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This study aimed to apply eight machine learning algorithms to develop the optimal model to predict amputation-free survival (AFS) after first revascularization in patients with peripheral artery disease (PAD). Among 2130 patients from 2011 to 2020, 1260 patients who underwent revascularization were randomly assigned to training set and validation set in an 8:2 ratio. 67 clinical parameters were analyzed by lasso regression analysis. Logistic regression, gradient boosting machine, random forest, decision tree, eXtreme gradient boosting, neural network, Cox regression, and random survival forest (RSF) were applied to develop prediction models. The optimal model was compared with GermanVasc score in testing set comprising patients from 2010. The postoperative 1/3/5-year AFS were 90%, 79.4%, and 74.1%. Age (HR:1.035, 95%CI: 1.015–1.056), atrial fibrillation (HR:2.257, 95%CI: 1.193–4.271), cardiac ejection fraction (HR:0.064, 95%CI: 0.009–0.413), Rutherford grade ≥ 5 (HR:1.899, 95%CI: 1.296–2.782), creatinine (HR:1.03, 95%CI: 1.02–1.04), surgery duration (HR:1.03, 95%CI: 1.01–1.05), and fibrinogen (HR:1.292, 95%CI: 1.098–1.521) were independent risk factors. The optimal model was developed by RSF algorithm, with 1/3/5-year AUCs in training set of 0.866 (95% CI:0.819–0.912), 0.854 (95% CI:0.811–0.896), 0.844 (95% CI:0.793–0.894), in validation set of 0.741 (95% CI:0.580–0.902), 0.768 (95% CI:0.654–0.882), 0.836 (95% CI:0.719–0.953), and in testing set of 0.821 (95%CI: 0.711–0.931), 0.802 (95%CI: 0.684–0.919), 0.798 (95%CI: 0.657–0.939). The c-index of the model outperformed GermanVasc Score (0.788 vs 0.730). A dynamic nomogram was published on shinyapp (https://wyy2023.shinyapps.io/amputation/). The optimal prediction model for AFS after first revascularization in patients with PAD was developed by RSF algorithm, which exhibited outstanding prediction performance. • Risk factors for amputation-free survival (AFS) of peripheral artery disease were identified by lasso regression analysis. • Among 8 machine learning algorithms, the optimal prediction model for AFS was developed by random survival forest algorithm. • New machine learning algorithm can build prediction models with excellent capability than conventional LR and Cox models. [ABSTRACT FROM AUTHOR]

Peripheral artery disease (PAD) is a cardiovascular disease that limits patients' walking ability. Persistent ankle-foot orthosis (AFO) use may increase the distance patients can walk as well as physical activity. The purpose of the study was to determine the implementation and patients' perspectives related to the use or disuse of the AFO intervention six months post-intervention. This study was guided by a semi-structured interview and survey based on the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) constructs. A convergent mixed methods design was used to evaluate participants' perceptions six months following a three-month AFO intervention. A survey and semi-structured questionnaire based on the i-PARIHS constructs were administered and analyzed. Vascular surgery clinic and biomechanics research laboratory. Patients (N = 7; male, 100%; age, 71.9 ± 0.6.7y; body mass index, 29.0 ± 0.5.5; ankle brachial index 0.50 ± 0.17) with claudication completed the study. A certified orthotist fit participants with an AFO that was worn for 3 months. Qualitative analysis of semi-structured interviews and quantitative analysis of the survey. The highest positive ratings were seen in the dimensions of usability and cost-effectiveness. The patients found the AFO device and instructions to wear, easy when starting the intervention and there were no out-of-pocket costs. The lower scores and challenges faced with observability and relative advantage domains indicated issues related to motivation for sustained use of the AFO. Barriers associated with AFO function that prevent common activities and poor health seem to be the biggest issue for not wanting to wear the AFO after the 3-month intervention. Addressing patients' perceptions and challenges to wearing the AFO is essential to increasing compliance and physical activity. Future research should concentrate on understanding the compatibility of orthotic device interventions with the subject's lifestyle. Clinical Trial Registration No.: NCT02902211. • Chronic peripheral artery disease causes muscle weakness that impairs walking. • An ankle-foot orthosis may improve the distance patients with peripheral artery disease can walk. • 6 months post-intervention questionnaire assessments were based on i-PARIHS framework. [ABSTRACT FROM AUTHOR]

