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Hintergrund: Anhaltende Symptome nach akuter Coronavirus-Krankheit-2019 (COVID-19) sind häufig und es besteht kein signifikanter Zusammenhang mit der Schwere der akuten Erkrankung. Bei Long COVID (anhaltende Symptome > 4 Wochen nach akuter COVID-19) treten häufig respiratorische Symptome auf, aber Lungenfunktionstests zeigen nur leichte Veränderungen, die die Symptome nicht erklären. Obwohl COVID-19 zu einer Beeinträchtigung des peripheren Nervensystems und der Skelettmuskulatur führen kann, wurde die Funktion der Atemmuskulatur in diesem Zusammenhang nicht untersucht. Methoden: In dieser Studie haben wir den Schweregrad der Dyspnoe (NYHA-Funktionsklasse) bei Long-COVID-Patienten untersucht und analysierten dessen Zusammenhang mit dem Body-Mass-Index (BMI), der Einsekundenkapazität (FEV1), der forcierten Vitalkapazität, anderen Parametern der Bodyplethysmographie, der Diffusionskapazität für Kohlenmonoxid (DLCO), den arteriellen Blutgasen und der Funktion der Atemmuskulatur, die anhand des Atemwegsokklusionsdrucks (P0,1) und des maximalen Inspirationsdrucks (PImax) in 2 Atemwegskliniken in Deutschland zwischen Oktober 2020 und August 2021 gemessen wurde. Ergebnisse: Insgesamt wurden 116 Patienten in die Studie aufgenommen. Das Durchschnittsalter betrug 50,2 ± 14,5 Jahre, BMI 26,7 ± 5,87 kg/m2, NYHA-Klasse I 19%, II 27%, III 41% und IV 14%. Während die Lungenfunktionswerte und die Computertomografie oder die konventionelle Röntgenaufnahme des Brustkorbs im normalen Bereich lagen, war die Funktion der Atemmuskulatur deutlich beeinträchtigt. Der P0,1 war auf 154 ± 83% des Sollwerts erhöht und der PImax war auf 41 ± 25% des Sollwerts reduziert. Die PImax-Reduktion war stark mit dem Schweregrad der Dyspnoe verbunden, aber nicht abhängig vom BMI, der Zeit nach der akuten COVID-19 und den meisten anderen Parametern. Schlussfolgerungen: Diese Studie zeigt, dass die Atemwegssymptome bei Patienten mit Long COVID hauptsächlich durch eine verminderte Inspirationsmuskelkraft verursacht sein können. Die Bewertung von PImax und P0,1 könnte eine Dyspnoe besser erklären als klassische Lungenfunktionstests und die DLCO. Eine prospektive Studie ist erforderlich, um diese Ergebnisse zu bestätigen.

Background: Persistent symptoms after acute coronavirus-disease-2019 (COVID-19) are common, and there is no significant correlation with the severity of the acute disease. In long-COVID (persistent symptoms >4 weeks after acute COVID-19), respiratory symptoms are frequent, but lung function testing shows only mild changes that do not explain the symptoms. Although COVID-19 may lead to an impairment of the peripheral nervous system and skeletal muscles, respiratory muscle function has not been examined in this setting. Methods: In this study, we assessed the severity of dyspnea (NYHA-function class) in long-COVID patients and analyzed its association with body mass index (BMI), FEV1, forced vital capacity, other parameters of body plethysmography, diffusing capacity for carbon monoxide (DLCO), arterial blood gases, and inspiratory muscle function, assessed by airway occlusion pressure (P0.1) and maximal inspiratory pressure (PImax) in two respiratory clinics in Germany between Oct 2020 and Aug 2021. Results: A total of 116 patients were included in the study. The mean age was 50.2 ± 14.5 years; BMI, 26.7 ± 5.87 kg/m2; NYHA class I, 19%; II, 27%; III, 41%; and IV, 14%. While lung function values and computed tomography or conventional X-ray of the chest were in the normal range, inspiratory muscle function was markedly impaired. P01 was elevated to 154 ± 83%predicted and PImax was reduced to 41 ± 25%predicted. PImax reduction was strongly associated with the severity of dyspnea but independent of BMI, time after acute COVID-19 and most of the other parameters. Conclusions: This study shows that in long-COVID patients, respiratory symptoms may be mainly caused by reduced inspiratory muscle strength. Assessment of PImax and P0.1 might better explain dyspnea than classical lung function tests and DLCO. A prospective study is needed to confirm these results.

