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Mostaza JM, Pintó X, Armario P, Masana L, Real JT, Valdivielso P, Arrobas-Velilla T, Baeza-Trinidad R, Calmarza P, Cebollada J, Civera-Andrés M, Cuende Melero JI, Díaz-Díaz JL, Espíldora-Hernández J, Fernández Pardo J, Guijarro C, Jericó C, Laclaustra M, Lahoz C, López-Miranda J, Martínez-Hervás S, Muñiz-Grijalvo O, Páramo JA, Pascual V, Pedro-Botet J, Pérez-Martínez P, Puzo J. SEA 2024 Standards for Global Control of Vascular Risk. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2024; 36:133-194. [PMID: 38490888 DOI: 10.1016/j.arteri.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 02/03/2024] [Indexed: 03/17/2024]
Abstract
One of the objectives of the Spanish Society of Arteriosclerosis is to contribute to the knowledge, prevention and treatment of vascular diseases, which are the leading cause of death in Spain and entail a high degree of disability and health expenditure. Atherosclerosis is a multifactorial disease and its prevention requires a global approach that takes into account the associated risk factors. This document summarises the current evidence and includes recommendations for patients with established vascular disease or at high vascular risk: it reviews the symptoms and signs to evaluate, the laboratory and imaging procedures to request routinely or in special situations, and includes the estimation of vascular risk, diagnostic criteria for entities that are vascular risk factors, and general and specific recommendations for their treatment. Finally, it presents aspects that are not usually referenced in the literature, such as the organisation of a vascular risk consultation.
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Affiliation(s)
- José María Mostaza
- Servicio de Medicina Interna, Unidad de Lípidos y Arteriosclerosis, Hospital La Paz-Carlos III, Madrid, España.
| | - Xavier Pintó
- Unidad de Riesgo Vascular, Servicio de Medicina Interna, Hospital Universitario Bellvitge, Centro de Investigación Biomédica en Red, Fisiopatología de la Obesidad y Nutrición (CIBERobn), Fundación para la Investigación y Prevención de las Enfermedades Cardiovasculares (FIPEC), Universidad de Barcelona, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Barcelona, España
| | - Pedro Armario
- Servicio de Medicina Interna, Área de Atención Integrada de Riesgo Vascular, Complex Hospitalari Universitari Moisès Broggi, Consorci Sanitari Integral (CSI), Sant Joan Despí, Universidad de Barcelona, Barcelona, España
| | - Luis Masana
- Unidad de Medicina Vascular y Metabolismo (UVASMET), Institut d'Investigació Sanitària Pere Virgili (IISPV), Hospital Universitari Sant Joan de Reus, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Universitat Rovira i Virgili, Tarragona, España
| | - José T Real
- Servicio de Endocrinología y Nutrición, Hospital Clínico, Universidad de València, Valencia, España; Departamento de Medicina, Universidad de Valencia, Valencia, España; CIBER de Diabetes y Enfermedades Metabólicas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, España
| | - Pedro Valdivielso
- Unidad de Lípidos, Servicio de Medicina Interna, Hospital Universitario Virgen de la Victoria, Málaga, España; Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA-Bionand), Universidad de Málaga, Málaga, España
| | - Teresa Arrobas-Velilla
- Laboratorio de Nutrición y RCV, UGC de Bioquímica clínica, Hospital Virgen Macarena, Sevilla, España
| | | | - Pilar Calmarza
- Servicio de Bioquímica Clínica, Hospital Universitario Miguel Servet, Zaragoza, España; Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Investigación Sanitaria (ISS) de Aragón, Universidad de Zaragoza, Zaragoza, España
| | - Jesús Cebollada
- Servicio de Medicina Interna, Hospital Clínico Universitario Lozano Blesa, Zaragoza, España
| | - Miguel Civera-Andrés
- Servicio de Endocrinología y Nutrición, Hospital Clínico, Universidad de València, Valencia, España; Departamento de Medicina, Universidad de Valencia, Valencia, España
| | - José I Cuende Melero
- Consulta de Riesgo Cardiovascular, Servicio de Medicina Interna, Complejo Asistencial Universitario de Palencia, Palencia, España
| | - José L Díaz-Díaz