The innovative pharmacological combination of low-dose rivaroxaban plus aspirin provides clinicians with an ideal opportunity to intensify the medical treatment of patients with coronary artery disease (CAD) and comorbid peripheral artery disease (PAD). We aimed to determine the cost-effectiveness of PAD screening using the ankle-brachial index (ABI) test in patients with CAD (with rivaroxaban administered if the PAD screening was positive) compared with no-screening strategy in China. A Markov decision model using a 1-month cycle was developed to simulate the 25-year effectiveness and cost of PAD screening on 75-year-old patients with CAD in China, evaluating the quality-adjusted life years (QALYs) and incremental cost-effectiveness ratio (ICER). One-way, two-way, and probabilistic sensitivity analyses were conducted to assess the impact of variations in the key parameters for ICERs. Our model found an incremental cost of RMB4,959 (US$740) and an incremental QALY of 0.054 after one-time ABI screening, leading to an ICER of RMB91,936 (US$13,717) per QALY gained over a 25-year period. The reduction in all-cause mortality related to rivaroxaban and its cost were the factors most affecting the ICER. The screening would become cost-effective by decreasing the monthly cost of rivaroxaban to RMB184.5 (US$27.5) or by using domestic-brand rivaroxaban according to the threshold of a willingness to pay RMB72,447 (US$10,809) per QALY gained. Our study demonstrated that ABI screening for PAD to decide on low-dose rivaroxaban administration was not cost-effective for patients with CAD in China. Nevertheless, policy-guided cost changes for domestic-brand rivaroxaban could easily resolve this issue. • ABI screening for PAD was not cost-effective for patients with CAD in China. • The reduction in all-cause mortality related to rivaroxaban most affected the ICER. • Policy-guided cost changes for rivaroxaban could easily resolve this issue in China. [ABSTRACT FROM AUTHOR]

In recent randomized controlled studies, the prevention of stroke and cognitive function of ticagrelor has been controversial. We conducted a meta-analysis to compare ticagrelor with other antiplatelet treatment in patients with vascular high-risk factors disease, defined as acute coronary syndrome, stroke or transient ischemic attack, coronary artery disease or peripheral artery disease. We searched the PubMed, Embase, and Cochrane libraries for published randomized controlled trials and additional available data from ClinicalTrials.gov. The primary outcome was related adverse stroke events and the secondary outcome was cognitive function related adverse events. The outcomes were statistically analyzed using Peto odds ratio. 12 RCTs with 105,654 patients were included in meta-analysis. Primary outcomes: all stroke (OR 0.84, 95%CI 0.78–0.90, P < 0.001); Secondary outcomes: ischemic stroke (OR 0.83, 95%CI 0.77–0.90, P < 0.001), transient ischemic attack (OR 0.78, 95%CI 0.62–0.97, P = 0.029), intracranial hemorrhage (OR 1.33, 95%CI 1.09–1.61, P = 0.005), Parkinson's disease (OR 0.30, 95%CI 0.12–0.72, P = 0.007), dementia (OR 0.31, 95%CI 0.13–0.77, P = 0.012), dizziness (OR: 1.39, 95%CI 1.03–1.87, P = 0.032), insomnia (OR 1.45, 95%CI 1.05–2.00, P = 0.026). Ticagrelor may provide more favorable outcomes for all stroke, ischemic stroke, and transient ischemic attack prevention in patients with vascular high-risk factors. However, this benefit may come with the cost of intracranial hemorrhage, dizziness and insomnia. Ticagrelor may reduce the risk of dementia and Parkinson's disease, although available data are limited. • Ticagrelor reduces the risk of all-cause stroke, ischemic stroke and TIA in patients with vascular high-risk factors; • Ticagrelor may reduce the risk of dementia and Parkinson's disease in patients with vascular high-risk factors； • Ticagrelor is a highly potent platelet drug that does not increase the risk of death; • Ticagrelor still needs to be further studied on its effect on cognitive function. [ABSTRACT FROM AUTHOR]

