Classification, epidemiology, risk factors, and natural history of peripheral arterial disease

Novo, Salvatore

doi:10.1046/j.1463-1326.2002.0040s20s1.x

Cited by 78 publications

(57 citation statements)

References 7 publications

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“…Because only a small percentage of these individuals are symptomatic, PAD is poorly recognized in primary care practice (1,3,5,6). This is disconcerting bec a u s e b o t h a s y m p t o m a t i c a n d symptomatic PAD contribute to increased mortality, and both have been associated with increased cardiovascular events, gangrene, revascularization, and amputation, leading to considerable disability and use of health care resources (6 -10).…”

Section: Diabetes Care 27:2843-2849 2004mentioning

confidence: 99%

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Peripheral Arterial Disease, Diabetes, and Mortality

et al. 2004

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OBJECTIVE -The aims of this study were to provide estimates of 1) the risk of mortality for individuals with both diabetes and peripheral arterial disease (PAD) relative to that for individuals with either condition alone and 2) the association between PAD progression and mortality for individuals with diabetes, PAD, and both conditions. RESEARCH DESIGN AND METHODS -This longitudinal cohort study was conducted in Rochester, Minnesota. Local residents age 50 -70 years with a prior diagnosis of PAD and/or diabetes were identified from the Mayo Clinic diagnostic registry and invited to a baseline examination (1977)(1978). Those who met inclusion criteria were assessed for PAD progression at 2 and 4 years and followed for vital status through 31 December 1999.RESULTS -The numbers who met criteria for PAD, diabetes, and both conditions at baseline were 149, 238, and 186, respectively. Within each group, observed survival was less than expected (P Ͻ 0.001). The adjusted risk of death for both conditions was 2.2 times that for PAD alone. Among the 449 who returned at 4 years, the risk of subsequent death was greater for those whose PAD had progressed; among individuals with diabetes alone at baseline, 100% (17 of 17) who met criteria for PAD progression were dead by 31 December 1999 compared with 62% (111 of 178) of those who had not met criteria (adjusted relative hazard 2.29 [95% CI 1.30 -4.02], P ϭ 0.004). The increased mortality associated with PAD progression was significant only for individuals with diabetes (alone or with PAD).CONCLUSIONS -Diabetes is a risk factor for both PAD and PAD-associated mortality, emphasizing the critical need to detect and monitor PAD in diabetic patients. Diabetes Care 27:2843-2849, 2004U p to 20% of elderly individuals have peripheral arterial disease (PAD) upon noninvasive testing (1-4). Because only a small percentage of these individuals are symptomatic, PAD is poorly recognized in primary care practice (1,3,5,6). This is disconcerting bec a u s e b o t h a s y m p t o m a t i c a n d symptomatic PAD contribute to increased mortality, and both have been associated with increased cardiovascular events, gangrene, revascularization, and amputation, leading to considerable disability and use of health care resources (6 -10). As a consequence, numerous studies have attempted to assist physicians in identifying individuals at greatest risk of developing PAD. Such studies consistently identify diabetes as a key risk factor (1,2,4,11-15). The extent to which diabetes contributes to progression to disability and/or premature mortality in individuals with PAD, however, is less clear. A study from our institution prospectively determined the presence of diabetes and PAD in a cohort of individuals at baseline (i.e., 1977-1978) and again 4 years later (16 -21). The study confirmed that individuals with diabetes were at significantly increased risk of developing PAD (21). However, among individuals who met criteria for PAD at baseline, the likelihood of progression at 4 years, measured as rat...

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Section: Diabetes Care 27:2843-2849 2004mentioning

confidence: 99%

“…p to 20% of elderly individuals have peripheral arterial disease (PAD) upon noninvasive testing (1)(2)(3)(4). Because only a small percentage of these individuals are symptomatic, PAD is poorly recognized in primary care practice (1,3,5,6).…”

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confidence: 99%

Peripheral Arterial Disease, Diabetes, and Mortality

et al. 2004

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“…1,2 Up to 20% of elderly individuals have PAD upon noninvasive testing. [3][4][5][6] As only a small percentage of these individuals are symptomatic, PAD is poorly recognized in primary care practice. 7,8 Several cohort studies have shown that a low ankle-brachial index (ABI) is a risk factor of fatal and nonfatal coronary heart disease and all-cause mortality among people with and without existing clinical coronary artery disease, and among people with existing peripheral vascular disease.…”

Section: Introductionmentioning

confidence: 99%

Risk factors of peripheral arterial disease and relationship between low ankle brachial index and mortality from all-cause and cardiovascular disease in Chinese patients with hypertension

