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Gajanana D, Raikar MG, Ram P, Bhalla V, Figueredo V, Janzer S, George JC. Validation of digital ankle-brachial index as a screening tool in symptomatic patients with peripheral arterial disease. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2019; 20:207-209. [DOI: 10.1016/j.carrev.2018.06.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2018] [Accepted: 06/26/2018] [Indexed: 11/24/2022]
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Tosun V, Güntekin Ü, Şimşek H, Kandemir YB. Aortic-flow propagation velocity is associated with proteinuria and left ventricular hypertrophy in newly diagnosed hypertensive patients. Echocardiography 2019; 36:328-335. [PMID: 30605931 DOI: 10.1111/echo.14239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 11/27/2018] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Subclinical target organ damage (TOD) is an important long-term complication of hypertension and is associated with cardiovascular events and death. Aortic-flow propagation velocity (APV) is one of the arterial stiffness parameters. The aim of this study was to investigate the predictive value of APV on left ventricular hypertrophy (LVH) and proteinuria. METHODS A total of 149 newly diagnosed HT patients were included in the study. Urine samples and blood tests were obtained from each patient for diagnosis of proteinuria. All patients underwent echocardiographic examination. All patients' APV measurements, carotid intima-media thicknesses (CIMT), and ankle-brachial indexes (ABI) were measured and recorded. RESULTS The LVH (+) group consisted of 47 patients, and the LVH (-) group consisted of 102 patients. The proteinuria (+) group consisted of 32 patients, and the proteinuria (-) group consisted of 117 patients. Average CIMT was significantly higher in both proteinuria (+) and LVH (+) groups compared with the (-) groups. ABI and APV were significantly lower in both proteinuria (+) and LVH (+) groups compared with the (-) groups. APV was negatively correlated with LVH, proteinuria, and CIMT and positively correlated with ABI. In the multivariate binary logistic regression analysis, APV was the significant independent predictor of proteinuria. Additionally, APV and ABI were found to be independent predictors of LVH or/and proteinuria. CONCLUSION Hypertensive patients who had TOD had worse consequences of APV, CIMT, and ABI. APV had a powerful predictive value to identify the patients with higher risk of TOD among newly diagnosed hypertensive patients.
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Affiliation(s)
- Veysel Tosun
- Department of Cardiology, Şanlıurfa Education and Research Hospital, Şanlıurfa, Turkey
| | - Ünal Güntekin
- Faculty of Medicine, Department of Cardiology, Akdeniz University, Antalya, Turkey
| | - Hakkı Şimşek
- Faculty of Medicine, Department of Cardiology, Dicle University, Diyarbakır, Turkey
| | - Yasemin B Kandemir
- Faculty of Medicine, Department of Anatomy, Akdeniz University, Antalya, Turkey
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Disease-specific characteristics of vascular cell adhesion molecule-1 levels in patients with peripheral artery disease. Heart Vessels 2018; 34:976-983. [PMID: 30535754 PMCID: PMC6531410 DOI: 10.1007/s00380-018-1315-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 11/30/2018] [Indexed: 12/25/2022]
Abstract
Peripheral arterial disease (PAD) is one of the most common manifestations of systemic atherosclerosis. The prevalence of unrecognized PAD is high, leading to a lack of opportunity to detect subjects at a high risk for cardiovascular events. Inflammatory processes play an important role in the disease initiation as well as in the disease progression. Vascular cell adhesion molecule 1 (VCAM-1), a biomarker of endothelial dysfunction, appears to be an important mediator in inflammatory processes. Therefore, we hypothesized that in patients with PAD, circulating VCAM-1 might be elevated due to its function in mediating adhesion of immune cells to the vascular endothelium in the process of endothelial dysfunction and inflammation, and, therefore, applicable as a diagnostic biomarker. A total of 126 non-consecutive patients were enrolled in this study, of whom 51 patients had typical clinical manifestations of PAD and as controls 75 patients with no history of PAD or cardiovascular disease. All serum samples were obtained either during hospitalization or during out-patient visits and analyzed for VCAM-1 by the ELISA. Compared with controls, median levels of VCAM-1 were significantly elevated in patients suffering from PAD (953 vs. 1352 pg/ml; p < 0.001). Furthermore, VCAM-1 appeared to be highly discriminative for the detection of PAD (AUC = 0.76; CI 0.67-0.83). We could not observe dynamics related to increasing disease stages according to Rutherford classes in patients with apparent PAD. VCAM-1 was shown to be a potential discriminator and biomarker for the severity of systemic atherosclerosis. In a logistic regression analysis, VCAM-1 was robustly associated with the diagnosis of PAD, even after correction for clinically relevant cofounders (namely age, arterial hypertension, diabetes and LDL levels). Thusly, VCAM-1 might serve as a biomarker for PAD screening and detection.
