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Mahamat-Azaki O, Zakaria AMZ, Oumar A, Mahamat YK, Ali AA, Lackdjoulki D, Soya E. [Peripheral arterial disease in black African diabetics: epidemioclinical, ultrasonographic profile and determining factors]. Ann Cardiol Angeiol (Paris) 2024; 73:101736. [PMID: 38636245 DOI: 10.1016/j.ancard.2024.101736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 01/15/2024] [Accepted: 01/22/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Diabetes can lead to micro and macro-angiopathies. The peripheral arterial disease (PAD) is a serious and an incapacitating disease. It is still under-estimated and under-treated throughout the world, particularly in sub-Saharan Africa. Doppler ultrasound, and in particular ankle brachial index (ABI), can be used to detect it. The aim was to determine the prevalence of PAD to study the clinical and ultrasonographic aspects and to identify the determining factors. PATIENTS AND METHODS This was a descriptive and analytical study over a period of 5 years, including a total of 782 diabetic patients hospitalised in the diabetology department of the CHU la Reference Nationale. RESULTS Among the 782 patients, 166 (21.2%) had an ABI < 0.9 reflected the PAD and 72 (9.2%) had an ABI > 1.3, suggestive of mediacalcosis. PAD of the lower limb was mild in 102 patients (61.4%), moderate in (26.3%) and severe in (12.3%). The mean age of the arteritic patients was 56.4 ± 10.2 years. Male gender predominated (59.6%) with a sex ratio of 1.6. All patients had type 2 diabetes (100%). The mean duration of diabetes was 13 ± 5.9 years. The majority of our patients with arterial disease had diabetes for at least 10 years (54.2%). The other cardiovascular in this population were obesity (45.2%), followed by hypertension and dyslipidaemia (32.5%). Diabetes was unbalanced (HbA ≥7%) in the majority of cases (75.3%). Clinically, the majority of patients had a trophic disorder (68%). Asymptomatic patients accounted for 24.6% of cases and those with intermittent claudication for 7.4%. Duplex doppler of the lower limbs showed that all patients with PAD had atheromatous lesions. The distal location was predominantly in the tibial arteries (54.8%). The determinants of PAD in this diabetic population were hypertension (p = 0.01) and obesity (p = 0.01). CONCLUSION In our series, PAD was often discovered at an advanced stage, with a non-negligible prevalence. The determining factors found were hypertension and obesity. Screening and control of major cardiovascular risk factors is a priority in the management of this disease.
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Affiliation(s)
- Oumar Mahamat-Azaki
- Service de cardiologie, CHU de la Référence Nationale. BP : 130 Ndjamena-Tchad..
| | | | - Abba Oumar
- Service de diabétologie, CHU de la Référence Nationale. BP : 130 Ndjamena-Tchad
| | | | - Adam Ahamat Ali
- Service de médecine, CHU de la Renaissance. BP : 2029 Ndjamena-Tchad
| | - Deneube Lackdjoulki
- Service de cardiologie, CHU de la Référence Nationale. BP : 130 Ndjamena-Tchad
| | - Esaie Soya
- Service des explorations externes de l'Institut de Cardiologie d'Abidjan, BPV 206 Abidjan, Côte d'Ivoire
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Paul E, Jaquinandi V, Larralde A, Schnell F, Mahé G. [Contribution of the maximal exercise test to diagnosis the vascular origin of leg pain in athletes]. J Med Vasc 2018; 43:379-383. [PMID: 30522712 DOI: 10.1016/j.jdmv.2018.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 09/21/2018] [Indexed: 11/29/2022]
Abstract
Leg pain is a common debilitating symptom in athletes. Vascular disease is not often proposed as a possible cause. Maximal exercise with measure of the ankle-brachial index after exercise can be an interesting diagnostic test. We report an illustrative case where an athlete presented leg pain revealing arterial disease disclosed by exercise. Interestingly, sub-maximal exercise did not cause pain, causing a delay in diagnosis. The vascular origin of leg pain can be detected with a maximal exercise test that induces the symptomatic pain or at least clinical discomfort.
