Association of obesity and metabolic syndrome with the severity and outcome of intermittent claudication

Golledge, Jonathan; Leicht, Anthony S.; Crowther, Robert G.; Clancy, Paula; Spinks, Warwick L.; Quigley, Frank

doi:10.1016/j.jvs.2006.09.006

Cited by 81 publications

(96 citation statements)

References 35 publications

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“…It is well established that obesity is a risk factor for the development of PAD [26]. However, the incidences of obesity did not differ between the subjects with and without PAD in the current study.…”

Section: Discussioncontrasting

confidence: 74%

Potential role for organochlorine pesticides in the prevalence of peripheral arterial diseases in obese persons: Results from the National Health and Nutrition Examination Survey 1999–2004

et al. 2011

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Section: Discussioncontrasting

confidence: 74%

Potential role for organochlorine pesticides in the prevalence of peripheral arterial diseases in obese persons: Results from the National Health and Nutrition Examination Survey 1999–2004

et al. 2011

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“…37 Previous studies Very little is known about the relationship between obesity and cardiovascular risk in PAD, and no study has compared the effect of different anthropometric measures on outcome. In 61 patients with intermittent claudication, Golledge et al 21 found that the incidence of cardiovascular events at 24 months was higher in patients with central obesity defined using the International Diabetes Federation criteria than in patients without this diagnosis (42.8 ± 9.1 vs 11.2±6.1%). Probably due to the small number of patients and events, the authors did not report the statistical significance of their findings.…”

Section: Discussionmentioning

confidence: 99%

“…[13][14][15] Obesity, which is associated with inflammation and metabolic syndrome, 16,17 conditions portending a worse outcome in PAD, [18][19][20][21] may be particularly detrimental for cardiovascular risk in affected individuals. Nevertheless, very few studies have investigated the relationship between obesity and occurrence of cardiovascular events in PAD; moreover, with conflicting results.…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, very few studies have investigated the relationship between obesity and occurrence of cardiovascular events in PAD; moreover, with conflicting results. [21][22][23][24] This prompted us to conduct a prospective study aimed at evaluating the prognostic impact of obesity in a homogeneous cohort of PAD patients. Furthermore, as no study of obesity in PAD investigated the joint and independent effects of general and abdominal obesity, the secondary aim of our study was to compare the predictive value of BMI (an index of general obesity) and WC (an index of abdominal obesity).…”

Section: Introductionmentioning

confidence: 99%

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The prognostic impact of general and abdominal obesity in peripheral arterial disease

et al. 2009

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Objective: Obesity is an independent cardiovascular risk factor, but its prognostic role in patients with peripheral arterial disease (PAD) is not well defined. Accordingly, we assessed the impact of body mass index (BMI) and waist circumference (WC) on cardiovascular risk in a homogeneous cohort of PAD patients. Methods: BMI and WC were measured in 190 consecutive PAD patients with ABI o0.90, referred to our university hospital for intermittent claudication. The occurrence of cardiac, cerebrovascular and peripheral events was prospectively assessed. The ability to classify risk was determined by calculating the hazard ratios (HRs) and c-statistics. Results: During a median follow-up of 31.5 months, 63 patients (33.2%) had a cardiovascular event. Considered as continuous variables, both adiposity indices were significantly associated with increased cardiovascular risk, even after adjustment for possible confounding factors (HR ¼ 1.08, 95% CI 1.01-1.15, P ¼ 0.045 for BMI and HR ¼ 1.04, 95% CI 1.01-1.07, P ¼ 0.004 for WC). When BMI and WC were included together in a fully adjusted Cox model, the significant association between BMI and cardiovascular risk disappeared (HR ¼ 0.98, 95% CI 0.88-1.10, P ¼ 0.772), whereas WC remained significantly associated with a worse outcome (HR ¼ 1.04, 95% CI 1.01-1.08, P ¼ 0.033). The better discriminative ability of WC vs BMI was confirmed by the c-statistic, which was significantly higher for WC (0.63, 95% CI 0.56-0.70) than for BMI (0.56, 95% CI 0.51-0.63, P ¼ 0.038). Conclusions: Abdominal obesity and, to a lesser degree, general obesity worsen the prognosis of PAD patients independently of possible confounding factors. Weight reduction should be integrated in the active management of these patients.

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“…A prospective study showed that high plasma adiponectin levels were associated with a lower risk of myocardial infarction in healthy men, independent of CRP level or glycemic status [49]. In addition, in patients with peripheral arterial disease, serum adiponectin was positively correlated with the ankle-brachial pressure index, maximum walking distance, and initial claudication distance [50], and in another study, serum levels were negatively correlated with the Fontaine stage [51].…”

Section: The Role Of Adiponectin In Metabolic Syndrome and Cardiometamentioning

confidence: 97%

The role of leptin/adiponectin ratio in metabolic syndrome and diabetes

López‐Jaramillo¹,

Gómez-Arbeláez²,

López‐López

et al. 2013

Hormone Molecular Biology and Clinical Investigation

346

299

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Abstract:The metabolic syndrome comprises a cluster of cardiometabolic risk factors, with insulin resistance and adiposity as its central features. Identifying individuals with metabolic syndrome is important due to its association with an increased risk of coronary heart disease and type 2 diabetes mellitus. Attention has focused on the visceral adipose tissue production of cytokines (adipokines) in metabolic syndrome and type 2 diabetes mellitus, as the levels of the anti-inflammatory adipokine adiponectin are decreased, while proinflammatory cytokines are elevated, creating a proinflammatory state associated with insulin resistance and endothelial dysfunction. In this review, we will give special attention to the role of the leptin/adiponectin ratio. We have previously demonstrated that in individuals with severe coronary artery disease, abdominal obesity was uniquely related to decreased plasma concentrations of adiponectin and increased leptin levels. Leptin/adiponectin imbalance was associated with increased waist circumference and a decreased vascular response to acetylcholine and increased vasoconstriction due to angiotensin II. Leptin and adiponectin have opposite effects on subclinical inflammation and insulin resistance. Leptin upregulates proinflammatory cytokines such as tumor necrosis factor-α and interleukin-6; these are associated with insulin resistance and type 2 diabetes mellitus. In contrast, adiponectin has anti-inflammatory properties and downregulates the expression and release of a number of proinflammatory immune mediators. Therefore, it appears that interactions between angiotensin II and leptin/adiponectin imbalance may be important mediators of the elevated risk of developing type 2 diabetes mellitus and cardiovascular diseases associated with abdominal obesity.

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Association of obesity and metabolic syndrome with the severity and outcome of intermittent claudication

Abstract: These findings, if confirmed in other cohorts, suggest the importance of treating obesity in patients with intermittent claudication. Serum adiponectin concentrations may be an important guide to the efficacy of treatment in patients with intermittent claudication and obesity.

Cited by 81 publications

References 35 publications

Potential role for organochlorine pesticides in the prevalence of peripheral arterial diseases in obese persons: Results from the National Health and Nutrition Examination Survey 1999–2004

Potential role for organochlorine pesticides in the prevalence of peripheral arterial diseases in obese persons: Results from the National Health and Nutrition Examination Survey 1999–2004

The prognostic impact of general and abdominal obesity in peripheral arterial disease

The role of leptin/adiponectin ratio in metabolic syndrome and diabetes

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