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Jirak P, Mirna M, Wernly B, Paar V, Thieme M, Betge S, Franz M, Hoppe U, Lauten A, Kammler J, Schulze PC, Lichtenauer M, Kretzschmar D. Analysis of novel cardiovascular biomarkers in patients with peripheral artery disease. Minerva Med 2018; 109:443-450. [PMID: 29652038 DOI: 10.23736/s0026-4806.18.05628-8] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Peripheral artery disease (PAD) is a common form of manifestation of atherosclerosis. PAD has a considerable impact on morbidity, hospitalization rates and health-care costs. Biomarkers have been introduced in many cardiovascular disease entities over the last years. However, an analysis on the correlation of biomarker levels and PAD is still lacking. METHODS A total of 106 patients were enrolled in this current study, 51 that were diagnosed with PAD and 55 with excluded coronary and peripheral artery disease as controls. During outpatient visits, plasma samples of all patients were obtained and analyzed for sST2 (hemodynamics and inflammation), galectin-3 (fibrosis and remodeling), GDF-15 (remodeling and inflammation), suPAR (inflammation), and fetuin-A (vascular calcification) by use of ELISA after informed consent. RESULTS Compared with controls, patients with PAD showed significantly higher levels of sST2 (5248 vs. 7503 pg/mL, P<0.001), suPAR (2267 vs. 2414 pg/mL, P=0.02), galectin-3 (2795 vs. 4494 pg/mL, P<0.001), and GDF-15 (549 vs. 767 pg/mL, P<0.001). Fetuin-A showed a trend towards lower levels in patients with PAD (117 vs. 100 ng/mL, P=0.119). CONCLUSIONS Circulating levels of sST2, suPAR, galectin-3, and GDF-15 were significantly elevated in PAD patients. In contrast, fetuin-A levels showed a decrease in PAD patients indicating increased vascular calcification. Thus, by incorporating different pathophysiological processes present in PAD, tested novel biomarkers facilitate a more precise diagnosis as well as a more accurate evaluation of disease severity and progression.
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Affiliation(s)
- Peter Jirak
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - Moritz Mirna
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - Bernhard Wernly
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - Vera Paar
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - Marcus Thieme
- Department of Cardiology, Clinic of Internal Medicine I, University Heart Center Thüringen, Friedrich Schiller University, Jena, Germany
| | - Stefan Betge
- Department of Cardiology, Clinic of Internal Medicine I, University Heart Center Thüringen, Friedrich Schiller University, Jena, Germany
| | - Marcus Franz
- Department of Cardiology, Clinic of Internal Medicine I, University Heart Center Thüringen, Friedrich Schiller University, Jena, Germany
| | - Uta Hoppe
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria
| | - Alexander Lauten
- Department of Cardiology, Charité Medical University, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), Berlin, Germany
| | - Jürgen Kammler
- Department of Cardiology, Kepler University Hospital, Linz, Austria
| | - Paul C Schulze
- Department of Cardiology, Clinic of Internal Medicine I, University Heart Center Thüringen, Friedrich Schiller University, Jena, Germany
| | - Michael Lichtenauer
- Department of Cardiology, Clinic of Internal Medicine II, Paracelsus Medical University, Salzburg, Austria -
| | - Daniel Kretzschmar
- Department of Cardiology, Clinic of Internal Medicine I, University Heart Center Thüringen, Friedrich Schiller University, Jena, Germany
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Arca M, Ansell D, Averna M, Fanelli F, Gorcyca K, Iorga ŞR, Maggioni AP, Paizis G, Tomic R, Catapano AL. Statin utilization and lipid goal attainment in high or very-high cardiovascular risk patients: Insights from Italian general practice. Atherosclerosis 2018; 271:120-127. [PMID: 29499359 DOI: 10.1016/j.atherosclerosis.2018.02.