Association between the ankle&amp;ndash;brachial index, intermittent claudication, and physical activity level: what is the influence on the functional capacity of patients with or at high risk of cardiovascular disease?

Tj, Nardi Gomes; I, Martins de Albuquerque; P, de Moraes Costa; Dm, Cardoso; G, de Moraes Costa; Jl, Da Costa

doi:10.2147/ijgm.s76446

Cited by 5 publications

(1 citation statement)

References 38 publications

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“…Although reduced blood flow is a significant contributor to clinical limb manifestations as indicated by the association of low ABI with leg pain symptoms (Wang et al, 2005 ), leg blood flow and ABI appear to be no more than weakly associated with functional/exercise capacity (Pernow and Zetterquist, 1968 ; Szuba et al, 2006 ; McDermott et al, 2013 ; Nardi Gomes et al, 2015 ). Indeed, revascularization of occluded blood vessels does not fully restore the muscle functional limitations in PAD patients (Regensteiner et al, 1993a ; Gardner and Killewich, 2001 ; West et al, 2012 ), while exercise treatment improves functional capacity with negligible (Larsen and Lassen, 1966 ; Sorlie and Myhre, 1978 ) to modest increases in leg blood flow (Hiatt et al, 1990 ).…”

Section: Pathophysiology Of Limb Manifestations and Functional Impairmentioning

confidence: 99%

Mitochondrial Bioenergetics in the Metabolic Myopathy Accompanying Peripheral Artery Disease

et al. 2017

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Peripheral artery disease (PAD) is a serious but relatively underdiagnosed and undertreated clinical condition associated with a marked reduction in functional capacity and a heightened risk of morbidity and mortality. The pathophysiology of lower extremity PAD is complex, and extends beyond the atherosclerotic arterial occlusion and subsequent mismatch between oxygen demand and delivery to skeletal muscle mitochondria. In this review, we evaluate and summarize the available evidence implicating mitochondria in the metabolic myopathy that accompanies PAD. Following a short discussion of the available in vivo and in vitro methodologies to quantitate indices of muscle mitochondrial function, we review the current evidence implicating skeletal muscle mitochondrial dysfunction in the pathophysiology of PAD myopathy, while attempting to highlight questions that remain unanswered. Given the rising prevalence of PAD, the detriment in quality of life for patients, and the associated significant healthcare resource utilization, new alternate therapies that ameliorate lower limb symptoms and the functional impairment associated with PAD are needed. A clear understanding of the role of mitochondria in the pathophysiology of PAD may contribute to the development of novel therapeutic interventions.

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Section: Pathophysiology Of Limb Manifestations and Functional Impairmentioning

confidence: 99%

Mitochondrial Bioenergetics in the Metabolic Myopathy Accompanying Peripheral Artery Disease

et al. 2017

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Prediction of 6-minute walk performance in patients with peripheral artery disease