- Sección de Medicina Interna, Unidad de Lípidos y Riesgo Cardiovascular, Hospital Abente y Lago Complejo Hospitalario Universitario A Coruña, La Coruña, España
| | - Javier Espíldora-Hernández
- Instituto de Investigación Biomédica de Málaga y Plataforma en Nanomedicina (IBIMA-Bionand), Universidad de Málaga, Málaga, España; Unidad de Lípidos y Unidad Asistencial de Hipertensión Arterial- Riesgo Vascular (HTA-RV), UGC Medicina Interna, Hospital Universitario Virgen de la Victoria, Málaga, España
| | - Jacinto Fernández Pardo
- Servicio de Medicina Interna, Hospital General Universitario Reina Sofía de Murcia, Universidad de Murcia, Murcia, España
| | - Carlos Guijarro
- Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Universidad Rey Juan Carlos, Alcorón, España
| | - Carles Jericó
- Servicio de Medicina Interna, Área de Atención Integrada de Riesgo Vascular, Complex Hospitalari Universitari Moisès Broggi, Consorci Sanitari Integral (CSI), Sant Joan Despí, Universidad de Barcelona, Barcelona, España
| | - Martín Laclaustra
- Centro de Investigación en Red en Enfermedades Cardiovasculares (CIBERCV), Instituto de Investigación Sanitaria (ISS) de Aragón, Universidad de Zaragoza, Zaragoza, España
| | - Carlos Lahoz
- Servicio de Medicina Interna, Unidad de Lípidos y Arteriosclerosis, Hospital La Paz-Carlos III, Madrid, España
| | - José López-Miranda
- Unidad de Lípidos y Arteriosclerosis, UGC de Medicina Interna, Hospital Universitario Reina Sofía, Córdoba, España; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, España; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, España
| | - Sergio Martínez-Hervás
- Servicio de Endocrinología y Nutrición, Hospital Clínico, Universidad de València, Valencia, España; Departamento de Medicina, Universidad de Valencia, Valencia, España; CIBER de Diabetes y Enfermedades Metabólicas (CIBERDEM), Instituto de Salud Carlos III (ISCIII), Madrid, España
| | - Ovidio Muñiz-Grijalvo
- Servicio de Medicina Interna, UCERV, UCAMI, Hospital Virgen del Rocío de Sevilla, Sevilla, España
| | - José A Páramo
- Servicio de Hematología, Clínica Universidad de Navarra, Navarra, España; Laboratorio Aterotrombosis, CIMA, Universidad de Navarra, Pamplona, España
| | - Vicente Pascual
- Centro de Salud Palleter, Universidad CEU-Cardenal Herrera, Castellón, España
| | - Juan Pedro-Botet
- Unidad de Lípidos y Riesgo Vascular, Servicio de Endocrinología y Nutrición, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, España
| | - Pablo Pérez-Martínez
- Unidad de Lípidos y Arteriosclerosis, UGC de Medicina Interna, Hospital Universitario Reina Sofía, Córdoba, España; Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, España; CIBER Fisiopatología de la Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III (ISCIII), Madrid, España
| | - José Puzo
- Servicio de Bioquímica Clínica, Unidad de Lípidos, Hospital General Universitario San Jorge de Huesca, Huesca, España; Departamento de Medicina, Universidad de Zaragoza, Zaragoza, España
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Cornejo del Río V, Mostaza J, Lahoz C, Sánchez-Arroyo V, Sabín C, López S, Patrón P, Fernández-García P, Fernández-Puntero B, Vicent D, Montesano-Sánchez L, García-Iglesias F, González-Alegre T, Estirado E, Laguna F, de Burgos-Lunar C, Gómez-Campelo P, Abanades-Herranz JC, de Miguel-Yanes JM, Salinero-Fort MA. Prevalence of peripheral artery disease (PAD) and factors associated: An epidemiological analysis from the population-based Screening PRE-diabetes and type 2 DIAbetes (SPREDIA-2) study. PLoS One 2017; 12:e0186220. [PMID: 29073236 PMCID: PMC5657631 DOI: 10.1371/journal.pone.0186220] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 09/27/2017] [Indexed: 11/20/2022] Open
Abstract