Paclitaxel-eluting devices (PED) reduce restenosis and target lesion revascularization (TLR) in femoropopliteal intervention. Recent data suggest a two-fold increased long-term mortality in patients treated with PED. The aim of our study is to evaluate if endovascular therapy (EVT) with PED increases mortality risk in patients with symptomatic lower limb peripheral artery disease (PAD) compared to non-eluting devices (NED). The study is a retrospective, single-center registry on patients undergoing EVT for PAD from January 2009 to June 2018. Propensity score analysis on logistic regression model for independent predictors of long-term mortality was used to match PED and NED patients. Mortality was assessed at 2, 5 and 7 years in the entired matched population and in a sub-group of patients ≤75 years. During the study period, 1294 patients, 718 NED and 576 PED, met the inclusion/exclusion criteria and entered in the study. Propensity score matching analysis identified 854 matched patients, 414 PED and 440 NED. The population was mainly characterized by diabetic patients with CLI (80%) and high prevalence of CAD (30%), heart failure (15%) and renal insufficiency (20%). Mean follow-up length was 58 ± 34 months, (median 52.5). Mortality was 18% in NED vs 12% in PED patients at two years (p = 0.01), 36% vs 30% at 5 years (p = 0.03) and 41% vs 39% at seven years (p = 0.2) respectively. In patients ≤75 years, mortality at 7-year was 28% in PED vs 36% in NED, p = 0.07. These results suggest a reduced mortality at 2 and 5 years with PED as compare to NED treatment in a real-world CLI scenario. At 7-year follow-up, the advantage was numerically evident only in patients ≤75 years. • Angioplasty of lower limb arteries is associated with a high incidence of restenosis. • Paclitaxel-eluting devices reduce restenosis and target lesion revascularization in lower limb ischemia. • Recent data are conflicting about long-term mortality in patients treated with PED. • In real world scenario paclitaxel-eluting devices reduce major limb adverse events and mortality at 2 and 5 years follow-up. [ABSTRACT FROM AUTHOR]

Background The COMPASS (Cardiovascular Outcomes for People Using Anticoagulation Strategies) trial showed that rivaroxaban plus aspirin reduced major adverse cardiovascular events (MACE) in patients with chronic coronary artery disease (CAD) and/or peripheral artery disease (PAD). We explored whether CHA 2 DS 2 -VASc or CHADS 2 scores, well-validated tools for assessing risk of thromboembolic events in atrial fibrillation, can identify vascular patients at highest risk of recurrent events who may derive greatest benefits of treatment. Methods Predictive accuracies of the CHA 2 DS 2 -VASc and CHADS 2 scores for MACE, were assessed in this analysis of the COMPASS trial. Kaplan-Meier estimates of cumulative risk were used to compare the effects of rivaroxaban plus aspirin (n = 9152) with aspirin alone (n = 9126) according to risk scores. Results High CHA 2 DS 2 -VASc (6–9) or CHADS 2 (3–6) scores were associated with over three times greater absolute risk of MACE compared with CHA 2 DS 2 -VASc score of 1–2 or CHADS 2 score of 0. The effects of rivaroxaban plus aspirin compared with aspirin alone were consistent across CHA 2 DS 2 -VASc and CHADS 2 score categories for MACE, bleeding and net clinical benefit, with greatest reduction in MACE observed in patients treated for 30 months with highest CHADS 2 score (3–6) (hazard ratio = 0.67, 95% CI: 0.53–0.86, p = 0.0012, 25 events per 1000 patients prevented). Conclusion The CHA 2 DS 2 -VASc and CHADS 2 scores can be used in patients with chronic CAD and/or PAD to identify patients who are at highest risk of MACE. Those identified at highest risk by CHADS 2 scores had greatest benefit from dual pathway inhibition with rivaroxaban plus aspirin. Clinical Trial Registration: NCT01776424 • High CHA 2 DS 2 -VASc/CHADS 2 scores were associated with higher risk of MACE in ASCVD. • Patients with higher CHADS 2 scores had greater benefit of rivaroxaban and aspirin. • The net clinical benefit of rivaroxaban and aspirin vs aspirin alone progressively increased as the CHA 2 DS 2 -VASc score increased - the higher the CHA 2 DS 2 -VASc score the greater the net clinical benefit. [ABSTRACT FROM AUTHOR]

