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Oliveras V, Martín-Baranera M, Gracia M, Del Val JL, Plans M, Pujol-Moix N. [The relevance of the ankle-arm index to the reclassification of cardiovascular risk in asymptomatic hypertensive middle-aged males]. Med Clin (Barc) 2015; 144:435-9. [PMID: 24889750 DOI: 10.1016/j.medcli.2014.02.028] [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: 11/07/2013] [Revised: 02/21/2014] [Accepted: 02/27/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND OBJECTIVE The ankle-brachial index allows for the detection of subclinical cardiovascular disease and risk, by diagnosing peripheral arterial disease and arterial calcification. Asymptomatic hypertensive men, between 45-55 years and with the suspicion of low risk, could be an important population group to benefit from this technique. The aim of the study was to compare the frequency of abnormal ankle-brachial index (subclinical peripheral arterial disease and arterial calcification) between asymptomatic hypertensive and non-hypertensive men, of the same age and suspicion of low risk. PATIENTS AND METHODS Two hundred and forty-four asymptomatic men (122 hypertensive and 122 non-hypertensive), between 45 and 55 years and an REGICOR index<10, were voluntarily recruited using consecutive sampling. Complete anamnesis, physical examination, laboratory tests and ankle-brachial index determination were carried out on all patients. RESULTS We detected abnormal ankle-brachial index values in 9.8% (12 cases) of the hypertensive subjects and in 1.6% (2 cases) of non-hypertensive subjects (P=.006). In the multivariate analysis, hypertension was significantly associated with an abnormal ankle-brachial index (P<.026) (odds ratio [OR] 5.9, 95% confidence interval [95% CI] 1.2-28.3), smoking (P=.018) (OR 2.7; 95% CI 1.2-6.2) and abdominal obesity (P=.005) (OR 2.8; 95% CI 1.3-5.9). CONCLUSIONS The population group analyzed in this study might be considered as an overriding segment for detecting subclinical cardiovascular disease and risk with the ankle-brachial index. Further studies are needed to establish the prevalence of abnormal ankle-brachial index in this population in order to assess its efficiency.
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Affiliation(s)
- Víctor Oliveras
- Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, España; Centro de Salud Adrià, Institut Català de la Salut, Barcelona, España.
| | - Montserrat Martín-Baranera
- Servicio de Epidemiología Clínica, Consorci Sanitari Integral, L'Hospitalet de Llobregat, Barcelona, España
| | - Maya Gracia
- Unitat de Risc Vascular, Clínica Sagrada Familia, Barcelona, España
| | - José Luís Del Val
- Unitat de Suport a la Recerca Barcelona Ciutat, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, España
| | - Miquel Plans
- Centro de Salud Verdaguer, Institut Català de la Salut, Sant Joan Despí, Barcelona, España
| | - Núria Pujol-Moix
- Departamento de Medicina, Universitat Autònoma de Barcelona, Barcelona, España; Institut d'Investigació Biomèdica Sant Pau (IIRB), Barcelona, España
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Diagnóstico precoz de la arteriopatía periférica mediante la determinación automática del índice tobillo-brazo. Med Clin (Barc) 2014; 143:352-3. [DOI: 10.1016/j.medcli.2014.01.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 01/09/2014] [Indexed: 11/24/2022]
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3
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Cardiovascular morbidity–mortality associated to ankle-brachial index in the general population. Rev Clin Esp 2014. [DOI: 10.1016/j.rceng.2013.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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4
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Guijarro C, Mostaza JM, Hernández-Mijares A. [Lower limb arterial disease and renal artery stenosis]. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2013; 25:218-23. [PMID: 24238748 DOI: 10.1016/j.arteri.2013.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Accepted: 10/17/2013] [Indexed: 12/23/2022]
Abstract
Peripheral arterial disease (PAD) refers to the atherosclerotic involvement of non-coronary and extracranial arteries, including visceral arteries, the aorta and its branches and the arteries of the limbs. PAD usually refers exclusively to atherosclerosis of the limbs (in particular the lower limbs). Age, male sex, smoking and diabetes, as well as hypertension and dyslipidemia, are the most relevant risk factors for the development of PAD. PAD is frequently associated with coronary heart disease and stroke. PAD patients have increased risk of developing cardiovascular complications (coronary disease, stroke) and total and cardiovascular mortality, even after adjustment by conventional risk factors. Despite this PAD exhibit a worse control of risk factors. This opens up an important opportunity to optimize their control, which can result in an improvement of the prognosis of patients with PAD. Ischemic nephropathy includes a constellation of disorders that are frequently associated: hypertension, renal failure and renal artery stenosis (RAS). RAS risk factors are similar to those of PAD. Recent studies have shown that renal revascularization is not associated with improvement in blood pressure control, preservation of renal function or reduction of cardiovascular events in most patients. Therefore, revascularization should be reserved for selected cases on an individual basis. In all cases, a strict control of vascular risk factors should be attempted.