AIM To describe the prevalence of Peripheral Artery Disease (PAD) in a random population sample and to evaluate its relationship with Mediterranean diet and with other potential cardiovascular risk factors such as serum uric acid and pulse pressure in individuals ranged 45 to 74 years. METHODS Cross-sectional analysis of 1568 subjects (mean age 6.5 years, 43% males), randomly selected from the population. A fasting blood sample was obtained to determine glucose, lipids, and HbA1C levels. An oral glucose tolerance test was performed in non-diabetic subjects. PAD was evaluated by ankle-brachial index and/or having a prior diagnosis. RESULTS PAD prevalence was 3.81% (95% CI, 2.97-4.87) for all participants. In men, PAD prevalence was significantly higher than in women [5.17% (95% CI, 3.74-7.11) vs. 2.78% (95% CI, 1.89-4.07); p = 0.014]. Serum uric acid in the upper quartile was associated with the highest odds ratio (OR) of PAD (for uric acid > 6.1 mg/dl, OR = 4.31; 95% CI, 1.49-12.44). The remaining variables more strongly associated with PAD were: Heart rate >90 bpm (OR = 4.16; 95%CI, 1.62-10.65), pulse pressure in the upper quartile (≥ 54 mmHg) (OR = 3.82; 95%CI, 1.50-9.71), adherence to Mediterranean diet (OR = 2.73; 95% CI, 1.48-5.04), and former smoker status (OR = 2.04; 95%CI, 1.00-4.16). CONCLUSIONS Our results show the existence of a low prevalence of peripheral artery disease in a population aged 45-74 years. Serum uric acid, pulse pressure and heart rate >90 bpm were strongly associated with peripheral artery disease. The direct association between Mediterranean diet and peripheral artery disease that we have found should be evaluated through a follow-up study under clinical practice conditions.
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Affiliation(s)
- V. Cornejo del Río
- Hospital Carlos III, Madrid, Spain
- Grupo de Investigación en cuidados IdIPAZ, Hospital La Paz, Madrid, Spain
| | | | - C. Lahoz
- Hospital Carlos III, Madrid, Spain
| | | | - C. Sabín
- Hospital Carlos III, Madrid, Spain
| | - S. López
- Hospital Carlos III, Madrid, Spain
| | | | | | | | - D. Vicent
- Hospital Carlos III, Madrid, Spain
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | | | | | | | | | | | - C. de Burgos-Lunar
- Dirección General de Salud Pública, Subdirección de Promoción, Prevención y Educación de la Salud, Consejería de Sanidad, Madrid, Spain
- Red de Investigación en servicios de salud en enfermedades crónicas (REDISSEC), Madrid, Spain
| | - P. Gómez-Campelo
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Plataforma de Apoyo al Investigador Novel, IdiPAZ, Madrid, Spain
| | | | | | - M. A. Salinero-Fort
- Red de Investigación en servicios de salud en enfermedades crónicas (REDISSEC), Madrid, Spain
- Subdirección General de Investigación Sanitaria, Consejería de Sanidad, Madrid, Spain
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Oriol Torón PÁ, Badía Farré T, Romaguera Lliso A, Roda Diestro J. Metabolic syndrome and peripheral artery disease: Two related conditions. ACTA ACUST UNITED AC 2016; 63:258-64. [PMID: 27165186 DOI: 10.1016/j.endonu.2016.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 03/01/2016] [Accepted: 03/13/2016] [Indexed: 12/26/2022]
Abstract
AIMS To ascertain the prevalence of metabolic syndrome (MS) in patients with peripheral artery disease (PAD) at the Martorell primary care (PC) center. To analyze the differences in comorbidities and cardiovascular risk factors between patients with PAD with and without MS. METHODS A cross-sectional, descriptive study on patients diagnosed with PAD according to computerized clinical records of the Martorell PC center. Variables collected included age, sex, high blood pressure (HBP), dyslipidemia (DLP), diabetes (DM), smoking, obesity, cardiovascular disease (CVD), erectile dysfunction (ED), renal failure (RF), and oligoalbuminuria. An analysis comparing patients with and without MS was performed. RESULTS There were 131 patients diagnosed with PAD, 104 (79%) of whom were male. Sixty-three (48.1%) also had MS. Patients with both PAD and MS had, as compared to those with PAD only, a higher prevalence of HBP (87.3 vs. 60.3%, P: 0.001), DLP (77.8 vs. 60.3%, P: 0.03), DM (69.8 vs. 30.9%, P<.001), obesity (25.4 vs. 10.3%, P: 0.03), CVD (42.9 vs. 19.1%); P: 0.004), ED (81.3 vs. 54.3%, P: 0.02), and RF (40.3 vs. 17.9%, P: 0.006). CONCLUSION Patients with both PAD and MS had a higher prevalence of HBP, DLP, DM, and obesity. They also had more cardiovascular events and were significantly associated with pathological conditions highly relevant for cardiovascular prognosis such as erectile dysfunction and chronic kidney disease.
