Prevalence of peripheral arterial disease in subjects with moderate cardiovascular risk: Italian results from the PANDORA study Data from PANDORA (Prevalence of peripheral Arterial disease in subjects with moderate CVD risk, with No overt vascular Diseases nor Diabetes mellitus)

Abstract

BackgroundThe PANDORA study has recently examined the prevalence of low ankle brachial index (ABI) in subjects with moderate risk of cardiovascular disease. This sub-analysis of the PANDORA study examines the prevalence of asymptomatic peripheral arterial disease (PAD), as determined by ABI, in Italian subjects presenting with moderate cardiovascular risk, in the absence of diabetes or overt vascular disease.MethodsPANDORA is a non-interventional, cross-sectional study that was performed in 6 European countries, involving subjects with at least one cardiovascular (CV) risk factor. The primary objective was to evaluate the prevalence of asymptomatic PAD using ABI. For this post-hoc sub-analysis, data were extracted for subjects enrolled in Italy, comprising 51.5% (n = 5298) of subjects from the original PANDORA study. Secondary objectives were to establish the prevalence and treatment of CV risk factors.ResultsThe mean age was 63.9 years and 22.9% (95% CI 21.7-24.0) of subjects presented with asymptomatic PAD. A range of risk factors comprising smoking, hypertension, low HDL-cholesterol, family history of coronary heart disease and habit of moderate-high alcohol intake were significantly associated with asymptomatic PAD (p < 0.0001). Statin treatment had the lowest incidence in Italian subjects. Furthermore, patients treated with statins were significantly less likely to have asymptomatic PAD than those who were not (p = 0.0001).ConclusionsAsymptomatic PAD was highly prevalent in Italian subjects, the majority of whom were not candidates for ABI assessment according to current guidelines. Findings from this study suggest that these patients should be carefully examined in clinical practice and ABI measured so that therapeutic interventions known to decrease their CV risk may be offered.Trial registration numberClinicalTrials.gov: NCT00689377

Meta-analysis of the association between cigarette smoking and peripheral arterial disease

“…Eight studies (14.5%) recruited only men,32 39 51 56 58 60 71 72 2 (3.6%) only women,53 54 and 45 (81.8%) both 21–31 33–38 40–50 52 55 57 59 61–70 73–75. Forty-three (78.2%) were cross-sectional studies,22–26 28–31 33 34 36 40–45 47–50 52–55 57–71 74 75 10 (18.2%) were cohort studies21 27 32 38 39 46 51 56 72 73 and 2 (3.6%) were case-control studies 35 37. Forty-seven (84.5%) studies defined PAD using the ABI,21–26 29–34 36–38 40–49 52–55 57–71 73–75 and 7 (12.7%) based on symptoms of intermittent claudication, using either the Edinburgh, WHO/Rose or San Diego claudication questionnaires 28 35 39 50 51 56 72.…”

Aortic‐flow propagation velocity is associated with proteinuria and left ventricular hypertrophy in newly diagnosed hypertensive patients

“…10 If the slope of the flame was unclear, baseline shifting was used to change the aliasing velocity until a clear delineation of isovelocity slope was seen. 10 If the slope of the flame was unclear, baseline shifting was used to change the aliasing velocity until a clear delineation of isovelocity slope was seen.…”

“…To determine the ABI, systolic blood pressures of the brachial, anterior, and posterior tibial arteries were measured using a mercury manometer with inflatable cuffs. 10,11 A handheld vascular arterial Doppler was used to accurately hear the Korotkoff sounds on the anterior tibial artery. The maximum ankle arterial pressures were divided by the maximum of the brachial arterial pressures to calculate the ABI.…”

The Management of Peripheral Arterial Disease (PAD) in Primary Care

“…Firstly, due to their indepth knowledge of their patients, they are able to appropriately select at risk patients for screening, which should include those listed in table 4 below. Evidence from the recent eurpoean PANDORA study looking at the prevalence of asymptomatic PAD using ABI<0.9, found that many PAD diagnosed patients failed to meet the screening requirements for ABI testing, which may lead to a broadening of the screening criteria to include more patients (Sanna et al, 2011).…”