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Affiliation(s)
- E Paul
- Service d'imagerie et explorations vasculaires, 2, rue Henri Le Guilloux, 35000 Rennes, France.
| | - V Jaquinandi
- Service d'imagerie et explorations vasculaires, 2, rue Henri Le Guilloux, 35000 Rennes, France
| | - A Larralde
- Service d'imagerie et explorations vasculaires, 2, rue Henri Le Guilloux, 35000 Rennes, France
| | - F Schnell
- Service de médecine du sport, CHU de Pontchaillou, 2, rue Henri Le Guilloux, 35000 Rennes, France
| | - G Mahé
- Service d'imagerie et explorations vasculaires, 2, rue Henri Le Guilloux, 35000 Rennes, France
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Rada C, Oummou S, Merzouk F, Amarir B, Boussabnia G, Bougrini H, Benzaroual D, Elkarimi S, Elhattaoui M. [Ankle-brachial index screening for peripheral artery disease in high cardiovascular risk patients. Prospective observational study of 370 asymptomatic patients at high cardiovascular risk]. J Mal Vasc 2016; 41:353-357. [PMID: 27865565 DOI: 10.1016/j.jmv.2016.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2016] [Accepted: 09/26/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Peripheral arterial disease is a marker of systemic atherosclerosis; it is associated with a high risk of cardiovascular disease. The aim of our study was to assess the prevalence of peripheral arterial disease by measuring the ankle-brachial pressure index in patients at high cardiovascular risk and to study the risk factors associated with this disease. METHODOLOGY This was a descriptive and analytic cross-sectional study which focused on 370 patients seen at the medical consultation for atherosclerosis prevention. The ankle-brachial index was measured with a portable Doppler (BIDOP 3) using 4 and 8Hz dual frequency probes. The standards were: normal ankle-brachial index 0.9 to 1.3; peripheral artery obstructive disease ankle-brachial index less than 0.9; poorly compressible artery (medial arterial calcification) ankle-brachial index greater than 1.3. Cardiovascular risk factors were also studied. RESULTS Three hundred and seventy subjects (mean age 65.5±8.7years) were screened Cardiovascular risk factors were: sedentary lifestyle (91.5 %), hypertension (68.1 %), elevated LDL-cholesterolemia (36.3 %), diabetes (48.3 %) and tobacco smoking (33.8 %). The prevalence of peripheral artery disease was 32.4 % of which 77.5 % were asymptomatic. We found a significant correlation with smoking, diabetes, dyslipidemia and the presence of coronary artery disease or vascular cerebral disease. Screening for peripheral arterial disease (PAD) with the ankle-brachial index has increased the percentage of polyvascular patients from 6.2 to 29 %. Factors independently associated with PAD were advanced age, presence of cardiovascular disease, smoking and glycated hemoglobin. CONCLUSION PAD is a common condition in people at high cardiovascular risk, the frequency of asymptomatic forms justifies the screening with pocket Doppler which is a simple, inexpensive and effective test to assess the overall cardiovascular risk.
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Affiliation(s)
- C Rada
- Service de cardiologie et maladies vasculaires, faculté de médecine, CHU Mohammed VI, Assif 53, 40080 Marrakech, Maroc.