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Affiliation(s)
| | | | - Amparo Romaguera Lliso
- Departament de Metodología, Qualitat i Avaluació Assistencial, AP Costa de Ponent, Institut Catalá de la Salut, Barcelona, España
| | - Jovita Roda Diestro
- Diplomada Universitaria en Enfermería, ABS Sant Andreu de la Barça, Barcelona, España
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Valdivielso P, Ramírez-Bollero J, Pérez-López C. Peripheral arterial disease, type 2 diabetes and postprandial lipidaemia: Is there a link? World J Diabetes 2014; 5:577-585. [PMID: 25317236 PMCID: PMC4138582 DOI: 10.4239/wjd.v5.i5.577] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Revised: 03/19/2014] [Accepted: 07/17/2014] [Indexed: 02/05/2023] Open
Abstract
Peripheral arterial disease, manifested as intermittent claudication or critical ischaemia, or identified by an ankle/brachial index < 0.9, is present in at least one in every four patients with type 2 diabetes mellitus. Several reasons exist for peripheral arterial disease in diabetes. In addition to hyperglycaemia, smoking and hypertension, the dyslipidaemia that accompanies type 2 diabetes and is characterised by increased triglyceride levels and reduced high-density lipoprotein cholesterol concentrations also seems to contribute to this association. Recent years have witnessed an increased interest in postprandial lipidaemia, as a result of various prospective studies showing that non-fasting triglycerides predict the onset of arteriosclerotic cardiovascular disease better than fasting measurements do. Additionally, the use of certain specific postprandial particle markers, such as apolipoprotein B-48, makes it easier and more simple to approach the postprandial phenomenon. Despite this, only a few studies have evaluated the role of postprandial triglycerides in the development of peripheral arterial disease and type 2 diabetes. The purpose of this review is to examine the epidemiology and risk factors of peripheral arterial disease in type 2 diabetes, focusing on the role of postprandial triglycerides and particles.
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Suarez Fernandez C. ¿Debemos buscar enfermedad subclínica en pacientes de alto riesgo vascular? Med Clin (Barc) 2013; 140:356-7. [DOI: 10.1016/j.medcli.2012.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2012] [Revised: 11/22/2012] [Accepted: 11/22/2012] [Indexed: 10/27/2022]
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Real de Asúa D, Puchades R, García-Polo I, Suárez C. A Study on the Relationship between Serum Beta 2-Microglobulin Levels, Underlying Chronic Kidney Disease, and Peripheral Arterial Disease in High-Vascular-Risk Patients. Int Cardiovasc Res J 2012; 6:107-12. [PMID: 24757603 PMCID: PMC3987415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2012] [Revised: 10/18/2012] [Accepted: 11/23/2012] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Serum beta 2-microglobulin (B2M) levels have been found to be increased in patients with peripheral arterial disease (PAD), yet it is still unknown whether B2M correlates with PAD intensity. OBJECTIVES We aim to evaluate the correlation between B2M and the ankle-brachial index (ABI) values in high-vascular-risk patients. METHODS This is a cross-sectional study of 63 high-vascular-risk patients admitted to the Cardiology Department or evaluated as outpatients in the Internal Medicine Department of our institution. Patients were classified into two groups according to their ABI: patients without PAD (n = 44, ABI values between 0.9 and 1.4) and patients with PAD (n = 19, ABI values lower than 0.9 or higher than 1.4). We performed univariate and multivariate analysis based on a multiple linear regression model. RESULTS Serum B2M levels were higher in patients with pathological ABI values than in those without PAD (2.36 ± 1.13 vs. 1.80 ± 0.65 mg/L; P<0.05). We found no correlation between B2M and ABI in our total population (r = -0.12) or in patients with PAD (r = -0.09; NS for both comparisons). Age, gender, arterial hypertension, estimated glomerular filtration rate (eGFR), uric acid, total cholesterol, and LDL-cholesterol correlated with B2M in the univariate analysis. In the final linear regression model, eGFR, uric acid and total cholesterol correlated independently with B2M (P<0.01). CONCLUSION We found no correlation between B2M levels and ABI values in high-vascular-risk patients that could usefully help in the subsequent diagnosis of PAD. However, we observed a significant correlation between B2M and eGFR, even when renal function was only slightly impaired.
