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Bareiro FAQ, Carnicero JA, Acha AA, Artalejo CR, Jimenez MCG, Mañas LR, García García FJ. How cognitive performance changes according to the ankle-brachial index score in an elderly cohort? Results from the Toledo Study of Healthy Ageing. GeroScience 2024; 46:609-620. [PMID: 37870701 PMCID: PMC10828423 DOI: 10.1007/s11357-023-00966-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/26/2023] [Indexed: 10/24/2023] Open
Abstract
In the ageing process, the vascular system undergoes morphological and functional changes that may condition brain functioning; for this reason, the aims of this study were to assess the effect of vascular function indirectly measured by ankle-brachial index (ABI) on both cognitive performance at baseline and change in cognitive performance at end of follow-up. We developed a prospective, population-based, cohort study with 1147 participants aged > 65 years obtained from the Toledo Study for Healthy Ageing who had cognitive assessment and measured ABI in the first wave (2006-2009) were selected for the cross-sectional analysis. Those participants who also performed the cognitive assessment in the second wave (2011-2013) were selected for the prospective analysis. Cognitive impairment diagnosis and symptoms and/or history of cardio/neurovascular disease were used as exclusion criteria. Multivariate segmented regression model was used to assess the associations between ABI and cognitive performance in both the cross-sectional and prospective analyses. As ABI score decreased from 1.4, the cross-sectional analysis showed a higher decrease in cognitive performance and the prospective analysis showed a higher degree of worsening in cognitive performance. Our findings suggest that the ABI, a widespread measure of vascular health in primary care, may be a useful tool for predicting cognitive performance and its evolution.
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Affiliation(s)
- Fabio A Quiñónez Bareiro
- Department of Geriatrics, Hospital Virgen del Valle, Hospital Universitario de Toledo, Toledo, Spain
| | - José A Carnicero
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain.
- Geriatric Research Group, Biomedical Research Foundation at Getafe University Hospital, Ctra. Toledo Km. 12.5, 28905, Getafe, Spain.
| | - Ana Alfaro Acha
- Department of Geriatrics, Hospital Virgen del Valle, Hospital Universitario de Toledo, Toledo, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| | - Cristina Rosado Artalejo
- Department of Geriatrics, Hospital Virgen del Valle, Hospital Universitario de Toledo, Toledo, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
| | - María C Grau Jimenez
- Department of Geriatrics, Hospital Virgen del Valle, Hospital Universitario de Toledo, Toledo, Spain
| | - Leocadio Rodriguez Mañas
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
- Geriatric Department, Hospital Universitario de Getafe, Getafe, Spain
| | - Francisco J García García
- Department of Geriatrics, Hospital Virgen del Valle, Hospital Universitario de Toledo, Toledo, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Madrid, Spain
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Laukka D, Kangas E, Kuusela A, Hirvonen J, Rissanen T, Rahi M, Kivelev J, Rantasalo V, Venermo M, Rinne J, Hakovirta H. Low and Borderline Ankle-Brachial Index Is Associated With Intracranial Aneurysms: A Retrospective Cohort Study. Neurosurgery 2024; 94:00006123-990000000-01031. [PMID: 38270446 PMCID: PMC11073771 DOI: 10.1227/neu.0000000000002837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 11/24/2023] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND AND OBJECTIVES A low ankle-brachial index (ABI) has been linked to systemic inflammation and an elevated risk of cardiovascular events, most notably myocardial infarction and stroke. Intracranial aneurysms (IAs) share similar risk factors with other cardiovascular diseases. However, the association between low ABI and IAs has not been sufficiently investigated. Our objective was to investigate the potential connection between ABI values and the prevalence of unruptured IAs. METHODS This retrospective cohort study reviewed 2751 patients who had ABI measurements at a public tertiary hospital from January 2011 to December 2013. Patients with available cerebrovascular imaging or a diagnosis of ruptured IA were included in the study (n = 776) to examine the association between ABI and saccular IAs. The patients were classified into 4 groups: low ABI (≤0.9, n = 464), borderline ABI (0.91-0.99; n = 47), high ABI (>1.4, n = 57), and normal ABI (1.00-1.40; n = 208). RESULTS The prevalence of IAs was 20.3% (18.1% unruptured IAs) in the low ABI group, 14.9% (12.8% unruptured IAs) in the borderline ABI group, 7.0% (5.3% unruptured IAs) in the high ABI group, and 2.4% (1.9% unruptured IAs) in the normal ABI group (P < .001). There were no significant differences in the prevalence of ruptured IAs between the ABI groups (P = .277). Sex- and age-adjusted multinomial regression, including clinically relevant variables, revealed that low ABI (odds ratio [OR], 13.02; 95% CI, 4.01-42.24), borderline ABI (OR, 8.68; 95% CI, 2.05-36.69), and smoking history (OR, 2.01; 95% CI, 1.07-3.77) were associated with unruptured IAs. CONCLUSION The prevalence of unruptured IAs was 9-fold higher in the low ABI group and nearly 7-fold higher in the borderline ABI group when compared with the normal ABI group. ABI measurements could be clinically relevant for identifying individuals at higher risk of IAs and may help guide screening and preventive strategies.