| | - S Oummou
- Service de cardiologie et maladies vasculaires, faculté de médecine, CHU Mohammed VI, Assif 53, 40080 Marrakech, Maroc
| | - F Merzouk
- Service de cardiologie et maladies vasculaires, faculté de médecine, CHU Mohammed VI, Assif 53, 40080 Marrakech, Maroc
| | - B Amarir
- Service de cardiologie et maladies vasculaires, faculté de médecine, CHU Mohammed VI, Assif 53, 40080 Marrakech, Maroc
| | - G Boussabnia
- Service de cardiologie et maladies vasculaires, faculté de médecine, CHU Mohammed VI, Assif 53, 40080 Marrakech, Maroc
| | - H Bougrini
- Service de cardiologie et maladies vasculaires, faculté de médecine, CHU Mohammed VI, Assif 53, 40080 Marrakech, Maroc
| | - D Benzaroual
- Service de cardiologie et maladies vasculaires, faculté de médecine, CHU Mohammed VI, Assif 53, 40080 Marrakech, Maroc
| | - S Elkarimi
- Service de cardiologie et maladies vasculaires, faculté de médecine, CHU Mohammed VI, Assif 53, 40080 Marrakech, Maroc
| | - M Elhattaoui
- Service de cardiologie et maladies vasculaires, faculté de médecine, CHU Mohammed VI, Assif 53, 40080 Marrakech, Maroc
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Codjo HL, Adoukonou TA, Wanvoegbe A, Dohou H, Bankolé C, Alassani A, Dovonou CA, Houénassi DM. [Prevalence of peripheral artery disease among diabetics in Parakou in 2013]. Ann Cardiol Angeiol (Paris) 2016; 65:260-4. [PMID: 27260949 DOI: 10.1016/j.ancard.2016.04.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 04/29/2016] [Indexed: 10/21/2022]
Abstract
We aimed to determine the prevalence of peripheral artery disease and its associated factors among diabetics. The cross-sectional study was conducted and included all diabetics admitted to the diabetic clinic at the Parakou University hospital during the period of 1st February and 31st July 2013. The diagnosis of peripheral artery disease was based on the Ankle Brachial Index (ABI)<0.9. The socio-demographics data, the data concerning the diabetes and its complications were recorded in each patient. They were 401 diabetics and 59.5 % were females. The mean age was 53.7±11.5 years. Among the diabetics, 168 fulfilled the criteria of PAD, the overall prevalence was 41.9 %. In total, 31.5 % were symptomatics according to Leriche and Fontaine classification. The main associated factors were the increase of age (P=0.01), the absence of activity with high income (P=0.004), the absence of physical activity (P=0.023), the duration of diabetes (P=0.007), the presence of peripheral neuropathy (P=0.003), the glycosylated hemoglobin≥7 % (P<0.001). After a multivariate analysis, only diabetes control was independently associated with arteriopathy (P=0,004). The PAD was more frequent among diabetics in Parakou. The associated factors must be taken into account in order to improve the management of the disease and to reduce the burden of the PAD.
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Affiliation(s)
- H L Codjo
- Unité d'enseignement et de recherche en cardiologie, faculté de médecine, université de Parakou, BP 123, Parakou, Bénin; Service de médecine, centre hospitalier universitaire de Parakou, Parakou, Bénin.
| | - T A Adoukonou
- Service de médecine, centre hospitalier universitaire de Parakou, Parakou, Bénin
| | - A Wanvoegbe
- Unité d'enseignement et de recherche en endocrinologie, maladies métaboliques et en nutrition, faculté de médecine, université d'Abomey Calavi, BP 188, Cotonou, Bénin
| | - H Dohou
- Service de cardiologie, hôpital d'instruction des armées de Parakou, Parakou, Bénin
| | - C Bankolé
- Service de médecine, centre hospitalier universitaire de Parakou, Parakou, Bénin
| | - A Alassani
- Service de médecine, centre hospitalier universitaire de Parakou, Parakou, Bénin
| | - C A Dovonou
- Service de médecine, centre hospitalier universitaire de Parakou, Parakou, Bénin
| | - D M Houénassi
- Unité d'enseignement et de recherche en cardiologie, faculté de médecine, université de Parakou, BP 123, Parakou, Bénin; Service de cardiologie, hôpital d'instruction des armées de Parakou, Parakou, Bénin
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Sfeir D, Lazareth I, Stansal A, Ghaffari P, Michon Pasturel U, Bonhomme S, Priollet P. [Leg ulcers: Should general practitioners hospitalize their patients?]. ACTA ACUST UNITED AC 2016; 41:18-25. [PMID: 26809200 DOI: 10.1016/j.jmv.2015.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 11/28/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Determine whether general practitioners have sufficient expertise in the field of leg ulcers. METHOD A cross-sectional survey was conducted among 179 general practitioners working in the region Île-de-France to evaluate the implementation of leg ulcer guidelines issued by the Superior Health Authority (HAS) in 2006. Participating physicians were either internship supervisors or practitioners in Paris' 14th district. RESULTS The first hundred usable answers (response rate 65%) came from 71 internship supervisors and 29 practitioners of Paris' 14th district. Only 40% of the physicians were aware of the guidelines, with no significant difference noted between the two groups. 9/10 practitioners examined less than 10 patients with leg ulcers per year. Physical examinations were done according to the guidelines and a venous Doppler was prescribed in two thirds of the cases. The ankle-brachial pressure index (ABPI) essential to diagnose lower limb arteriopathy was measured for only 10% of the patients. In accordance with the guidelines, compression was by far (73%) considered as the main treatment as compared to dressing (37%), but compression therapy was well prescribed in only one-third of the cases. Despite poor prognosis criteria (characteristic and time course), referral for a specialized opinion was rare. CONCLUSION Even if they were not always aware of the detailed guidelines, the practitioners applied the main recommendations. Nevertheless, practices could be improved by measuring the ABPI, searching for a diagnosis of arteriopathy, and better prescription of compression therapy. General practitioners should refer patients with leg ulcers to a specialized hospital unit.