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Affiliation(s)
- Diego Real de Asúa
- Vascular Risk Unit, Internal Medicine Department, Fundación de Investigación Biomédica, Hospital Universitario La Princesa, Madrid, Spain,Corresponding author: Diego Real de Asúa, Department of Internal Medicine, Hospital Universitario La Princesa C/ Diego de León 62, 28006 Madrid, Spain. Tel: +34-915-202 222, Fax:+34-915-202 209.
| | - Ramón Puchades
- Vascular Risk Unit, Internal Medicine Department, Fundación de Investigación Biomédica, Hospital Universitario La Princesa, Madrid, Spain
| | - Iluminada García-Polo
- Vascular Risk Unit, Internal Medicine Department, Fundación de Investigación Biomédica, Hospital Universitario La Princesa, Madrid, Spain
| | - Carmen Suárez
- Vascular Risk Unit, Internal Medicine Department, Fundación de Investigación Biomédica, Hospital Universitario La Princesa, Madrid, Spain
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Novo-García C, Ciria-Uriel J, Novo-García E, Niño-de Mateo M. Determinación del índice tobillo-brazo mediante doppler portátil y tensiómetro automático en pacientes diabéticos. ENFERMERIA CLINICA 2012; 22:198-204. [DOI: 10.1016/j.enfcli.2012.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2011] [Revised: 04/20/2012] [Accepted: 06/03/2012] [Indexed: 11/28/2022]
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Riesgo vascular, diabetes e índice tobillo-brazo. Rev Esp Cardiol (Engl Ed) 2011; 64:729; author reply 729-30. [DOI: 10.1016/j.recesp.2011.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 03/23/2011] [Indexed: 11/21/2022]
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Valdivielso P, Mancera-Romero J, Sánchez-Chaparro MA. Vascular Risk, Diabetes and the Ankle-Brachial Index. REVISTA ESPAÑOLA DE CARDIOLOGÍA (ENGLISH EDITION) 2011; 64:729. [DOI: 10.1016/j.rec.2011.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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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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Pellitero S, Reverter JL, Pizarro E, Granada ML, Aguilera E, Sanmartí A. [Usefulness of pulse oximetry in screening of carotid atherosclerosis in patients with type 2 diabetes mellitus]. Med Clin (Barc) 2010; 135:15-20. [PMID: 20207378 DOI: 10.1016/j.medcli.2009.11.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2009] [Revised: 11/10/2009] [Accepted: 11/10/2009] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND OBJECTIVE Pulse oximetry of the toes has been suggested in the screening of peripheral arterial disease. We studied the uselfuness of pulse oximetry in detection of type 2 diabetic patients with carotid atherosclerosis. SUBJECTS AND METHODS 105 patients with type 2 diabetes mellitus (DM) without previous clinical peripheral arterial disease were enrolled. All patients had (1) ankle-brachial index (ABI) measurement, (2) pulse oximetry to measure SaO(2) of their index fingers and big toes in the supine position and at elevated 30cm and (3) a carotid ultrasound [carotid artery intima-media thickness (IMT) and carotid plaques (CP) measurements]. The ABI was considered abnormal when it was <0.9 and when the pulse oximetry showed a decrease in SaO(2) of >2% of the finger compared to foot or to 30cm foot elevation. RESULTS 60 patients were men (age of 62+/-7 years, HbA(1c) of 6.9+/-1.0); 58.1% had CP. There were no differences in anthropometric and biochemical results between patients with or without CP. The ABI was <0.9 in 49% and 25% of patients with and without CP, respectively. Neither were there differences in pulse oximetry in patients with CP or in those with ABI <0.9. The IMT did not change in relation to pulse oximetry, but it was higher in patients with CP and with ABI <0.9 than in patients without alterations. These results were independent of the presence of previous clinical macroangiopathy. CONCLUSION Pulse oximetry is not a useful screening method of carotid atherosclerosis in type 2 DM.