The transfemoral (TF) approach is the gold-standard access route for transcatheter aortic valve replacement (TAVR). Alternative approaches, among which the transcervical (TC) approach, are needed in some patients. We aimed to compare TC-TAVR with TF-TAVR. All patients who underwent TAVR in our institution between 2016 and 2020, using Edwards SAPIEN family balloon-expandable transcatheter heart valves, were retrospectively included. Endpoints included 30-day all-cause mortality, procedural complications (according to the VARC-2 criteria), procedure duration, hospital length of stay (LOS) and echocardiographic outcomes. For 30-day all-cause mortality, we furthermore used a Cox proportional-hazards model to adjust for significant between-group differences in baseline characteristics as well as anesthesia modality. TAVR was performed in 306 patients, using a TF approach (n = 255) or a TC approach (n = 51). TC-TAVR was associated with significantly higher STS scores (4.06 [IQR (interquartile range), 2.05, 5.56] vs. 2.97 [IQR, 2.08, 4.88], p < 0.001) and higher prevalence of peripheral artery disease, history of stroke, previous cardiovascular surgery. 30-day mortality (hazard ratio, 0.87 [0.77, 9.77], p = 0.909) and stroke rates (2.0% vs. 1.6%, p = 0.840) were similar, as well as procedural duration (74.0 [53.0, 99.5] vs. 77.0 [58.0, 98.0] minutes, p = 0.370), LOS (6.0 [IQR, 3.0, 8.0] vs. 6.0 [IQR, 4.0, 9.0] days, p = 0.175) and postprocedural mean transvalvular gradient (10.00 [IQR, 8.00, 13.00] vs. 10.00 [IQR, 8.00, 12.00] mmHg, p = 0.724). Despite a higher cardiovascular disease burden in TC patients, TC-TAVR and TF-TAVR yielded similar outcomes. TC-TAVR may be a safe alternative when TF-TAVR is contraindicated. • Transcatheter aortic valve replacement via a transfemoral access is not possible in 15% of cases. • Transcervical and transfemoral accesses had similar results in terms of mortality, incidence of neurovascular complications, hospital length of stay, and improvement in aortic valve function. • Transcervical access may be a good alternative when transfemoral access is unavailable. [ABSTRACT FROM AUTHOR]

