myers Squibb: Honoraria; Novartis: Honoraria, Research Funding, Speakers Bureau. Saglio:Bristol Myers Squipp: Consultancy, Speakers Bureau; Novartis Pharmaceutical: Consultancy, Speakers Bureau; Pfizer: Consultancy.

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Biomarkers of inflammation may be of use for identification of more severe peripheral arterial occlusive disease

Jornal Vascular Brasileiro ◽

10.1590/jvb.2014.045 ◽

2014 ◽

Vol 13 (3) ◽

pp. 182-191 ◽

Cited By ~ 1

Author(s):

Luciana Garofolo ◽

Sandra Roberta Gouvea Ferreira ◽

Fausto Miranda Junior

Keyword(s):

Risk Factors ◽

Peripheral Arterial Occlusive Disease ◽

Severe Disease ◽

Ankle Brachial Index ◽

Correlation Coefficients ◽

Population Based ◽

Arterial Occlusive Disease ◽

Occlusive Disease ◽

Mean Values ◽

Peripheral Arterial

Background:Atherosclerosis is a multifactorial disease with an inflammatory pathophysiological basis. Cytokines released during the atherosclerotic process induce production of C-reactive protein (CRP) in the liver, which is an important marker of inflammation.Objective:We tested whether inflammatory biomarkers were associated with deterioration of peripheral arterial occlusive disease (PAOD) in a population at high cardiovascular risk.Methods:1,330 subjects ≥30 years of age underwent clinical and laboratory examinations as part of a population-based study of the prevalence of diabetes. PAOD was defined as an ankle-brachial index (ABI) ≤0.90. After application of exclusion criteria, the sample comprised 1,038 subjects. Traditional risk factors, CRP and interleukin 6 (IL-6) were also compared across three ABI categories (≤0.70; 0.71-0.90; ≥0.90). Mean values for these variables were compared by presence/absence of DAOP (Student's t test) and by ABI categories (ANOVA). Poisson regression and logistic regression models were used to test for associations between risk factors and DAOP and between risk factors and the ABI categories. Pearson's linear correlation coefficients were calculated for the relationship between CRP and IL-6 levels.Results:Mean age was 56.8±12.9 years, 54% of the sample were women and the prevalence of DAOP was 21.0% (95%CI 18.4-24.1). Individuals with ABI ≤0.70 had higher concentrations of CRP-us (2.1 vs. 1.8) and of IL-6 (1.25 vs. 1.17). Concentrations of CRP and IL-6 were only correlated in patients with DAOP, (p=0.004).Conclusions:The finding that CRP and IL-6 levels were only elevated among people with advanced DAOP may suggest that these biomarkers have a role to play as indicators of more severe disease. Prospective studies are needed to test this hypothesis.

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