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Affiliation(s)
- Carlos Guijarro
- Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Departamento de Medicina y Cirugía, Universidad Rey Juan Carlos, Alcorcón, Madrid, España.
| | - José María Mostaza
- Unidad de Lípidos y Riesgo Cardiovascular, Servicio de Medicina Interna, Hospital Carlos III, Madrid, España
| | - Antonio Hernández-Mijares
- Servicio de Endocrinología, Hospital Universitario Dr. Peset, Departamento de Medicina, Universitat de València, Valencia, España
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Lahoz C, Barrionuevo M, García-Fernández T, Vicente I, García-Iglesias MF, Mostaza JM. Cardiovascular morbidity-mortality associated to ankle-brachial index in the general population. Rev Clin Esp 2013; 214:1-7. [PMID: 24119392 DOI: 10.1016/j.rce.2013.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 08/05/2013] [Accepted: 08/17/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND OBJECTIVES Abnormal ankle-brachial index (ABI) is associated with a high risk of cardiovascular disease. This study has aimed to investigate the association between low ABI and risk of cardiovascular death in a general population attended in a primary care center. PATIENTS AND METHODS A total of 1,361 volunteers aged between 60 and 79 years without any evidence of peripheral artery disease who attended a primary care center participated in the study. They underwent a complete physical examination, together with standard blood tests and ABI was determined. The participants were contacted by telephone 4 years later and asked about any cardiovascular problems for that period. Causes of death and hospitalization were confirmed in the medical records in the primary care center and/or hospital. RESULTS Information was obtained about the clinical evolution of 1,300 participants (mean age 69.9 years, 38.2% men). Mean follow-up was 49.8 months. There were 13 cardiovascular death and 49 major cardiovascular events. Low ABI (<0.9) was associated with a significant higher risk of cardiovascular death (adjusted relative risk 6.83; 95% confidence interval 1.36-34.30, P=.020), and with a higher risk of major cardiovascular events (adjusted relative risk 2.42; 95% confidence interval 0.99-5.91, P=.051). High or uncompressible ABI was not associated with higher cardiovascular risk. CONCLUSIONS A low ABI was associated with higher risk of cardiovascular death in the general population followed-up in a primary care center.
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Affiliation(s)
- C Lahoz
- Unidad de Lípidos y Riesgo Cardiovascular, Hospital Carlos III, Madrid, España.
| | | | | | - I Vicente
- Centro de Salud Monóvar, Madrid, España
| | - M F García-Iglesias
- Unidad de Lípidos y Riesgo Cardiovascular, Hospital Carlos III, Madrid, España
| | - J M Mostaza
- Unidad de Lípidos y Riesgo Cardiovascular, Hospital Carlos III, Madrid, España
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Baena-Díez JM, Alzamora MT, Forés R, Pera G, Torán P, Sorribes M. Ankle-brachial index improves the classification of cardiovascular risk: PERART/ARTPER Study. Rev Esp Cardiol 2011; 64:186-92. [PMID: 21330032 DOI: 10.1016/j.recesp.2010.10.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2010] [Accepted: 10/18/2010] [Indexed: 12/20/2022]
Abstract
INTRODUCTION AND OBJECTIVES The sensitivity of cardiovascular risk functions is low because many cardiovascular events occur in low- or intermediate-risk patients. The aim of the present study was to evaluate how the ankle-brachial index (ABI) reclassifies these patients. METHODS We conducted a descriptive, transversal, multicenter study (28 centers) of 3171 randomly selected patients aged >49 years. We studied demographic variables, clinical history and cardiovascular risk factors, ABI (defined as pathologic if <0.9) and 10-year cardiovascular risk with the Framingham-Wilson, REGICOR and SCORE equations, dividing risk into three categories: low (Framingham<10%, REGICOR<5% and SCORE<2.5%, intermediate (10-19.9%, 5-9.9% and 2.5-4.9%, respectively) and high (≥20%, ≥10% and ≥5%, respectively). Low- or intermediate-risk patients were reclassified as high-risk if they presented ABI <0.9. RESULTS We compared patients with ABI <0.9 and patients with ABI ≥0.9 and found the former were significantly older, more frequently men, had a worse history and more cardiovascular risk factors, and included more high-risk patients than when the classification used Framingham-Wilson (42.7% vs. 18.5%), REGICOR (25.8% vs. 9.3%) and SCORE (42.2% vs. 15.9%) equations. In men, using ABI led to a 5.8% increase in the high-risk category versus Framingham-Wilson, a 19.1% increase versus REGICOR and a 4.4% increase versus SCORE. In women, the increases were 78.6% versus Framingham-Wilson, 151.6% versus REGICOR and 50.0% versus SCORE. CONCLUSIONS The ABI reclassifies a substantial proportion of patients towards the high-risk category. This is particularly marked in women and by comparison with REGICOR scores.