In TAVI patients, peripheral arterial disease (PAD) is a common concomitant disease. Given the fact that calcified severe aortic stenosis (AS) limits the blood flow that reaches the periphery, it is conceivable that the treatment of AS may positively influence the peripheral perfusion. To evaluate whether, and if so, how the peripheral perfusion changes after TAVI in patients with PAD comparing with patients without PAD. On the basis of objective vascular tests, peripheral perfusion in the lower extremities were studied in 108 TAVI patients with or without concomitant PAD. 108 consecutive patients with a median logistic EuroSCORE of 12.7 (IQR: 8.5 to 22.0) % underwent TAVI with an extensive pre- and post-procedural assessment of the peripheral perfusion. In patients without PAD, the time to peak flow (tPF) did not differ before (6.45 ± 5.24 s) and after (6.45 ± 5.91 s) TAVI (p = 1.000). In PAD patients, however, the tPF was significantly shortened following TAVI (9.51 ± 9.45 s vs. 8.33 ± 8.16 s, p < 0.001), thereby reflecting an improvement in peripheral blood flow. The resting arterial blood flow before and after TAVI showed the highest level at the beginning (0 s) and constantly decreased afterwards. No improvement in the peak flow was achieved. In PAD patients, TAVI led to improved peripheral blood flow as reflected by shortened time to peak flow measurements. • Peripheral arterial disease (PAD) is highly prevalent in TAVI candidates. • TAVI induces an improvement in peripheral blood flow. • TAVI results in significantly shortened time to peak flow in patients with PAD. • Peak flow was not altered by TAVI procedure. [ABSTRACT FROM AUTHOR]

Objective To determine if Functional Electrical Stimulation (FES) would improve ischemic pain, walking distance, and quality of life of patients with intermittent claudication. Design Single blind, randomized block, two factorial design. Patients Patients diagnosed with Peripheral Artery Disease (PAD) and intermittent claudication (IC). Ankle Brachial Index ranged 0.4-0.9 on at least one leg. Patients were randomly assigned to experimental (FES + Walk, N = 13) or control (WALK, N = 14) groups. Intervention Experimental group patients received FES to the dorsiflexor and plantarflexor muscles while walking for 1 h/day, six days/week for eight weeks. Control group patients received similar intervention without FES. A Follow-up period of both groups lasted eight weeks. Outcome measures Outcome measures were taken at baseline (T 0 ), after intervention (T 1 ), and after follow-up (T 2 ). Primary measures included Perceived Pain Intensity (PPI), Six minute walk (6MW), and Peripheral Arterial Disease Quality of Life (PADQOL). Secondary measures included Intermittent Claudication Questionnaire (ICQ) and Timed Up and Go (TUG). Results Group by time interactions in PPI were significant ( P < 0.001) with differences of 27.9 points at T 1 and 36.9 points at T 2 favoring the FES + Walk group. Groups difference in Symptoms and Limitations in Physical Function of the PADQOL reached significance (T 1 = 8.9, and T 2 = 8.3 improvements; P = 0.007). ICQ was significant (T 1 = 9.3 and T 2 = 13.1 improvements; P = 0.003). Improvement in 6MW and TUG tests were similar between groups. Conclusions and relevance Walking with FES markedly reduced ischemic pain and enhanced QOL compared to just walking. FES while walking may offer an effective treatment option for the elderly with PAD and Intermittent Claudication. Trial registration NIH-NIA 1R21AG048001 https://projectreporter.nih.gov/project_info_description.cfm?aid=8748641&icde=30695377&ddparam=&ddvalue=&ddsub=&cr=1&csb=default&cs=ASC . https://clinicaltrials.gov/ct2/show/NCT02384980?term=David+Embrey&rank=1 . [ABSTRACT FROM AUTHOR]

Background Measurement of the ankle brachial index (ABI) is a simple, noninvasive means of diagnosing peripheral arterial disease, and has been shown to be associated with mortality rate. Here, we examined the association between ABI and physical function in patients with heart failure (HF). Methods The study population consisted of 524 admitted patients (67.2 ± 13.9 years, 343 males) with HF. Blood pressure and the ABI were determined by oscillometry. Prior to hospital discharge, ABI, 6-minute walking distance, walking velocity, handgrip strength, quadriceps isometric strength, and standing balance were determined. The 524 patients were divided according to ABI as follows: ABI ≤ 0.90 (low ABI), ABI 0.91 to 0.99 (borderline ABI), and ABI 1.00 to 1.40 (normal ABI). Results Lower ABI values were associated with shorter 6-minute walking distance (p trend = 0.001), slower walking velocity (p trend = 0.023), and poorer standing balance (p trend = 0.048). There were no significant associations between ABI and handgrip strength or quadriceps isometric strength. After adjusting for potential confounders, patients with ABI ≤ 0.90 had shorter 6-minute walking distance compared to those with ABI 1.00 to 1.40 (adjusted mean value: 344 m vs. 395 m, respectively, p < 0.001). There were no significant differences in any of the other physical function parameters examined. Conclusions In patients with HF, low ABI is associated with the magnitude of impairment in walking endurance. [ABSTRACT FROM AUTHOR]