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 02/04/2018] [Accepted: 02/14/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND AND AIMS Statin utilization and lipid goal achievement were estimated in a large sample of Italian patients at high/very-high cardiovascular (CV) risk. METHODS Patients aged ≥18 years with a valid low-density lipoprotein cholesterol (LDL-C) measurement in 2015 were selected from the IMS Health Real World Data database; non-high-density lipoprotein cholesterol (non-HDL-C) was assessed in those with available total cholesterol measurements. Index dates were defined as the last valid lipid measurement in 2015. Patients were hierarchically classified into mutually exclusive risk categories: heterozygous familial hypercholesterolemia (primary and secondary prevention), atherosclerotic CV disease (including recent acute coronary syndrome [ACS], chronic coronary heart disease, stroke, and peripheral arterial disease), and diabetes mellitus (DM) alone. Statin and non-statin lipid-modifying therapy (LMT) use, and European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guideline-recommended goal attainment, were assessed. RESULTS Among 66,158 patients meeting selection criteria, the overall rate of LMT prescriptions was 53.3%, including 7.7% on high-intensity statin therapy. Statin use was highest for recent ACS and lowest for DM alone. LDL-C goal attainment was 16.0% for <1.8 mmol/l and 45.0% for <2.5 mmol/l; 24.3% reached non-HDL-C <2.6 mmol/l and 52.2% were at <3.3 mmol/l. Goal achievement was greatest with high-intensity statin use. CONCLUSIONS Statin use in this cohort was consistent with previous reports in Italian patients at high/very-high CV risk, and low relative to statin use in other European countries. The low rate of ESC/EAS lipid goal attainment observed was consistent with outcomes of other European studies.
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Affiliation(s)
- Marcello Arca
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Italy.
| | | | - Maurizio Averna
- Department of Internal Medicine and Medical Specialties, School of Medicine, University of Palermo, Italy
| | | | | | | | | | | | | | - Alberico L Catapano
- Department of Pharmacological and Biomolecular Sciences, University of Milan and IRCCS Multimedica, Milan, Italy
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Biscetti F, Straface G, Angelini F, Pitocco D, Landolfi R, Flex A. Association of RANK/RANKL/OPG gene polymorphisms with risk of peripheral arterial disease (PAD) and critical limb ischemia in the general Italian population. Meta Gene 2017. [DOI: 10.1016/j.mgene.2016.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Signorelli SS. Peripheral Artery Disease: To Screen or Not Screen, That Is the Question! Angiology 2016; 68:749-751. [DOI: 10.1177/0003319716677667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Salvatore Santo Signorelli
- Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy
- 3rd Internal Medicine Division, University Hospital “G. Rodolico,” Catania, Italy
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Vella J, Vella M, Cassar K, Camilleri L, Serracino-Inglott A, Azzopardi LM, LaFerla G. Factors Affecting Penetration of Ciprofloxacin in Lower Extremity Ischemic Tissues. INT J LOW EXTR WOUND 2015; 15:126-31. [PMID: 26711367 DOI: 10.1177/1534734615623707] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aims of this study were to evaluate factors influencing the distribution of ciprofloxacin in tissue of patients suffering from varying degrees of peripheral arterial disease (PAD). Blood and tissue samples were collected from patients undergoing debridement or amputation procedures and the amount of ciprofloxacin in them was determined using high-performance liquid chromatography. All patients were administered a 200-mg dose of intravenous ciprofloxacin prior to the debridement or amputation procedure. Data, including patient gender, age, type of diabetes, presence of neuropathy, medications taken, and severity of PAD were collected. These data were then analyzed to determine factors influencing the concentrations of ciprofloxacin in tissue of the lower limbs. The Kruskal-Wallis test, Spearman correlation, and chi-square test were used to relate covariates and fixed factors with the concentration of ciprofloxacin in tissue. Following bivariate analysis, a 3-predictor regression model was fitted to predict tissue concentrations of ciprofloxacin given information about these predictors. Blood and tissue samples were collected from 50 patients having an average age of 68 years. Thirty-three patients were males and 35 patients suffered from type 2 diabetes. The average number of medications that these patients were taking was 10. The majority of patients (n = 35) were suffering from severe PAD. Tissue concentrations of ciprofloxacin were mainly related to plasma concentrations of ciprofloxacin, number of medications that the patients were taking and severity of PAD.