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Affiliation(s)
- Dan Laukka
- Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
- Clinical Neurosciences, University of Turku, Turku, Finland
| | - Essi Kangas
- Department of Surgery, University of Turku, Turku, Finland
- Department of Vascular Surgery, Turku University Hospital, Turku, Finland
| | - Aino Kuusela
- Department of Surgery, University of Turku, Turku, Finland
| | - Jussi Hirvonen
- Department of Radiology, Turku University Hospital and University of Turku, Turku, Finland
- Department of Radiology, University of Tampere, Tampere, Finland
| | - Tiia Rissanen
- Department of Clinical Medicine, Biostatistics, University of Turku, Turku, Finland
- Department of Biostatistics, University of Turku and Turku University Hospital, Turku, Finland
| | - Melissa Rahi
- Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
- Clinical Neurosciences, University of Turku, Turku, Finland
| | - Juri Kivelev
- Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
- Clinical Neurosciences, University of Turku, Turku, Finland
| | - Ville Rantasalo
- Department of Surgery, University of Turku, Turku, Finland
- Department of Vascular Surgery, Turku University Hospital, Turku, Finland
| | - Maarit Venermo
- Department of Vascular Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Jaakko Rinne
- Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
- Clinical Neurosciences, University of Turku, Turku, Finland
| | - Harri Hakovirta
- Department of Surgery, University of Turku, Turku, Finland
- Department of Vascular Surgery, Turku University Hospital, Turku, Finland
- Department of Surgery, Satasairaala, Pori, Finland
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Fang M, Hu J, Jeon Y, Matsushita K, Selvin E, Hicks CW. Diabetic foot disease and the risk of major clinical outcomes. Diabetes Res Clin Pract 2023; 202:110778. [PMID: 37321302 PMCID: PMC10527937 DOI: 10.1016/j.diabres.2023.110778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/25/2023] [Accepted: 06/08/2023] [Indexed: 06/17/2023]
Abstract
AIMS Data on the long-term consequences of diabetic foot disease (DFD) are scarce. We examined the association between DFD and major clinical outcomes in patients with diabetes in the general population. METHODS We conducted a prospective cohort analysis of 1,428 participants with diabetes in the Atherosclerosis Risk in Communities Study. DFD and four clinical outcomes (nontraumatic lower-extremity amputation, cardiovascular disease, major fall, and death) were captured through 2018 using administrative data. We used Cox regression models to evaluate the association between incident DFD (modeled as a time-varying exposure) and the subsequent risk of clinical outcomes. RESULTS During over two decades of follow-up (1996-1998 to 2018), the cumulative incidence of DFD was 33.3%. Risk factors for DFD included older age, poor glycemic control, long diabetes duration, and prevalent vascular disease (chronic kidney disease, retinopathy, cardiovascular disease). Following incident DFD, the five-year cumulative incidence of major clinical outcomes was 38.9% for mortality, 25.2% for cardiovascular disease, 14.5% for nontraumatic lower-extremity amputation, and 13.2% for major fall. DFD remained associated with all four clinical outcomes after multivariable adjustment, with hazard ratios ranging from 1.5 (cardiovascular disease) to 34.7 (lower-extremity amputation). CONCLUSIONS DFD is common and confers substantial risk for major morbidity and mortality.
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Affiliation(s)
- Michael Fang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jiaqi Hu
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yein Jeon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Elizabeth Selvin
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Caitlin W Hicks
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins University, USA.