Background High sensitivity CRP (hsCRP), coronary artery calcification on CT (CT calcium), carotid artery intima media thickness on ultrasound (cIMT) and ankle-brachial index (ABI) improve prediction of cardiovascular disease (CVD) risk, but the benefit of screening with these novel risk markers in the U.S. population is unclear. Methods and results A microsimulation model evaluating lifelong cost-effectiveness for individuals aged 40–85 at intermediate risk of CVD, using 2003–2004 NHANES-III (N = 3736), Framingham Heart Study, U.S. Vital Statistics, meta-analyses of independent predictive effects of the four novel risk markers and treatment effects was constructed. Using both an intention-to-treat (assumes adherence < 100% and incorporates disutility from taking daily medications) and an as-treated (100% adherence and no disutility) analysis, quality adjusted life years (QALYs), lifetime costs (2014 US $), and incremental cost-effectiveness ratios (ICER in $/QALY gained) of screening with hsCRP, CT coronary calcium, cIMT and ABI were established compared with current practice, full adherence to current guidelines, and ubiquitous statin therapy. In the intention-to-treat analysis in men, screening with CT calcium was cost effective ($32,900/QALY) compared with current practice. In women, screening with hsCRP was cost effective ($32,467/QALY). In the as-treated analysis , statin therapy was both more effective and less costly than all other strategies for both men and women. Conclusions When a substantial disutility from taking daily medication is assumed, screening men with CT coronary calcium is likely to be cost-effective whereas screening with hsCRP has value in women. The individual perceived disutility for taking daily medication should play a key role in the decision. [ABSTRACT FROM AUTHOR]

Objective The aim of this study was to determine the associations of brachial–ankle pulse wave velocity (baPWV), high-sensitivity cardiac troponin T (hs-cTnT) and N-terminal pro-B type natriuretic peptide (NT-proBNP) with the development of adverse outcomes after percutaneous coronary intervention (PCI). Methods The baPWV, hs-cTnT and NT-proBNP were analyzed in 372 patients who underwent PCI. The primary endpoint was cardiac death. Results There were 21 events of cardiac death during a mean of 25.8 months of follow-up. When the baPWV cut-off level was set to 1672 cm/s using the receiver operating characteristic curve, the sensitivity was 85.7% and the specificity was 60.1% for differentiating between the group with cardiac death and the group without cardiac death. Kaplan–Meier analysis revealed that the higher baPWV group (≥ 1672 cm/s) had a significantly higher cardiac death rate than the lower baPWV group (< 1672 cm/s) (11.4% vs. 1.4%, log-rank: P < 0.0001). This value was more useful in patients with myocardial injury (hs-cTnT ≥ 0.1 ng/mL) or heart failure (NT-proBNP ≥ 450 pg/mL). Conclusions The results of this study show that high baPWV is a predictive marker for cardiac death after PCI. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Recent studies have suggested that smaller thighs are a disadvantage for health and survival, but the association of thigh circumference with atherosclerosis remains uncertain. The purpose of this study was to investigate the association between thigh circumference and peripheral arterial disease (PAD), as measured by ankle brachial index (ABI). Methods: This study used data from the National Health and Nutrition Examination Survey (1999–2004), in which participants'' ABI and thigh circumference were measured simultaneously. A total of 5716 participants (2959 men and 2757 women) were included in the final analysis. A diagnosis of PAD was determined on the basis of ABI<0.9. Results: The overall prevalence of PAD in this sample was 6.6%. Thigh circumference of those with PAD was 50.1cm compared to 52.2cm for those without PAD (p<0.0001). After adjusting for potential covariates, the prevalence of PAD generally decreased as thigh circumference increased up to 55cm. In the first quantile (smallest thigh circumference), men and women had as much as a 4.8-fold (95% CI, 2.28–10.29) and a 3-fold (95% CI, 1.45–6.18) increased risk of PAD, respectively. Above 55cm, PAD was no longer related to thigh circumference. Conclusions: Small thigh circumference may be associated with PAD, as measured by ABI. [Copyright &y& Elsevier]