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Affiliation(s)
- José M Baena-Díez
- Centro de Salud La Marina, Institut Català de la Salut, Barcelona, España.
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Vallejo OG. Utilidad del índice tobillo-brazo para el diagnostico de la enfermedad arterial periférica. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2011. [DOI: 10.1016/j.arteri.2011.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Forés Raurell R, Alzamora Sas MT, Baena Díez JM, Pera Blanco G, Torán Monserrat P, Ingla Mas J. Infradiagnóstico de la arteriopatía periférica en la población española. Estudio ARTPER. Med Clin (Barc) 2010; 135:306-9. [DOI: 10.1016/j.medcli.2009.11.046] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2009] [Revised: 10/29/2009] [Accepted: 11/03/2009] [Indexed: 12/01/2022]
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Mostaza JM, Lahoz C. ¿A quién medir el índice tobillo-brazo? Med Clin (Barc) 2010; 135:312-3. [DOI: 10.1016/j.medcli.2010.03.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 03/16/2010] [Accepted: 03/16/2010] [Indexed: 11/26/2022]
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10
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[Ankle-brachial index in patients with chest pain and suspected acute coronary syndrome]. Med Clin (Barc) 2010; 134:202-5. [PMID: 19879603 DOI: 10.1016/j.medcli.2009.07.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Accepted: 07/08/2009] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Acute chest pain (ACP) is a non-specific symptom that may be the expression of coronary artery disease (CAD). Atherosclerosis is usually present in more than one vascular territory. Ankle-brachial index (ABI) is a useful tool for the diagnosis of peripheral arterial disease (PAD). Our aim was to evaluate the value of ABI in patients with ACP when CAD is suspected. PATIENTS AND METHODS We performed a cross-sectional study of 94 patients, mean age: 57.4 (12.2), admitted consecutively due to ACP with suspicion of CAD. ABI and presence of CAD were determined. RESULTS CAD was present in 22 patients (23.4%) and absent in 72 (76.6%). Asymptomatic PAD (ABI < or = 0.9) was present in 6 patients (27.2%) of CAD group and in 7 patients (9.7%) of the non-CAD group. Significant difference was found in ABI based on the presence or not of CAD [0.95 (0.23) vs 1.17 (0.15), p<0.001]. The diagnostic value of ABI for CAD detection was evaluated: area under the ROC curve was 0.8 (IC 95%: 0.70-0.87) and optimal cut-off point was 0.8 (sensitivity=22.7% and specificity=98.6%). In the multivariate analysis, ABI was the best independent predictor of CAD (p<0.001). CONCLUSION ABI is a simple, cheap and efficient method, which complements other conventional diagnostic methods in the recognition of patients with ACP due to CAD.
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Alzamora MT, Forés R, Baena-Díez JM, Pera G, Toran P, Sorribes M, Vicheto M, Reina MD, Sancho A, Albaladejo C, Llussà J. The peripheral arterial disease study (PERART/ARTPER): prevalence and risk factors in the general population. BMC Public Health 2010; 10:38. [PMID: 20529387 PMCID: PMC2835682 DOI: 10.1186/1471-2458-10-38] [Citation(s) in RCA: 132] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2009] [Accepted: 01/27/2010] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The early diagnosis of atherosclerotic disease is essential for developing preventive strategies in populations at high risk and acting when the disease is still asymptomatic. A low ankle-arm index is a good marker of vascular events and may be diminished without presenting symptomatology (silent peripheral arterial disease). The aim of the study is to know the prevalence and associated risk factors of peripheral arterial disease in the general population. METHODS We performed a cross-sectional, multicentre, population-based study in 3786 individuals >49 years, randomly selected in 28 primary care centres in Barcelona (Spain). Peripheral arterial disease was evaluated using the ankle-arm index. Values < 0.9 were considered as peripheral arterial disease. RESULTS The prevalence (95% confidence interval) of peripheral arterial disease was 7.6% (6.7-8.4), (males 10.2% (9.2-11.2), females 5.3% (4.6-6.0); p < 0.001).Multivariate analysis showed the following risk factors: male sex [odds ratio (OR) 1.62; 95% confidence interval 1.01-2.59]; age OR 2.00 per 10 years (1.64-2.44); inability to perform physical activity [OR 1.77 (1.17-2.68) for mild limitation to OR 7.08 (2.61-19.16) for breathless performing any activity]; smoking [OR 2.19 (1.34-3.58) for former smokers and OR 3.83 (2.23-6.58) for current smokers]; hypertension OR 1.85 (1.29-2.65); diabetes OR 2.01 (1.42-2.83); previous cardiovascular disease OR 2.19 (1.52-3.15); hypercholesterolemia OR 1.55 (1.11-2.18); hypertriglyceridemia OR 1.55 (1.10-2.19). Body mass index > or =25 Kg/m2 OR 0.57 (0.38-0.87) and walking >7 hours/week OR 0.67 (0.49-0.94) were found as protector factors. CONCLUSIONS The prevalence of peripheral arterial disease is low, higher in males and increases with age in both sexes. In addition to previously described risk factors we found a protector effect in physical exercise and overweight.