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Di Minno G, Spadarella G, Cafaro G, Petitto M, Lupoli R, Di Minno A, de Gaetano G, Tremoli E. Systematic reviews and meta-analyses for more profitable strategies in peripheral artery disease. Ann Med 2014; 46:475-89. [PMID: 25045928 PMCID: PMC4245179 DOI: 10.3109/07853890.2014.932618] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
In the peripheral arteries, a thrombus superimposed on atherosclerosis contributes to the progression of peripheral artery disease (PAD), producing intermittent claudication (IC), ischemic necrosis, and, potentially, loss of the limb. PAD with IC is often undiagnosed and, in turn, undertreated. The low percentage of diagnosis (∼30%) in this setting of PAD is of particular concern because of the potential worsening of PAD (amputation) and the high risk of adverse vascular outcomes (vascular death, coronary artery disease, stroke). A Medline literature search of the highest-quality systematic reviews and meta-analyses of randomized controlled trials documents that, due to risk of bias, imprecision, and indirectness, the overall quality of the evidence concerning diagnostic tools and antithrombotic interventions in PAD is generally low. Areas of research emerge from the information collected. Appropriate treatments for PAD patients will only derive from ad-hoc studies. Innovative imaging techniques are needed to identify PAD subjects at the highest vascular risk. Whether IC unresponsive to physical exercise and smoking cessation identifies those with a heritable predisposition to more severe vascular events deserves to be addressed. Devising ways to improve prevention of vascular events in patients with PAD implies a co-ordinated approach in vascular medicine.
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Affiliation(s)
- Giovanni Di Minno
- Department of Clinical Mediine and Surgery, Università degli Studi di Napoli , Naples , Italy
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Rodriguez-Roca GC, Villarín-Castro A, Carrasco-Flores J, Artigao-Rodenas LM, Carbayo-Herencia JA, Escobar-Cervantes C, Alonso-Moreno FJ, Segura-Fragoso A, Gómez-Serranillos M, Hernández-Moreno J. Concordance between automated oscillometric measurement of ankle-brachial index and traditional measurement by eco-Doppler in patients without peripheral artery disease. Blood Press 2014; 23:270-5. [PMID: 24646328 DOI: 10.3109/08037051.2013.876796] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM To evaluate the concordance between automated oscillometric measurement (WatchBP® Office ABI) of the ankle- brachial index (ABI) and the traditional measurement by eco-Doppler in a Spanish population without peripheral artery disease attended in primary care. METHODS The ABI was determined by both methods in a general population aged ≥ 18 years, from the RICARTO study. The intraclass correlation coefficient was calculated to assess the concordance between both techniques and the Bland-Altman plot was determined to analyze the agreement between them. RESULTS A total of 322 subjects (mean age 47.7 ± 16.0 years; 54.3% women) were included in the study. With regard to cardiovascular risk factors, 70.5% of subjects had dyslipidemia, 26.7% hypertension, 24.8% obesity, 8.4% diabetes and 25.5% were smokers. Mean ABI measured by eco-Doppler and the automated method were 1.17 ± 0.1 and 1.2 ± 0.1, respectively (mean differences - 0.03 ± 0.09; p < 0.001). The Pearson correlation coefficient and the intraclass correlation coefficient were in both cases 0.70. CONCLUSIONS The automated oscillometric measurement of ABI is a reliable and useful alternative to conventional eco-Doppler determination in the general population without peripheral artery disease attended in primary care.