Abstract: Introduction: To better understand the basis for previously reported ethnic differences in ankle brachial index (ABI), we investigated whether these differences were present in individuals without known peripheral arterial disease (PAD). Methods: We used data from National Health and Nutrition Examination surveys (NHANES 1999–2004) to determine whether ethnic differences were present in respondents without PAD (1≤ABI≤1.3). We assessed whether ethnicity was an independent predictor of ABI and ankle systolic blood pressure (SBP) in linear regression models that adjusted for conventional and novel cardiovascular risk factors. To minimize effects of atherosclerosis on ABI, we studied adults aged ≤60years, and also repeated our analyses in a subset aged ≤50years that did not have risk factors for PAD. Results: 3348 participants aged ≤60years were included in the study. Mean ABI was 1.11 in non-Hispanic Blacks (NHB) and 1.13 in non-Hispanic Whites (NHW) (P <0.0001). In multivariable linear regression analysis that adjusted for age, gender, ethnicity, smoking, height, diabetes, brachial SBP, dyslipidemia, diabetes, renal function, concurrent cardiovascular disease, and plasma levels of homocysteine, fibrinogen and C-reactive protein, NHB had lower ABI than NHW (β =−0.03±0.004, P <0.00001). Although, NHBs had higher ankle SBP than NHWs (by 5.4mmHg), NHBs had a lower mean ankle SBP (β =−3.663mmHg±0.500, P <0.0001) after adjusting for clinical covariates, including brachial SBP, in multivariable analysis. Conclusion: Ethnic differences in ABI are present in middle-aged adults at low risk for peripheral atherosclerosis. [Copyright &y& Elsevier]

Abstract: Background: Early detection of atherosclerosis in elderly people is important because of high cardiovascular mortality. However, only few studies have evaluated the prevalence of subclinical atherosclerosis in Asian elderly people. We evaluated subclinical atherosclerosis using various methods in a population-based cohort study, the Korean Longitudinal Study on Health and Aging (KLoSHA). Methods: Subjects aged over 65years without symptomatic chest pain were recruited for the KLoSHA in 2006 by random stratified sampling (439 men and 561 women). Anthropometrics, biochemical parameters, body composition, and abdominal fat by computed tomography (CT) were measured. Multidetector-row cardiac CT for coronary artery calcium score (CACS) and severity of stenosis, and carotid sonography for intima-media thickness (IMT) were used to detect subclinical atherosclerosis. Pulse wave velocity (PWV) and ankle-brachial index (ABI) were also measured. Results: The prevalence of subclinical atherosclerosis defined by coronary stenosis >50%, CACS >100, PWV >9m/s, carotid-IMT >0.8mm, or ABI <0.9 was 17.6%, 28.1%, 37.9%, 39.2%, and 29.6%, respectively. There were significant, but modest correlations among parameters. Although male sex, diabetes mellitus, hypertension, abnormal BMI, and higher insulin resistance were associated with subclinical atherosclerosis, older age was found to be the most robust predictor after controlling for multiple factors. Conclusion: Our results suggest that proactive screening with multiple measurements in elderly subjects, particularly in men and those with diabetes mellitus or hypertension, may help to identify asymptomatic patient with atherosclerosis. Further studies exploring the predictive value of diagnostic tools can determine the most appropriate measurement for predicting future cardiovascular events. [Copyright &y& Elsevier]