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Affiliation(s)
- María Teresa Alzamora
- Primary Healthcare Centre Riu Nord-Riu Sud, Institut Català de Salut, Santa Coloma de Gramenet, Spain.
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12
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Alvarez-Fernández LJ, Vallina-Victorero Vázquez MJ, Ramos Gallo MJ, Santiago MV. [Implications of the REACH registry for vascular surgery]. Med Clin (Barc) 2009; 132 Suppl 2:25-9. [PMID: 19631835 DOI: 10.1016/s0025-7753(09)71749-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Because of the increase in life expectancy, peripheral artery disease (PAD) has become a major health problem. A study performed in Spain in persons aged more than 65 years old found an overall prevalence of PAD of 9.9%. The most important risk factors for PAD were smoking, diabetes mellitus, advanced age, hyperlipidemia and hypertension. Treatment includes smoking cessation, exercise, statins, platelet antiaggregants, cilostazol or hemorheologic agents, and revascularization techniques. Data from the Spanish arm of REACH indicate that the PAD subgroup shows the poorest control of blood pressure and cholesterol and that use of platelet antiaggregants and statins is lowest in these patients, indicating that therapeutic and preventive strategies are not being correctly applied.
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Martínez-González J, de Albornoz MC, Lara PA, Gómez-Huelgas R. Índice tobillo-brazo y método oscilométrico. Med Clin (Barc) 2009; 132:35. [DOI: 10.1016/j.medcli.2008.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2007] [Accepted: 02/07/2008] [Indexed: 10/20/2022]
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[Usefulness of the ankle-arm index for detection of peripheral arterial disease in a working population of Junta de Andalucía at Málaga]. Med Clin (Barc) 2008; 132:7-11. [PMID: 19174058 DOI: 10.1016/j.medcli.2008.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2007] [Accepted: 02/07/2008] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND OBJECTIVE Detection of asymptomatic peripheral arterial disease increases the risk of vascular morbibity and mortality. We aimed to estimate the prevalence of clinical and subclinical peripheral arterial disease using the ankle-arm index (AAI) as diagnostic tool in a working population. SUBJECTS AND METHOD We included 450 workers, older than 50 years old, attending voluntary regular health check-up at Centro de Prevención de Riesgos Laborales de la Junta de Andalucía in Málaga (Spain). We recorded clinical and anthopometrical data. Blood samples were taken after an overnight fast. Vascular risk was calculated using Framinghan and SCORE scales. Every participant was asked for symptoms of intermittent claudicatio and AAI was measured. AAI was considered normal within 0.9-1.3 values. RESULTS Most of our workers were at low- or moderate vascular risk. Only 48 (10.6%) of individuals had an abnormal AAI: 9 (2%) showed an AAI<0.9 and 39 (8.6%) showed an AAI>1.3. An AAI<0.9 was found in 19% of those with a SCORE risk > or = 5%, and in 11% of those having a Framinghan risk > or = 20%. Intermittent claudication was present in 4 out of 9 (44%) of those having an AAI<0.9 and in 7 out of 402 (1.7%) with a normal AAI. CONCLUSIONS Systematic screening of peripheral arterial disease using the AAI is not recommended in active working population over 50 years-old of age. Thus, AAI measurement is indicated only for those individuals suffering from intermitent claudicatio and those who are at moderate- or high vascular risk.