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Affiliation(s)
- Silvia Pellitero
- Servicio de Endocrinología y Nutrición, Departamento de Medicina Interna, Hospital Germans Trias i Pujol, Universitat Autònoma Barcelona, Badalona, Barcelona, España.
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Afección renal subclínica y establecida en pacientes hipertensos de nuevo diagnóstico. Med Clin (Barc) 2010; 134:246-53. [DOI: 10.1016/j.medcli.2009.06.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Accepted: 06/25/2009] [Indexed: 12/31/2022]
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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: 131] [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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Suárez C, Polo IG, Ibáñez P. [Multidisciplinary approach to atherothrombotic disease]. Med Clin (Barc) 2009; 132 Suppl 2:38-40. [PMID: 19631838 DOI: 10.1016/s0025-7753(09)71752-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Atherothrombosis is a systemic disease that can manifest as involvement of distinct vascular territories; those most frequently leading to diagnosis being coronary, cerebrovascular and peripheral arterial vascular territories. Atheromatosis of the aorta or its branches can be asymptomatic or manifest clinically in the form of mesenteric ischemia or ischemic nephropathy. Atherothrombosis therefore involves distinct medical specialities and healthcare levels such as cardiology, neurology, nephrology, endocrinology, vascular surgery, internal medicine, and primary care. Simultaneous involvement of more than one vascular territory, whether symptomatic or asymptomatic, requires a global, multidisciplinary and coordinated approach. Additionally, medical intervention should not be limited to treatment of the acute accident as prevention, both primary and secondary, is a key factor in the management of this disease. It is here that specialties with an overall view such as internal medicine or primary care are especially well placed to play a fundamental and coordinating role. This multidisciplinary intervention involves not only physicians but also other health professionals such as dieticians, physical exercise specialists and, especially, nurses, who should play a key role in controlling risk factors, in health education and in monitoring treatment adherence.
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Manzano L, García-Díaz JDD, Suárez C, Mostaza JM, Cairols M, González-Sarmiento E, Rojas AM, Vieitez P, Sánchez-Zamorano MA, Zamora J. Thigh and buttock exertional pain for the diagnosis of peripheral arterial disease. Eur J Intern Med 2009; 20:429-34. [PMID: 19524189 DOI: 10.1016/j.ejim.2008.12.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Revised: 11/02/2008] [Accepted: 12/18/2008] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To evaluate the prevalence of both non-calf intermittent claudication (IC) and classic IC in patients with no known atherosclerotic disease, and their accuracy to detect peripheral arterial disease (PAD). DESIGN Cross sectional, observational study conducted at 96 internal medicine services. MATERIALS AND METHODS 1487 outpatients with no known atherosclerotic disease, and either diabetes or a SCORE risk estimation of at least 3% were enrolled. IC was assessed using the Edinburgh Claudication Questionnaire and PAD was confirmed by an ankle-brachial index (ABI) <0.9. RESULTS Overall, 7.2% met criteria of classic and 5.8% of non-calf IC. PAD was diagnosed in 393 cases (26.4%). In these PAD patients, 17.8% exhibited classic and 13.2% non-calf IC. Both calf and non-calf IC had similar overall accuracy for detecting PAD. Considering both categories as a whole, the sensitivity of IC to predict a low ABI was 31% and the specificity 93%. CONCLUSIONS Non-calf IC is comparable to classic IC for the diagnosis of PAD in patients with no known arterial disease. The systematic implementation of Edinburgh Claudication Questionnaire could be a valuable call-to-action to improve clinical evaluation of PAD, bearing in mind that PAD detected by either non-calf or classic IC must be confirmed by ABI testing.
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Affiliation(s)
- Luis Manzano
- Heart Failure and Vascular Risk Unit, Hospital Ramón y Cajal, Universidad de Alcalá, Madrid, Spain.