Chen

Stoner

Montgomery

et al. 2017

Journal of Vascular Surgery

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Background Peripheral artery disease (PAD) is a highly prevalent disease that impairs walking ability. Walking tests, such as the 6-minute walk test (6MWT) and 4-meter walk test, are commonly used to assess exercise endurance and ambulatory function over a short distance, respectively. The 6MWT performance is predictive of PAD severity and disease outcomes, but it is not feasible in many clinical settings because it requires a long walkway to serve as the test route and it lengthens clinic visits. As an alternative, the 4-meter walk test is convenient, inexpensive and repeatable, but it is not known if it accurately predicts endurance performance in the long-distance 6MWT. Objective To develop a statistical model to predict 6MWT gait speed given 4-meter walk test results and clinical characteristics among patients with PAD. Methods 6MWT gait speed measures were derived from 183 patients with symptomatic PAD who were evaluated at the University of Oklahoma Health Sciences Center (2004–2012). The testing procedures and research personnel remained constant throughout the duration of the study. Independent variables included demographic and clinical information, and 4-meter walk test gait speed. Five-fold cross validation and manual backward selection were used for model selection. Adjusted-R2 and corrected Akaike information criterion were applied to quantify the predictive performance of the regression models. Results A total of 183 people (mean age 65 ± standard deviation 10 years, 54% male) with moderate PAD severity (ankle/brachial index: 0.72±0.24) performed the walking tests. On average, participants covered 335 meters (m) (standard deviation=97 m) distance in the 6MWT. The 4-meter walk gait speed, ankle/brachial index (ABI) and dyspnea were independent predictors of 6MWT speed in the multivariate model(adjusted-R2 = 0.55). The model resulted in 95% prediction interval widths of 30 m for mean and 260 m for individual predicted 6MWT distance measures. Conclusions Slower 4-meter walking speed, lower ABI and presence of dyspnea all predict slower 6MWT gait speed, which corresponds to shorter 6MWT distance. Prediction of group means is reasonably precise; however, prediction of individual patient 6MWT performance is imprecise relative to between-group differences that are clinically important.

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Causal Association of Cardiovascular Risk Factors and Lifestyle Behaviors With Peripheral Artery Disease: A Mendelian Randomization Approach

Hoek

Oort

Elders

et al. 2022

JAHA

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Background We investigated the causal associations between the genetic liability to cardiovascular and lifestyle risk factors and peripheral artery disease (PAD), using a Mendelian randomization approach. Methods and Results We performed a 2‐sample inverse‐variance weighted Mendelian randomization analysis, multiple sensitivity analyses to assess pleiotropy and multivariate Mendelian randomization analyses to assess mediating/confounding factors. European‐ancestry genomic summary data ( P <5×10 −8 ) for type 2 diabetes, lipid‐fractions, smoking, alcohol and coffee consumption, physical activity, sleep, and education level were selected. Genetic associations with PAD were extracted from the Million‐Veteran‐Program genome‐wide association studies (cases=31 307, controls=211 753, 72% European‐ancestry) and the GoLEAD‐SUMMIT genome‐wide association studies (11 independent genome‐wide association studies, European‐ancestry, cases=12 086, controls=449 548). Associations were categorized as robust (Bonferroni‐significant ( P <0.00294), consistent over PAD‐cohorts/sensitivity analyses), suggestive ( P value: 0.00294–0.05, associations in 1 PAD‐cohort/inconsistent sensitivity analyses) or not present. Robust evidence for genetic liability to type 2 diabetes, smoking, insomnia, and inverse associations for higher education level with PAD were found. Suggestive evidence for the genetic liability to higher low‐density lipoprotein cholesterol, triglyceride‐levels, alcohol consumption, and inverse associations for high‐density lipoprotein cholesterol, and increased sleep duration were found. No associations were found for physical activity and coffee consumption. However, effects fully attenuated for low‐density lipoprotein cholesterol and triglycerides after correcting for apoB, and for insomnia after correcting for body mass index and lipid‐fractions. Nonsignificant attenuation by potential mediators was observed for education level and type 2 diabetes. Conclusions Detrimental effects of smoking and type 2 diabetes, but not of low‐density lipoprotein cholesterol and triglycerides, on PAD were confirmed. Lower education level and insomnia were identified as novel risk factors for PAD; however, complete mediation for insomnia and incomplete mediation for education level by downstream risk factors was observed.

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Association between the ankle–brachial index, intermittent claudication, and physical activity level: what is the influence on the functional capacity of patients with or at high risk of cardiovascular disease?

Cited by 5 publications

References 38 publications

Mitochondrial Bioenergetics in the Metabolic Myopathy Accompanying Peripheral Artery Disease

Mitochondrial Bioenergetics in the Metabolic Myopathy Accompanying Peripheral Artery Disease

Prediction of 6-minute walk performance in patients with peripheral artery disease

Causal Association of Cardiovascular Risk Factors and Lifestyle Behaviors With Peripheral Artery Disease: A Mendelian Randomization Approach

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