Luo

Zheng

et al. 2007

J Hum Hypertens

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The aim of this study was to evaluate the risk factors of peripheral arterial disease (PAD) and the relationship between ankle brachial index (ABI) and mortality from all-cause and cardiovascular disease (CVD) in Chinese patients with hypertension. The ABI cohort Study was designed to investigate risk factors of PAD and the relationship between ABI and mortality from all-cause and CVD in Chinese patients. ABI was identified at baseline by measuring systolic pressure at bilateral brachial and tibial arteries. Mortality surveillance was completed from November 2005 to January 2006. Among 3047 participants with hypertension at baseline, 839 (27.5%) were in the low-ABI group. Older age, female gender, higher serum level of triglycerides, lower serum level of high-density lipoprotein, a history of diabetes and a history of smoking were associated with low ABI. During the 13-month follow-up, there were 252 deaths, of which 100 died of CVD. Low ABI was associated with mortality from all-cause and CVD, whose adjusted relative risk was 1.619 (95% confidence interval 1.190-2.203) and 2.454 (1.531-3.933), respectively, in Cox regression models. The survival rate was significantly lower in the low-ABI group than in the normal-ABI group. This study demonstrated that low ABI was independently associated with a high risk of all-cause and CVD mortality in Chinese patients with hypertension. ABI should be promoted as an ideal tool to predict mortality in diabetic patients.

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“…18 As regards patients with DM (41% of PAD patients have DM 19 ), patients with renal failure and, more generally, patients with arterial calcification and incompressible arteries, the efficiency of ABPI seems to be limited. 20,21 Again, low sensitivity was observed in its detection of mild PAD 22 and in the prediction of future cardiovascular outcomes, together with high specificity.…”

Section: 17mentioning

confidence: 99%

“…First, the capacity of ABPI <0.90 regarding the diagnosis of PAD in detecting >50% stenosis is high in terms of specificity and accuracy but low in terms of sensitivity with regard to the elderly and patients with diabetes mellitus (DM). 18 As regards patients with DM (41% of PAD patients have DM 19 ), patients with renal failure and, more generally, patients with arterial calcification and incompressible arteries, the efficiency of ABPI seems to be limited. 20,21 Again, low sensitivity was observed in its detection of mild PAD 22 and in the prediction of future cardiovascular outcomes, together with high specificity.…”

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confidence: 99%

Ankle Brachial Pressure Index

2013

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Emler and colleagues, 1 in this issue of Angiology, assess the usefulness of infrared photosensors to determine ankle-brachial pressure index (ABPI) and to detect peripheral arterial disease (PAD). The importance of obtaining simple, reliable and nonoperator-dependent measurements and the possible use of technology-infrared light in particular-for the study of PAD are key points of the study. Ankle-Brachial Pressure Index: From Local Vascular Index to Prognostic Cardiovascular MarkerThe ABPI test is a noninvasive tool for the diagnosis of PAD; it is obtained by comparing the systolic blood pressure (SBP) of the posterior tibial and dorsalis pedis arteries of each leg with the higher brachial pressure of either arm.2 The success of this measurement derives from its easy execution, limited instrumentation needs, low cost, and early diagnosis of PAD.Ankle-brachial pressure index represents the primary noninvasive screening test for PAD.2 The ABPI also allows monitoring patients with claudication, 3 predicting functional decline, 4,5 and the follow-up after radiological or surgical intervention. 6 The ABPI also helps in determining the nature of leg ulcers, the rate of wound healing in relation to the arterial blood supply, and to optimize management. 7,8 The ABPI has progressively assumed greater importance, going from a simple index of PAD to a sensitive measure of the ''burden'' of atherosclerosis and cardiovascular risk of asymptomatic patients.9 A low ABPI (<0.90) at rest can define future cardiovascular risk, 2 since it is correlated with all-cause mortality independent of the Framingham Risk Score (FRS).10 A rapid 1-year decline in resting and postexercise ABI is associated with all-cause mortality, cardiac events, stroke, and kidney failure in patients with PAD. 11The inclusion of ABPI measurements in coronary heart disease risk-screening tools improves the identification of patients at moderate-to-high cardiovascular risk, 12 beyond the FRS. 10 A low ABPI is also an independent predictor of subsequent stroke recurrence risk, cardiovascular risk, and mortality in patients with acute stroke or transient ischemic attack. [13][14][15] Moreover, the ABPI is useful for identifying the participants at higher risk of cognitive impairment and dementia. 16,17The ABPI: LimitationsThe continuous growth in ABPI use, the need to extend its use in screening programmes for large populations, and its possible determination not only by specialists but also by other professionals (eg, general practitioners, nurses, and vascular technicians) have raised some concerns. First, the capacity of ABPI <0.90 regarding the diagnosis of PAD in detecting >50% stenosis is high in terms of specificity and accuracy but low in terms of sensitivity with regard to the elderly and patients with diabetes mellitus (DM).18 As regards patients with DM (41% of PAD patients have DM 19 ), patients with renal failure and, more generally, patients with arterial calcification and incompressible arteries, the efficiency of ABPI seems to be limited. 20,21...

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Classification, epidemiology, risk factors, and natural history of peripheral arterial disease

Cited by 78 publications

References 7 publications

Peripheral Arterial Disease, Diabetes, and Mortality

Peripheral Arterial Disease, Diabetes, and Mortality

Risk factors of peripheral arterial disease and relationship between low ankle brachial index and mortality from all-cause and cardiovascular disease in Chinese patients with hypertension

Ankle Brachial Pressure Index

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