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Mostaza JM, Manzano L, Suárez C, Cairols M, María Ferreira E, Rovira E, Sánchez A, Suárez-Tembra MA, Estirado E, de Dios Estrella J, Vega F, Ángel Sánchez-Zamorano M. Prevalencia de enfermedad arterial periférica asintomática, estimada mediante el índice tobillo-brazo, en pacientes con enfermedad vascular. Estudio MERITO II. Med Clin (Barc) 2008; 131:561-5. [DOI: 10.1157/13128016] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Palacios R, Alonso I, Hidalgo A, Aguilar I, Sánchez MA, Valdivielso P, González-Santos P, Santos J. Peripheral arterial disease in HIV patients older than 50 years of age. AIDS Res Hum Retroviruses 2008; 24:1043-6. [PMID: 18620492 DOI: 10.1089/aid.2008.0001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Our objective was to analyze the prevalence of peripheral arterial disease (PAD) in HIV patients at risk and to compare them with the general population. All HIV patients older than 50 years who attended our unit from October 2005-July 2006 and all persons attending for an annual medical checkup at an employees' insurance association during the same period were invited to participate in the study. Of the latter (n = 407), a person of the same sex and age (+/-5 years) was included for each HIV patient. PAD was assessed by the ankle-brachial index (ABI) in all subjects, and all completed the Edinburgh questionnaire. Ninety-nine HIV patients and 99 persons from the general population of the same age and sex were included in the study. The HIV patients had a greater prevalence of dyslipidemia, diabetes, and PAD, which was symptomatic in five of them and in one subject from the general population. Patients with HIV infection older than 50 had a high prevalence of PAD, and as it was asymptomatic in half the cases, an ABI may be performed in this population to actively look for PAD. Control of cardiovascular risk factors and the use of such drugs as platelet antiaggregation agents should therefore be optimized in this population.
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Affiliation(s)
- Rosario Palacios
- Infectious Diseases Unit, Virgen de la Victoria Hospital, Campus Teatinus 29010 Málaga, Spain
| | - Inmaculada Alonso
- Centro de Prevención de Riesgos Laborales, Consejeria de Empleo. 29010 Málaga, Spain
| | - Ana Hidalgo
- Infectious Diseases Unit, Virgen de la Victoria Hospital, Campus Teatinus 29010 Málaga, Spain
| | - Isabel Aguilar
- Infectious Diseases Unit, Virgen de la Victoria Hospital, Campus Teatinus 29010 Málaga, Spain
| | - Miguel A. Sánchez
- Internal Medicine Department, Virgen de la Victoria Hospital, Campus Teatinus 29010 Málaga, Spain
| | - Pedro Valdivielso
- Internal Medicine Department, Virgen de la Victoria Hospital, Campus Teatinus 29010 Málaga, Spain
| | - Pedro González-Santos
- Internal Medicine Department, Virgen de la Victoria Hospital, Campus Teatinus 29010 Málaga, Spain
| | - Jesús Santos
- Infectious Diseases Unit, Virgen de la Victoria Hospital, Campus Teatinus 29010 Málaga, Spain
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Alzamora MT, Baena-Díez JM, Sorribes M, Forés R, Toran P, Vicheto M, Pera G, Reina MD, Albaladejo C, Llussà J, Bundó M, Sancho A, Heras A, Rubiés J, Arenillas JF. Peripheral Arterial Disease study (PERART): prevalence and predictive values of asymptomatic peripheral arterial occlusive disease related to cardiovascular morbidity and mortality. BMC Public Health 2007; 7:348. [PMID: 18070367 PMCID: PMC2241612 DOI: 10.1186/1471-2458-7-348] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2007] [Accepted: 12/11/2007] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND The early diagnosis of atherosclerotic disease is essential for developing preventive strategies in populations at high risk and acting when the disease is still asymptomatic. A low ankle-arm index (AAI) is a good marker of vascular events and may be diminished without presenting symptomatology (silent peripheral arterial disease). The aim of the PERART study (PERipheral ARTerial disease) is to determine the prevalence of peripheral arterial disease (both silent and symptomatic) in a general population of both sexes and determine its predictive value related to morbimortality (cohort study). METHODS/DESIGN This cross-over, cohort study consists of 2 phases: firstly a descriptive, transversal cross-over study to determine the prevalence of peripheral arterial disease, and secondly, a cohort study to evaluate the predictive value of AAI in relation to cardiovascular morbimortality. From September 2006 to June 2007, a total of 3,010 patients over the age of 50 years will be randomly selected from a population adscribed to 24 healthcare centres in the province of Barcelona (Spain). The diagnostic criteria of peripheral arterial disease will be considered as an AAI < 0.90, determined by portable Doppler (8 Mhz probe) measured twice by trained personnel. Cardiovascular risk will be calculated with the Framingham-Wilson tables, with Framingham calibrated by the REGICOR and SCORE groups. The subjects included will be evaluted every 6 months by telephone interview and the clnical history and death registries will be reviewed. The appearance of the following cardiovascular events will be considered as variables of response: transitory ischaemic accident, ictus, angina, myocardial infartction, symptomatic abdominal aneurysm and vascular mortality. DISCUSSION In this study we hope to determine the prevalence of peripheral arterial disease, especially the silent forms, in the general population and establish its relationship with cardiovascular morbimortality. A low AAI may be a better marker of arterial disease than the classical cardiovascular risk factors and may, therefore, contribute to improving the predictive value of the equations of cardiovascular risk and thereby allowing optimisation of multifactorial treatment of atherosclerotic disease.