Abstract: Objective: Diabetes mellitus and low ankle brachial index (ABI) are both conditions associated with an increased cardiovascular risk. In the setting of an acute coronary syndrome (ACS), diabetes is associated with increased mortality, but little is known regarding a low ABI. The aim of the study was to evaluate the prevalence of diabetes and low ABI in patients after an ACS and their prognostic value. Methods: 1156 patients ≥40years admitted with an ACS were screened with ABI previous to hospital discharge to investigate the presence of peripheral arterial disease (PAD) (ABI value≤0.9). 1054 were finally followed for one year. Patients were stratified according to diabetes and PAD status. The primary endpoint of the study was all-cause mortality. Results: The prevalence of diabetes was 36% and PAD was 39.9%. After a median follow up of 382 days, 59 patients died (5.6%), the majority from a cardiovascular event. In both diabetic and nondiabetic patients, the presence of PAD was significantly associated with an increased incidence of the primary event. After adjustment for several prognostic variables, patients with diabetes and PAD had an increased risk of mortality (HR 4.05 (95% CI 1.86-8.83)). PAD and diabetic patients had an intermediate and similar incidence of cardiovascular events. Conclusions: Our results show that the presence of an ABI≤0.9 predicts cardiovascular risk to the same extent as diabetes, and the combination of diabetes and PAD is a powerful tool after an ACS to predict the occurrence of an adverse event. [Copyright &y& Elsevier]

Abstract: Changes in posture of the lower extremities induce changes in skin blood flow, known as veno-arteriolar response (VAR). We investigated the relationship between ankle brachial index (ABI) and VAR in patients (ABI&#60;0.9) with peripheral arterial disease (PAD) and age-matched normal controls (ABI>1). We measured ankle pressure, ABI at rest, and post-exercise ABI. Using laser Doppler flowmetry, skin blood flow was measured with the lower extremity in extended and flexed positions and the fractional change (extended-flexed/extended) in blood flow (VAR) was calculated. With external pressure applied serially to the lower extremity in the extended position using a sphygmomanometer, the pressure (PVAR) at which the VAR was similar to that in the flexed position was recorded. Patients and controls did not differ by age or comorbidity, except higher cigarette smoking in patients (95.8% vs. 4.3%, p=0.001). VAR and PVAR were significantly lower in patients than controls (0.42±0.16 vs. 0.65±0.11 flux/min, p=0.001 and 29±8 vs. 48±9 mm Hg, p=0.001, respectively). There was significant correlation between ABI-post and VAR (r=0.6, p=0.01) and between the VAR and PVAR (r=0.8, p=0.001). VAR&#60;0.3 flux/min was 100% sensitive, 80% specific, and area under curve of 0.88, p=0.001 for detecting PAD as defined by ABI&#60;0.9. Similarly, PVAR of 22 mm Hg was 100% sensitive, 85% specific, and area under curve of 0.94, p=0.001 for detecting PAD. Skin blood flow by this method correlates with the presence and severity of an abnormal ABI. This may offer a method of monitoring the effect of therapy and regression of peripheral atherosclerosis. [Copyright &y& Elsevier]

Abstract: In their recent paper, Cheung et al [B.M. Cheung, K.L. Ong, L.Y. Wong, Elevated serum alkaline phosphatase and peripheral arterial disease in the United States National Health and Nutrition Examination Survey 1999–2004. Int J Cardiol 2008 (Electronic publication ahead of print)] described a significant association between serum alkaline phosphatase levels and low ankle-brachial blood pressure index, a risk factor for cardiovascular pathology. We had verified that alkaline phosphatase is present at the rat heart, showing a distribution compatible with cardiomyocyte sarcoplasmic reticulum. Moreover, several drugs with cardiac effect were shown to interfere with heart alkaline phosphatase activity. We therefore propose that alkaline phosphatase may be a local regulator at heart function and a putative target for therapeutic interventions. [ABSTRACT FROM AUTHOR]