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Formosa C, Cassar K, Gatt A, Mizzi A, Mizzi S, Camileri KP, Azzopardi C, DeRaffaele C, Falzon O, Cristina S, Chockalingam N. Hidden dangers revealed by misdiagnosed peripheral arterial disease using ABPI measurement. Diabetes Res Clin Pract 2013; 102:112-6. [PMID: 24209599 DOI: 10.1016/j.diabres.2013.10.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2013] [Revised: 06/26/2013] [Accepted: 10/01/2013] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to compare ankle brachial indices (APBI) with pedal waveforms utilizing the continuous wave Doppler in a population with diabetes mellitus. METHODS A prospective study design was employed to investigate the ABPI in a cohort of 49 people with type 2 diabetes mellitus. ABPI assessment was completed using a portable handheld Doppler and ankle pressures of <0.9 were taken as suggestive of peripheral arterial disease (PAD). Arterial spectral waveforms in each foot were also recorded and compared to the ABPI readings. RESULTS Inconsistencies were identified between ABPIs and waveform interpretations in the study population. Approximately 35% of subjects had inconsistencies between their ABPI result and waveform interpretation in their right or left foot. CONCLUSIONS Both ABPIs and Doppler waveforms should be used in the assessment of people with diabetes in order to screen for PAD. This would ensure an accurate assessment of PAD and would allow initiation of appropriate secondary risk factor control measures.
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Teramoto T, Sasaki J, Ishibashi S, Birou S, Daida H, Dohi S, Egusa G, Hiro T, Hirobe K, Iida M, Kihara S, Kinoshita M, Maruyama C, Ohta T, Okamura T, Yamashita S, Yokode M, Yokote K. Cardiovascular disease risk factors other than dyslipidemia. Executive summary of the Japan Atherosclerosis Society (JAS) guidelines for the diagnosis and prevention of atherosclerotic cardiovascular diseases in Japan - 2012 version. J Atheroscler Thromb 2013; 20:733-42. [PMID: 23892529 DOI: 10.5551/jat.17368] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Tamio Teramoto
- Committee for Epidemiology and Clinical Management of Atherosclerosis
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Murphy TP, Dhangana R, Pencina MJ, D'Agostino RB. Ankle-brachial index and cardiovascular risk prediction: an analysis of 11,594 individuals with 10-year follow-up. Atherosclerosis 2011; 220:160-7. [PMID: 22099055 DOI: 10.1016/j.atherosclerosis.2011.10.037] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2011] [Revised: 10/25/2011] [Accepted: 10/25/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND Low ankle-brachial index (ABI) is associated with increased risk of subsequent cardiovascular disease events, independent of Framingham risk factors, but its ability to improve risk prediction prospectively has not been examined. METHODS We conducted post-hoc analysis of data from Atherosclerosis Risk in Communities Study (ARIC Study), a large prospective cohort study. 11,594 white and African American (24.2%) men and women, aged 45-64 years, with available Framingham Risk Score (FRS) variables and ABIs at baseline, and without known history of cardiovascular disease or diabetes mellitus or known peripheral arterial disease at baseline were assessed for hard cardiovascular events (hCVD; defined as heart attack, coronary death or stroke) over median follow-up of 10 years. Hazard ratios, C statistic, and net reclassification indexes were calculated to determine the independent predictive ability of ABI compared with FRS. RESULTS 659 hCVD events occurred. Standardized ABI was significantly associated with hCVD events but with a relatively small effect on events (hazard ratios of 0.85 per standard deviation (95% CI 0.79-0.91) (p-value<0.0001)). The C statistic of FRS modified with ABI was only modestly improved (0.756-0.758). Net reclassification improvement, an indicator of prospective prediction performance, using an ABI threshold of 0.9 was small and statistically insignificant (0.8%, p=0.50). CONCLUSIONS Although the ABI adjusted for Framingham risk variables was independently associated with subsequent events in terms of hazard ratios, the independent effect of ABI when adjusted for FRS was small in magnitude, and the FRS performed similarly with or without integration or supplementation with ABI. These findings do not provide strong evidence to support FRS modification to include ABI.
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Affiliation(s)
- Timothy P Murphy
- Vascular Disease Research Center, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, United States.
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