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Affiliation(s)
- María Teresa Alzamora
- Primary Healthcare Centre Riu Nord-Riu Sud, Institut Català de la Salut, Santa Coloma de Gramenet, Spain.
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Manzano L, Mostaza JM, Suárez C, Cairols M, Redondo R, Valdivielso P, Monte R, Blázquez JC, Ferreira EM, Trouillhet I, González-Igual JJ, Sánchez-Zamorano MA. [Value of the ankle-brachial index in cardiovascular risk stratification of patients without known atherotrombotic disease. MERITO study]. Med Clin (Barc) 2007; 128:241-6. [PMID: 17335735 DOI: 10.1157/13099239] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Peripheral arterial disease detected by measurement of ankle-brachial index enables the identification of asymptomatic patients with target organ damage. We have investigated the prevalence of peripheral arterial disease (ankle-brachial index < 0.9), and its potential clinical-therapeutic impact, in patients without known atherotrombotic disease from internal medicine practices. PATIENTS AND METHOD It was a multicenter, cross-sectional, observational study. Outpatients aged 50 through 80 years, with either diabetes or a SCORE risk estimation of at least 3%, were enrolled. RESULTS A total of 1,519 subjects (58% men) were evaluated, 917 with diabetes (61%). The mean age (standard deviation) was 66.2 (8.3) years. The prevalence of an ankle-brachial index < 0.9 was 26.19%. In multiple logistic regressions the risk factors associated to an ankle-brachial index < 0.9 were age, sedentary lifestyle, smoking, macroalbuminuria, and heart rate. There was a significant relationship between the ankle-brachial index and the SCORE risk estimation. With respect to the therapeutic aims of the patients with an ankle-brachial index < 0.9, only 21% were taking antiplatelet drugs, 26% showed low density lipoproteins-cholesterol values < 100 mg/dl (53% < 130 mg/dl), and 16% displayed recommended blood pressure levels. CONCLUSIONS Measurement of ankle-brachial is useful to reclassify as high risk a significant proportion of patients without known previous atherotrombotic disease. The ankle-brachial index should be incorporated into routine cardiovascular evaluation, particularly in subjects with diabetes or a score risk assessment > or = 3%.
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Affiliation(s)
- Luis Manzano
- Unidad de Insuficiencia Cardíaca y Riesgo Vascular del Anciano, Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, España.
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Fernández-Miranda C. Nuevas perspectivas en la medición del riesgo cardiovascular: exploraciones para detectar la aterosclerosis subclínica y marcadores de inflamación. Med Clin (Barc) 2007; 128:344-51. [PMID: 17376362 DOI: 10.1157/13099803] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Among the new technologies for the detection of subclinical atherosclerosis, ankle-brachial index, carotid ultrasonography, computed tomography detection of coronary calcifications and high-resolution nuclear magnetic resonance are those of greatest clinical usefulness. These explorations are especially useful for patients with an intermediate cardiovascular risk, or a 10-20% risk according to the National Cholesterol Education Program-Adult Treatment Panel III or 3-4% according to the SCORE project. This is because they allow the identification of high-risk patients who need a more intense treatment. In addition, high-sensitivity C-reactive protein concentrations may be considered as a new marker for the evaluation of cardiovascular risk. In this article, the current state of knowledge about these explorations and the guidelines of the main scientific societies are reviewed, and the practical conclusions of the working group are provided.