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Resúmenes. HIPERTENSION Y RIESGO VASCULAR 2009. [DOI: 10.1016/s1889-1837(09)70513-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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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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González-Juanatey JR, Grigorian-Shamagian L, Juiz-Crespo MA, Sánchez-Loureiro M, Rodríguez-Moldes E, Dopico-Pita J, Gutiérrez-Fernández G, Torres-Colomer J, Blanco-Rodríguez R, Otero-Raviña F. Impacto pronóstico de la localización de la enfermedad aterosclerosa previa en pacientes diabéticos. Estudio Barbanza-diabetes. Rev Esp Cardiol 2008. [DOI: 10.1157/13127848] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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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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Martín Borge V, Herranz de la Morena L, Castro Dufourny I, Pallardo Sánchez LF. [Peripheral arterial disease in diabetic patients: utility of the toe-brachial index]. Med Clin (Barc) 2008; 130:611-2. [PMID: 18482527 DOI: 10.1157/13120340] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate the influence of peripheral neuropathy, autonomic neuropathy and arterial wall calcification on the concordance of ankle-brachial index (ABI) and toe-brachial index (TBI) in diabetic patients. PATIENTS AND METHOD We evaluated in 221 diabetic patients (73.8% type 2; 66.6% male) the presence of: peripheral arterial disease, peripheral neuropathy, autonomic neuropathy and arterial wall calcification. RESULTS The mean (standard deviation) difference between ABI and TBI in our population was 0.33 (0.25). Patients with arterial wall calcification had a higher mean difference between ABI and TBI than patients without arterial wall calcification -0.87 (0.39) vs 0.30 (0.21) (p < 0.005)-. Mean difference between ABI and TBI was similar for patients with and without autonomic neuropathy -0.36 (0.26) vs 0.30 (0.24) (p = 0.057)- and for patients with and without peripheral neuropathy -0.34 (0.28) vs 0.31 (0.21) (p = 0.423)-. Among all patients there was a significant linear association (r = 0.506; p < 0.001) between ABI and TBI. For patients with arterial wall calcification there was no correlation between both indices (r = -0.070; p = 0,857). CONCLUSIONS Our findings indicate that in diabetic patients, TBI is the method of choice to evaluate lower limb perfusion in the presence of overt arterial wall calcification.
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Valdivielso P, Ariza MJ, de la Vega-Román C, González-Alegre T, Rioja J, Ulzurrun E, González-Santos P. Association of the -250G/A promoter polymorphism of the hepatic lipase gene with the risk of peripheral arterial disease in type 2 diabetic patients. J Diabetes Complications 2008; 22:273-7. [PMID: 18413186 DOI: 10.1016/j.jdiacomp.2007.06.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2006] [Revised: 06/04/2007] [Accepted: 06/19/2007] [Indexed: 01/09/2023]
Abstract
AIM This study aimed to investigate the association between a polymorphism in the hepatic lipase (LIPC) gene promoter and the presence of peripheral arterial disease (PAD) in persons with type 2 diabetes. PATIENT AND METHODS We evaluated 120 type 2 diabetics and identified those with PAD according to the ankle-arm index. The G-250A polymorphisms in the promoter of the LIPC gene were studied by PCR restriction. A logistic regression analysis was performed to determine the association between the rare allele and PAD. RESULTS The prevalence of PAD was 19%. The frequency of the -250A allele was 0.211 in the group without PAD and 0.395 in the group with PAD (P<.05). Carriers of the -250A allele differed only in the ankle-arm index (0.92+/-0.12 for carriers vs. 1.00+/-0.12 for noncarriers, P<.05), with the difference remaining significant after adjustment for covariates (age; sex; waist-to-hip ratio; body mass index; duration of diabetes; smoking; hypertension; glycated hemoglobin; triglycerides; HDL cholesterol; LDL cholesterol; small, dense LDL cholesterol). Only smoking [odds ratio (OR)=6.93, 95% confidence interval (CI)=2.12-22.69, P=.001] and the -250A allele (OR=2.89, 95% CI=1.07-7.84, P=.036) were significantly associated with vascular disease in the logistic regression analysis. CONCLUSIONS Patients with type 2 diabetes who are carriers of the rare -250A allele in the promoter of the hepatic lipase gene are susceptible to PAD.
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Affiliation(s)
- Pedro Valdivielso
- Hospital Virgen de la Victoria, Departamento de Medicina y Dermatologia, Universidad de Málaga, 29010-Málaga, Spain.
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