Mortality over a Period of 10 Years in Patients with Peripheral Arterial Disease

Crique, M. H.; Langer, Raquel David; Froněk, Arnošt; Feigelson, Heather Spencer; Klauber, Melville R.; McCann, Theresa J.; Browner, Deirdre

doi:10.1097/00132586-199210000-00026

Cited by 609 publications

(820 citation statements)

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“…It may merely be an adaptive response of the vessel wall to changes in shear stress and tensile stress. 24 Furthermore, atherosclerosis is viewed as a disorder restricted to the intimal layer of the arterial vessel wall, 23 and ultrasound imaging cannot discriminate between the intima layer and the media layer of vessel wall. In several studies, ultrasonographically determined increased intima-media thickness of the common carotid artery has been associated with elevated levels of cardiovascular risk factors.…”

Section: Discussionmentioning

confidence: 99%

Common carotid intima-media thickness and lower extremity arterial atherosclerosis. The Rotterdam Study.

Bots¹,

Hofman²,

Grobbee³

1994

Arterioscler Thromb

233

155

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High-resolution B-mode ultrasonography of the carotid arteries is used to investigate the signs of early atherosclerotic vessel wall disease. To assess whether carotid artery findings reflect atherosclerosis elsewhere, we studied the association between common carotid intima-media thickness and lower extremity arterial atherosclerosis among the first 1000 participants of the Rotterdam Study. The Rotterdam Study is a single-center population-based prospective follow-up study of 7983 subjects, £55 years old. Baseline measurements include ultrasound imaging of intima-media thickness of the distal common carotid artery and determination of the ankle-to-arm systolic blood pressure index. Lower extremity arterial disease was defined as an ankle-arm index <0.90 in at least one leg. An increase of 0.1 mm in common carotid artery intima-media thickness was associated with an age-and sex-adjusted reduction of the ankle-arm index of 0.026 (95% confidence interval [CI]: 0.018 to 0.034). The age-and sex-T o further understand the early phase of atherosclerosis, its natural history, and factors that contribute to its development, more information must be directly obtained on the arterial system in nonhospitalized subjects. Recently, it has been shown that with high-resolution B-mode ultrasonography vessel wall characteristics of the carotid arteries can be noninvasively assessed in an effective and accurate way in populations at large.12 This technique facilitates the evaluation of the lumen diameter, the intima-media thickness, and the presence and extent of plaques of the carotid artery and has now been applied in a number of studies. 37 The applicability of the findings of these studies with respect to the atherosclerotic process is conditional on the extent to which noninvasively assessed common carotid intima-media thickness reflects atherosclerotic vessel wall disease in other arteries that are at high risk of atherosclerosis, such as the coronary arteries, the abdominal aorta, and arteries of the lower extremities.8 In other words, can increased common carotid intima-media thickness be regarded as an indicator of generalized atherosclerosis?In this study we report on the association of noninvasivefy assessed common carotid intima-media thickReceived May 20, 1994; revision accepted September 9, 1994. From the Department of Epidemiology and Biostatistics, Erasmus University Medical School, Rotterdam, the Netherlands.Correspondence to Prof D.E. Grobbee, Department of Epidemiology and Biostatistics, Erasmus University Medical School, PO Box 1738, 3000 DR Rotterdam, Netherlands.© 1994 American Heart Association, Inc.adjusted odds ratio of lower extremity arterial disease for subjects with an intima-media thickness ^0.89 mm (upper quintile) to that of subjects with an intima-media thickness <0.89 mm was 3.4 (95% CI: 2.2 to 5.2). Analysis among subjects free from symptomatic cardiovascular disease yielded a reduction in ankle-arm index per 0.1 mm increase in intima-media thickness of 0.018 (95% CI: 0.008 to 0.028) an...

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Section: Discussionmentioning

confidence: 99%

Common carotid intima-media thickness and lower extremity arterial atherosclerosis. The Rotterdam Study.

Bots¹,

Hofman²,

Grobbee³

1994

Arterioscler Thromb

233

155

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“…3 The mortality for asymptomatic PAD is similar to that of mild to moderately symptomatic subjects. 27 The mortality rate for patients with PAD correlates well with the ABI. [27][28][29] All-cause mortality is approximately 30% at 5 years, 50% at 10 years, and 70% at 15 years.…”

Section: Natural History Of Lower Extremity Peripheral Arterial Diseasementioning

confidence: 99%

“…27 The mortality rate for patients with PAD correlates well with the ABI. [27][28][29] All-cause mortality is approximately 30% at 5 years, 50% at 10 years, and 70% at 15 years. 3 The majority of these patients die of cardiac, cerebrovascular, or other vascular causes.…”

Section: Natural History Of Lower Extremity Peripheral Arterial Diseasementioning

confidence: 99%

“…The 5-year mortality is roughly similar to that of patients with breast cancer or colorectal cancer. 27,30 It is evident that the majority of patients do not require surgical intervention; they rather need medical care from the cardiovascular medicine specialists. Abbreviations: LDL = low-density lipoprotein, HDL = high-density lipoprotein, LP(a) = lipoprotein(a).…”