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Liu Y, Liu S, Zhao J, Wu K, Xu B, Wang W. Increased plasma renin by vasodilators promotes the progression of abdominal aortic aneurysm. Front Pharmacol 2023; 14:1174278. [PMID: 37383707 PMCID: PMC10299739 DOI: 10.3389/fphar.2023.1174278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Accepted: 05/22/2023] [Indexed: 06/30/2023] Open
Abstract
Background: It is well-accepted that antihypertensive therapy is the cornerstone of treatment for abdominal aortic aneurysm (AAA) patients with hypertension. Direct-acting vasodilators were used in the treatment of hypertension by directly relaxing vascular smooth muscle but may have destructive effects on the aortic wall by activating the renin-angiotensin system axis. Their roles in AAA disease remain to be elucidated. In this study, we used hydralazine and minoxidil, two classical direct-acting vasodilators, to investigate their influence and potential mechanisms on AAA disease. Methods and results: In this study, we investigated the plasma renin level and plasma renin activity in AAA patients. Simultaneously, age and gender ratio-matched patients diagnosed with peripheral artery disease and varicose veins were selected as the control group using a ratio of 1:1:1. Our regression analysis suggested both the plasma renin level and plasma renin activity are positively associated with AAA development. In view of the well-established relationship between direct-acting vasodilators and increased plasma renin concentration, we established a porcine pancreatic elastase-infused AAA mouse model, followed by oral administration of hydralazine (250 mg/L) and minoxidil (120 mg/L) to investigate effects of direct-acting vasodilators on AAA disease. Our results suggested both hydralazine and minoxidil promoted the progression of AAA with increased aortic degeneration. Mechanistically, the vasodilators aggravated aortic inflammation by increased leukocyte infiltration and inflammatory cytokine secretion. Conclusion and relevance: The plasma renin level and plasma renin activity are positively associated with AAA development. Direct vasodilators aggravated experimental AAA progression, which raised cautionary concerns about their applications in AAA disease.
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Affiliation(s)
- Yu Liu
- Department of General and Vascular Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Shuai Liu
- Department of General and Vascular Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Jiani Zhao
- Department of General and Vascular Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Kemin Wu
- Department of General and Vascular Surgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Baohui Xu
- Department of Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Wei Wang
- Department of General and Vascular Surgery, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
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Boitano LT, Fan EY, Crawford AS, Tanious A, Jones D, Simons JP, Schanzer A. Symptomatic Peripheral Artery Disease Increases Risk of Perioperative Following Open Abdominal Aortic Aneurysm Repair. J Vasc Surg 2023:S0741-5214(23)01067-4. [PMID: 37088442 DOI: 10.1016/j.jvs.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 04/14/2023] [Accepted: 04/17/2023] [Indexed: 04/25/2023]
Abstract
BACKGROUND Peripheral artery disease (PAD) is associated with worse survival following abdominal aortic aneurysm (AAA) repair. However, little is known about the impact of PAD and sex on outcomes following open infrarenal AAA repair (OAR). METHODS All elective open infrarenal AAA cases were queried from the Society for Vascular Surgery Vascular Quality Initiative from 2003 to 2022. PAD was defined as history of non-cardiac arterial bypass, non-coronary percutaneous vascular intervention (PVI), or non-traumatic major amputation. Cohorts were stratified by sex and history of PAD. Multivariable logistic regression and Cox Proportional Hazards models were constructed to assess the primary endpoints: 30-day and five-year mortality, respectively. RESULTS Of 4,910 patients who underwent elective OAR, 3,421 (69.7%) were men without PAD, 298 (6.1%) were men with PAD, 1,098 (22.4%) were women without PAD, and 93 (1.9%) were women with PAD. Men with PAD had prior bypass (45%), PVI (62%), and amputation (6.7%). Women with PAD had prior bypass (32%), PVI (76%), and amputation (5.4%). Thirty-day mortality was significantly higher in men with PAD compared to men without PAD (4.4% vs 1.7%, p=0.001) and in women with PAD compared to women without PAD (7.5% vs 2.4%, p=0.01). After risk adjustment, when compared to men without PAD, women with PAD had nearly four-times the odds of 30-day mortality (OR 3.86, 95% CI 1.55-9.64, p=0.004) and men with PAD had almost three-times the odds of 30-day mortality (OR 2.77, 95% CI 1.42 - 5.40, p=0.003). Five-year survival was 87.8% in men without PAD, 77.8% in men with PAD, 85% in women without PAD and 76.2% in women with PAD, p<0.001. After risk adjustment, only men with PAD had an increased hazard of death at 5 years (HR 1.52, 95% CI 1.07-2.17, p=0.019) compared to men without PAD. CONCLUSION PAD is a potent risk factor for increased perioperative mortality in both men and women following OAR. In women, this equates to nearly four times the odds of perioperative mortality compared to men without PAD. Future study evaluating risk/benefit is needed to determine if women with PAD reflect a high-risk cohort that may benefit from a more conservative OAR threshold for treatment.