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Affiliation(s)
- Consuelo Fernández-Miranda
- Unidad de Lípidos y Aterosclerosis, Servicio de Medicina Interna, Hospital Universitario 12 de Octubre, Madrid, Spain
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Vinyoles E, Pujol E, Casermeiro J, de Prado C, Jabalera S, Salido V. Índice tobillo-brazo en la detección de arteriopatía periférica: estudio de validez y concordancia entre Doppler y método oscilométrico. Med Clin (Barc) 2007; 128:92-4. [PMID: 17288922 DOI: 10.1016/s0025-7753(07)72499-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate the sensitivity and specificity of ankle-brachial index (ABI) determined by oscillometry, using a Doppler ultrasound probe as a gold standard. We also aimed to evaluate the agreement between both methods. PATIENTS AND METHOD Right and left ABI measurements (ABIr,ABIl) with oscillometric (OMRON-705-CP) and Doppler (DIADOP-50) devices in hypertensive patients without peripheral arterial disease. RESULTS One hundred patients, 61 women, 66.4 (SD 10.9) year-old, smokers 16%, diabetics 38%. Oscillometric and doppler ABI could be calculated in 83% and 93% of patients, respectively. Oscillometric ABIr and ABIl measurements were <0.9 in 9.6% (CI 95%, 4.2-18.1) and 8.4% (CI 95%, 3.4-16.6), respectively, and Doppler measurements were 10.8% (CI 95%, 5.3-18.9) and 15.4% (CI 95%, 8.7-24.5) respectively. The oscillometric ABIr and ABIl sensitivity was 37.5% (CI 95%, 13.7-69.4) and 20.0% (CI 95%, 5.7-51.0) respectively, and the specificity was 93.0% (CI 95%, 84.6-97.8) and 97.1% (CI 95%, 89.9-99.2), respectively. The intraclass correlation (index Doppler/oscillometric device) was 0.64 (CI 95%, 0.44-0.77) for ABIr and 0.62 (CI 95%, 0.41-0.76) for ABIl. CONCLUSIONS About 8.4-15.4% of hypertensive patients attended have an abnormal Doppler ABI measurement. There is not a good concordance between Doppler and oscillometric ABI measurements. This oscillometric device does not seem useful as an ABI screening method.
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Affiliation(s)
- Ernest Vinyoles
- Unitat Docent de Medicina Familiar i Comunitària, CAP La Mina, Sant Adrià de Besòs, Barcelona, Spain.
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Estudio de prevalencia de isquemia crónica de miembros inferiores y de aneurisma de aorta abdominal en mayores de 65 años. ANGIOLOGIA 2007. [DOI: 10.1016/s0003-3170(07)75049-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Carbayo JA, Divisón JA, Escribano J, López-Abril J, López de Coca E, Artigao LM, Martínez E, Sanchis C, Massó J, Carrión L. Using ankle-brachial index to detect peripheral arterial disease: prevalence and associated risk factors in a random population sample. Nutr Metab Cardiovasc Dis 2007; 17:41-49. [PMID: 17174225 DOI: 10.1016/j.numecd.2005.08.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2004] [Revised: 03/07/2005] [Accepted: 08/05/2005] [Indexed: 10/24/2022]
Abstract
BACKGROUND AND AIM The ankle-brachial index (ABI) is being used increasingly to diagnose peripheral arterial disease (PAD) that predicts cardiovascular morbidity and mortality. The aim of this study is to determine the prevalence of PAD and associated risk factors in a Spanish random population sample of age > or =40. METHODS AND RESULTS PAD is defined as an ABI<0.9 in either leg. 784 participants of age > or =40 were randomly selected in a Spanish province. 55.4% of them were female. The prevalence of PAD in this sample was 10.5% (95% confidence interval (CI) 8.4-12.8); 9.7% in females and 11.4% in males. In logistic regression analyses, adjusted for age and gender, smoking per 10 pack-years (odds ratio (OR) 1.40, 95% CI 1.23-1.58), hypertension (OR 1.85, 95% CI 1.05-3.28), hypercholesterolemia (OR 1.76, 95% CI 1.04-2.98), and diabetes (OR 1.80, 95% CI 1.04-3.11) were positively associated with prevalent PAD. More than 91% of persons with PAD had one or more cardiovascular disease risk factors. CONCLUSIONS We conclude that in our study hypertension, hypercholesterolemia, diabetes mellitus and smoking are associated with PAD. The majority of individuals with PAD had at least one important cardiovascular risk factor advanced enough to be considered eligible for an aggressive treatment.
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Manzano L, García-Díaz JDD, Gómez-Cerezo J, Mateos J, del Valle FJ, Medina-Asensio J, Viejo LF, Fernández-Ballesteros A, Solís J, Herrero Domingo A, Ferreira E, Sánchez-Fuentes D, Barragán JM, González-Moraleja J, Vargas JA, López-Jiménez M, Zamora J. [Clinical value of the ankle-brachial index in patients at risk of cardiovascular disease but without known atherothrombotic disease: VITAMIN study]. Rev Esp Cardiol 2006. [PMID: 16938208 DOI: 10.1157/13091367] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
INTRODUCTION AND OBJECTIVES Detecting peripheral arterial disease by measuring the ankle-brachial index can help identify asymptomatic patients with established disease. We investigated the prevalence of peripheral arterial disease (i.e., an ankle-brachial index <0.9) and its potential clinical and therapeutic impact in patients with no known arterial disease who were seen at internal medicine departments. METHODS This multicenter, cross-sectional, observational study included patients at risk of cardiovascular disease who were selected on the basis of age, gender and the presence of conventional risk factors. No patient was known to have arterial disease. RESULTS The study included 493 patients, 174 (35%) of whom had diabetes, while 321 (65%) did not. Only 16% were in a low-risk category according to their Framingham score. An ankle-brachial index <0.9 was observed in 27.4%, comprising 37.9% of those with diabetes and 21.3% of those without. Multiple logistic regression analysis showed that the risk factors associated with an ankle-brachial index <0.9 were age, diabetes, and hypercholesterolemia. There was a significant relationship between the ankle-brachial index and Framingham risk categories. Therapeutically, only 21% of patients with an ankle brachial index <0.9 were taking antiplatelet drugs. Overall, 20% had a low-density lipoprotein cholesterol concentration <100 mg/dl and 52% had a concentration <130 mg/dl. Some 42% had arterial blood pressures below 140/90 mm Hg. CONCLUSIONS Asymptomatic peripheral arterial disease was detected in a high proportion of patients with an intermediate or high cardiovascular disease risk. The ankle-brachial index should be measured routinely in patients at risk of cardiovascular disease who are seen at internal medicine departments.