Section: Natural History Of Lower Extremity Peripheral Arterial Diseasementioning

confidence: 99%

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The significance of lower extremity peripheral arterial disease

Dieter

Chu

Pacanowski

et al. 2002

Clinical Cardiology

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Summary:The role of the cardiologist is expanding and involves the management of patients with lower extremity atherosclerotic occlusive arterial disease. Peripheral arterial disease (PAD) remains an underdiagnosed and undertreated disease. The purpose of this review is to educate the clinician on the significance of lower extremity atherosclerotic occlusive arterial disease. Pathophysiology and anatomy are briefly reviewed. The definition of PAD is based upon both anatomic and functional considerations. Risk factors for PAD include traditional atherosclerotic risk factors. There is a considerable overlap between coronary and cerebrovascular diseases and PAD. Diagnosis is made mainly by history and physical examination. Noninvasive and invasive tests help diagnosis and localize disease. Expanded therapies to improve outcomes include lifestyle changes, medical treatment, interventional cardiovascular procedures, or surgical intervention.

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“…Another marker of cardiovascular risk which has recently proposed is represented by ultrasound evidence of extracoronary atherosclerosis [9,10,26]. Peripheral atherosclerosis of the lower limb as assessed noninvasively by a Doppler method was associated with increased risk of death from CHD [9].…”

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confidence: 99%

Extracoronary atherosclerosis and genetic variants of apolipoprotein AI-CIII cluster in myocardial infarction survivors from southern Italy

Lorenzo¹,

Monticelli

Cocozza

et al. 1994

Clin Investig

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The relationships between some genetic markers, as evaluated by DNA analysis, and ultrasound evidence of extracoronary athero-sclerosis, as detected by ultrasound methods, were evaluated in 39 myocardial infarction survivors of middle age and in 40 healthy controls of comparable age. Coronary heart disease (CHD) patients showed higher levels of triglycerides (P --0.01) and greater number of exsmokers (P = 0.004). Carotid stenoses (> 15%) were detected in ten CHD patients and in two controls; iliac stenoses (> 15%) or abnormal ankle/arm ratio (< 0.97) were found in ten CHD patients and in one control; the scores of vascular disease severity in the myocardial infarction survivors were higher (Mann-Whitney test) than in controls (P < 0.01). Molecular genetic analysis of SstI restriction fragment length polymorphism (RFLP) of the apolipoprotein (apo) AI-CIII cluster and of the apo B gene demonstrated a higher frequency of the $2 allele (SstI RFLP) in coronary patients than in controls (P = 0.04) and no significant differences in the frequencies of XbaI RFLP of the apo B gene between patients and controls. The relative risk of myocardial infarction associated with an abnormal vascular score (> 8) or with the presence of the rare allele $2 (SstI apo AI-CIII polymorphism) was estimated by odds ratios. The lower 95% limits of odds ratios were above 1 (indicating significant increase in the relative risk of myocardial infarction) both in the case of vascular score and that of SstI RFLP. These associations were independent of one another and Abbreviations: apo = apolipoprotein; CHD = coronary heart disease; HDL = high-density lipoprotein; LDL = low-density lipoprotein; PCR = polymerase chain reactions; RFLP = restriction fragment length polymorphism; VLDL = very low density lipoprotein Correspondence to: F. De Lorenzo of triglyceride levels. SstI RFLP association with CHD disappeared after adjustment for smoking habits. Ultrasound evidence of extracoronary atherosclerosis and SstI RFLP are markers of cardiovascular risk, which might be of help in identifying coronary-prone individuals, independently of the influence of life-style changes or ongoing treatments. Key words: Restriction fragment length polymorphism -Ultrasound -Atherosclerosis -Myocardial infarction -Risk factorsCoronary Heart Disease (CHD) is a clinically heterogeneous disorder and the most common cause of death and disability in developed countries. In the majority of patients the etiology is poorly understood but is considered to involve a complex interaction between genetic and environmental risk factors [16,17,20]. A number of studies have demonstrated that the risk of CHD is related to the amount of serum cholesterol, triglycerides, and the levels of low-density (LDL) and very low density (VLDL) lipoproteins and inversely related to the level of high-density lipoprotein (HDL) [4,6]. Apolipoprotein (apo) AI is the principal protein component of human plasma HDL, whereas apo B and apo CIII are, respectively, the major components of LDL and VLDL [15]. In re...

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Mortality over a Period of 10 Years in Patients with Peripheral Arterial Disease

Cited by 609 publications

References 0 publications

Common carotid intima-media thickness and lower extremity arterial atherosclerosis. The Rotterdam Study.

Common carotid intima-media thickness and lower extremity arterial atherosclerosis. The Rotterdam Study.

The significance of lower extremity peripheral arterial disease

Extracoronary atherosclerosis and genetic variants of apolipoprotein AI-CIII cluster in myocardial infarction survivors from southern Italy

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