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Affiliation(s)
- D Sfeir
- Service de médecine vasculaire, institut de la cicatrisation Jean-Paul-Belmondo, groupe hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France.
| | - I Lazareth
- Service de médecine vasculaire, institut de la cicatrisation Jean-Paul-Belmondo, groupe hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - A Stansal
- Service de médecine vasculaire, institut de la cicatrisation Jean-Paul-Belmondo, groupe hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - P Ghaffari
- Service de médecine vasculaire, institut de la cicatrisation Jean-Paul-Belmondo, groupe hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - U Michon Pasturel
- Service de médecine vasculaire, institut de la cicatrisation Jean-Paul-Belmondo, groupe hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - S Bonhomme
- Service de médecine vasculaire, institut de la cicatrisation Jean-Paul-Belmondo, groupe hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
| | - P Priollet
- Service de médecine vasculaire, institut de la cicatrisation Jean-Paul-Belmondo, groupe hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France
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Esteghamati A, Aflatoonian M, Rad MV, Mazaheri T, Mousavizadeh M, Nakhjavani M, Noshad S. Association of osteoprotegerin with peripheral artery disease in patients with type 2 diabetes. Arch Cardiovasc Dis 2015; 108:412-9. [PMID: 26184866 DOI: 10.1016/j.acvd.2015.01.015] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 11/30/2014] [Accepted: 01/28/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Osteoprotegerin plays a critical role in the pathogenesis of atherosclerosis. Elevated osteoprotegerin concentrations have been reported in microvascular complications of diabetes. Patients with diabetes are at increased risk of macrovascular complications, particularly peripheral artery disease (PAD). AIM To investigate the association between osteoprotegerin concentration and PAD in diabetes. METHODS In a cross-sectional setting, patients with type 2 diabetes for>5 years and no apparent diabetic foot ulcer were recruited. Patients underwent colour Doppler ultrasonography of lower limbs and were designated PAD+ if arterial narrowing was detected. Ankle-brachial index (ABI) was measured. Serum osteoprotegerin concentrations were determined. RESULTS Ninety-eight patients (47 PAD+, 51 PAD-) were recruited. Osteoprotegerin concentrations (median [interquartile range]) were significantly higher in PAD+ versus PAD- patients (0.80 [0.50-1.95] ng/mL vs 0.30 [0.25-0.40] ng/mL; P<0.001). In logistic regression, log-osteoprotegerin was a predictor of PAD in univariate and multivariable analyses. In the final multivariable model, adjusting for age, sex, body mass index, smoking, hypertension, glycaemic control, lipid profile, renal function and C-reactive protein, one standard deviation increase in log-osteoprotegerin was associated with a more than twofold increase in the risk of having PAD (odds ratio 2.26, 95% confidence interval 1.50-3.40). In PAD+ patients, osteoprotegerin was a significant predictor of disease severity, determined by ABI and percentage of vessel occlusion in univariate and multivariable models. CONCLUSIONS Osteoprotegerin concentrations are increased in patients with diabetes and PAD. Osteoprotegerin is an independent predictor of the presence and severity of PAD in diabetic patients.