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Lee M, Pichert MD, Tran AT, Farooq A, Heyligers JM, de Vries JPPM, Spertus JA, Guzman RJ, Thomas M, Mena-Hurtado CI, Smolderen KG. Real-world abdominal aorta aneurysm screening patterns among patients with new or worsening of symptomatic peripheral artery disease. Int J Cardiol 2023; 375:94-97. [PMID: 36577485 PMCID: PMC10371801 DOI: 10.1016/j.ijcard.2022.12.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/23/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Patients with peripheral artery disease (PAD) have an increased risk of abdominal aortic aneurysms (AAA), but it remains unclear whether practitioners are screening patients for AAA as part of routine PAD management. METHODS The Patient-centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease (PORTRAIT) Registry is an international prospective registry of patients with new or worsening PAD symptoms presenting to 16 specialty centers in the United States, Netherlands, and Australia, from June 2011 to December 2015. Patients were stratified by AAA screening or AAA positivity. An adjusted median odds ratio was calculated for AAA screening rates across sites. RESULTS Of the 1275 patients in the study, 871 (68%) were screened for AAA, with 53 (6.1%) having AAA. AAA screening rates did not differ significantly by country (p = 0.36), but there was a large variation across sites for documentation of AAA screening with an adjusted median odds ratio 12.0 (95% CI 4.7-93.1), with AAA screening rates ranging from 7% to 100% across vascular specialty centers. CONCLUSIONS Among patients with PAD in a multicenter registry, over two-thirds were screened for AAA, with 6% having documented aneurysms. A large variation was seen across clinical sites, suggesting efforts are needed to increase awareness for guideline implementation and establish new benefit-risk evidence inclusive of high-risk populations such as patients with PAD.
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Affiliation(s)
- Megan Lee
- Vascular Medicine Outcomes Program at Yale University, Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States of America
| | - Matthew D Pichert
- Vascular Medicine Outcomes Program at Yale University, Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States of America
| | - Andy T Tran
- Cardiovascular Research, St Luke's Mid America Heart Institute, Kansas City, MO, United States of America; School of Medicine, University of Missouri-Kansas City, Kansas City, MO, United States of America
| | - Awais Farooq
- Department of Medicine, Southeast Health Medical Center, Dothan, AL, United States of America
| | - Jan M Heyligers
- Department of Vascular Surgery, Elisabeth TweeSteden Hospital, Tilburg, the Netherlands
| | | | - John A Spertus
- Cardiovascular Research, St Luke's Mid America Heart Institute, Kansas City, MO, United States of America; School of Medicine, University of Missouri-Kansas City, Kansas City, MO, United States of America
| | - Raul J Guzman
- Division of Vascular Surgery, Department of Surgery, Yale School of Medicine, New Haven, CT, United States of America
| | - Merrill Thomas
- School of Medicine, University of Missouri-Kansas City, Kansas City, MO, United States of America
| | - Carlos I Mena-Hurtado
- Vascular Medicine Outcomes Program at Yale University, Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States of America
| | - Kim G Smolderen
- Vascular Medicine Outcomes Program at Yale University, Department of Internal Medicine, Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT, United States of America; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States of America.
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Cinza-Sanjurjo S, González-Juanatey JR. Benefits of reducing the cardiovascular risk in patients with abdominal aortic aneurysm. Eur J Prev Cardiol 2022; 29:1955-1956. [PMID: 35904945 DOI: 10.1093/eurjpc/zwac144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Sergio Cinza-Sanjurjo
- Centro de Salud Porto do Son, Santiago de Compostela, 15970, Spain
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), 15706, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, 28090, Spain
| | - Jose Ramon González-Juanatey
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), 15706, Spain
- Centro de Investigación Biomédica en Red-Enfermedades Cardiovasculares (CIBERCV), Madrid, 28090, Spain
- Servicio de Cardiologí-a, Hospital Clí-nico Universitario de Santiago de Compostela, 15706, Spain
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