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Affiliation(s)
- Luis Manzano
- Servicio de Medicina Interna, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, España.
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Vicente Díez JI, Lahoz Rallo C, Mostaza Prieto JM. [Can we benefit from determination of the ankle-arm index in primary care consultations?]. Aten Primaria 2006; 38:358-61. [PMID: 17173802 PMCID: PMC7668870 DOI: 10.1157/13093375] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Jose Ignacio Vicente Díez
- Centro de Salud de Fuencarral. Madrid. España
- Correspondencia: Dr. J.I. Vicente Díez. Calanda, 3, 1.° C. 28043 Madrid. España.
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Guijarro C, Mesa N, Jiménez J, Puras E, Sánchez C, Fernández-Sánchez FJ, González-Anglada I, Luján S, Belinchón JC, Casas ML, López-Bescós L. Similitudes y diferencias entre los pacientes con aterosclerosis sintomática de distintos territorios. Cohorte AIRVAG (Atención Integral al Riesgo VAscular Global). Med Clin (Barc) 2006; 127:605-11. [PMID: 17145025 DOI: 10.1157/13094417] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE Even though atherosclerosis is a systemic disease, few prospective studies have evaluated in a thorough and systematic manner the whole vascular tree in patients with clinical damage of different territories. PATIENTS AND METHOD Prospective protocolized study of 269 consecutive patients younger than 70, attended because of symptomatic arteriosclerosis of any territory -53% coronary (CHD), 32% cerebrovascular (CVD), 15% peripheral (PVD)-. Patients underwent evaluation of risk factors and their control, systematic non-invasive study of the vascular tree (Doppler-ultrasound) and comparison between groups according to the index territory. RESULTS Even though all risk factors were represented in the 3 groups, male sex, smoking and diabetes were more frequent in PVD and dyslipemia was more common in CHD (p < 0.05) Abdominal aortic diameter and carotid intima-media thickness were similar for all groups, while the number of carotid plaques was higher in PVD. CHD patients more often presented left ventricular hypertrophy and reduced ejection fraction. PVD patients showed a marked reduction of the ankle-brachial index as well as increased C-reactive protein and homocysteine (p < 0.05). Severe unsuspected vascular lesions were found in 13% of cases (95% confidence interval, 9.5-17.6%). Risk factor control was better for CHD, followed by CVD and PVD, but was globally poor. CONCLUSIONS The systematic evaluation of the vascular tree detects generalized atherosclerotic lesions, in some cases severe and clinically unsuspected. New markers to identify patients at very high risk are necessary. Peripheral vascular disease identifies a group of patients of particular risk. Risk factor control is deficient, particularly among PVD patients.
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Affiliation(s)
- Carlos Guijarro
- Unidad de Medicina Interna, Fundación Hospital Alcorcón, Alcorcón, Madrid, España.
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Lahoz C, Mostaza JM. Índice tobillo-brazo: una herramienta útil en la estratificación del riesgo cardiovascular. Rev Esp Cardiol 2006; 59:647-9. [PMID: 16938205 DOI: 10.1157/13091364] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Lahoz C, Vicente I, Taboada M, Laguna F, Mostaza J. Índice tobillo-brazo y riesgo cardiovascular estimado mediante la función SCORE en sujetos no diabéticos en prevención primaria. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2006. [DOI: 10.1016/s0214-9168(06)73655-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Puras-Mallagray E, Cairols-Castellote M, Vaquero-Morillo F. Estudio piloto de prevalencia de la enfermedad arterial periférica en atención primaria. ANGIOLOGIA 2006. [DOI: 10.1016/s0003-3170(06)74959-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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