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Affiliation(s)
- Alireza Esteghamati
- Endocrinology and Metabolism Research Centre (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, P.O. Box 13145-784, Tehran, Iran.
| | - Maryam Aflatoonian
- Endocrinology and Metabolism Research Centre (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, P.O. Box 13145-784, Tehran, Iran
| | - Mona Vahidi Rad
- Endocrinology and Metabolism Research Centre (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, P.O. Box 13145-784, Tehran, Iran
| | - Tina Mazaheri
- Endocrinology and Metabolism Research Centre (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, P.O. Box 13145-784, Tehran, Iran
| | - Mostafa Mousavizadeh
- Endocrinology and Metabolism Research Centre (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, P.O. Box 13145-784, Tehran, Iran
| | - Manouchehr Nakhjavani
- Endocrinology and Metabolism Research Centre (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, P.O. Box 13145-784, Tehran, Iran
| | - Sina Noshad
- Endocrinology and Metabolism Research Centre (EMRC), Vali-Asr Hospital, Tehran University of Medical Sciences, P.O. Box 13145-784, Tehran, Iran
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Meyer D, Bureau JM, Vu Tri D. [Ankle brachial index: motivations, training, and practices among 165 general practitioners in Île-de-France]. ACTA ACUST UNITED AC 2013; 39:18-25. [PMID: 24332303 DOI: 10.1016/j.jmv.2013.11.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 10/26/2013] [Indexed: 10/25/2022]
Abstract
UNLABELLED Peripheral arterial disease (PAD) is under-diagnosed despite its predictive value for cardiovascular mortality. The ankle brachial index (ABI), a simple reliable measure recommended by the French health authorities to detect and evaluate the severity of PAD, is used by too few general practitioners (GPs). OBJECTIVE This study aimed at identifying motivations and barriers for using ABI in general practice. METHOD A representative, descriptive, cross-sectional survey was conducted amongst 165 GPs practicing in Île-de-France who were interviewed using stratified quotas. RESULTS Although 1 out of 5 GPs considered ABI to be an irrelevant indicator, most had a favorable opinion about its use (OR: 4.9 [CI 95 %: 4.2-5.7]). Only 42 % (CI 95 %: 34 %-49 %) of GPs knew ABI was recommended by the health authorities. This information had a critical impact on the acceptance of ABI relevancy (OR: 3.7 [CI 95 %: 3.2-4.2]). Training reinforced acceptance (OR: 5.0 [CI 95 %: 4.4-5.6]) and pre-residency education provided a better understanding of ABI (OR: 2.8 [CI 95 %: 2.3-3.4]). Time needed to measure ABI was the main barrier (OR: 0.6 [CI 95 %: 0.6-0.7]). A Doppler-calculation kit (OR: 11.8 [CI 95 %: 8.9-15.6]), equipment cost≤300Euros (OR: 3.4 [CI 99 %: 3.0-3.9]), a specific fee in addition to the regular consultation fee (OR: 2.6 [CI 95 %: 2.3-3.0]) and inclusion of ABI in the GP's evaluation scheme (OR: 2.6 [CI 95 %: 2.3-2.9]) would motivate more GPs. Seven out of 10 GPs agreed that ABI has a positive impact on patient adherence to treatment and follow-up, but ABI remained underexploited for symptomatic patients (OR: 0.4 [CI 95 %: 0.3-0.4]). CONCLUSION Better communication and training together with an upgraded status for ABI would provide motivation for GPs to measure ABI.
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Affiliation(s)
- D Meyer
- Service de chirurgie vasculaire, groupe hospitalier Paris-Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris cedex 14, France.
| | - J-M Bureau
- Service de rééducation vasculaire, hôpital Corentin-Celton, 92133 Issy-les-Moulineaux, France
| | - D Vu Tri
- Service de rééducation et d'appareillage, institut Robert-Merle-d'Aubigné, 94460 Valenton, France
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