Introduction The aim of this study was to examine physicians' preferences regarding adherence-promoting programs (APPs), and to investigate which APP characteristics influence the willingness of physicians to implement these in daily practice. Materials and Methods A discrete choice experiment was conducted among general practitioners, cardiologists, neurologists and ophthalmologists in Germany. The design considered five attributes with two or three attribute levels each: validation status of the APP; possibility for physicians to receive a certificate; type of intervention; time commitment per patient and quarter of the year to carry out the APP; reimbursement for APP participation, per included patient and quarter of the year.A multinomial logit model was run to estimate physicians' utility for each attribute and to evaluate the influence of different levels on the probability of choosing a specific APP. The relative importance of the attributes was compared between different pre-defined subgroups. Results In total, 222 physicians were included in the analysis. The most important characteristics of APPs were time commitment to carry out the program (34.8% importance), reimbursement (33.3%), and validation status of the program (23.7%). The remaining attributes (type of intervention: 3.6%; possibility to receive a certificate: 4.7%) were proven to be less important for a physician's decision to participate in an APP. Physicians on average preferred APP alternatives characterized by little time commitment (β=1.456, p

Summary. Background: In primary care, the gamma-glutamyl transferase (GGT) activity is used for assessing hepatobiliary dysfunction, but is also known to be associated with the risk of cardiovascular events as well as overall mortality. As this knowledge is mainly based on cohorts with middle-aged participants, we aim to assess these associations in elderly patients in a primary care setting. Patients and methods: 6,880 unselected primary care patients, aged 65 years or older, were enrolled by 344 general practitioners all over Germany (getABI study). During seven years of follow-up, coronary heart disease (CHD) events (myocardial infarction or coronary revascularization), cerebrovascular events (stroke or carotid revascularization) and deaths were recorded. Event rates were calculated and Cox regression analysis with adjustment for age, gender, GGT, classical and other risk factors (e.g. education, homocysteine, C-reactive protein, vitamin D) was performed. Results: 1,243 patients died. 27.8 deaths per 1,000 patient years (0.95 confidence interval [0.95 CI]: 26.2–29.3) occurred in the whole cohort. 605 participants had a CHD event, i.e. 16.1 per 1,000 patient years (0.95 CI: 14.8–17.4). 296 cerebrovascular events were observed, i.e. 7.7 per 1,000 patient years (0.95 CI: 6.9–8.6). Cox regression analysis with adjustment for the above-mentioned risk factors showed a significant impact of baseline elevation of GGT above the 3rd quartile (women > 18 U/L, men > 26 U/L) compared to the rest on mortality (hazard ratio [HR] 1.38, 95% CI 1.22–1.56, p

Aim To analyse the incidental findings during computed tomographic angiography (CTA) diagnostic work-up in patients with arteriogenic erectile dysfunction (ED). Patients and methods The medical records of all patients with suspected arteriogenic ED were entered into a database. Risk factors and underlying comorbidities were also collected. Pathological CTA findings were extracted from the CT readings and entered into the database. Incidental findings on CTA were classified as those requiring immediate medical treatment, requiring deferred medical treatment or of no clinical importance. Results A total of 200 patients underwent CTA for suspected arteriogenic ED. Mean patient age was 59.6 p 11.7 years. Of these, 181 patients (90.5%) had obstructions of erection-related arteries. In 168 patients (84.0%), CTA showed multiple incidental pathological findings. Eighty-five of 200 patients (42.5%) exhibited incidental findings requiring immediate further medical workup and/or treatment: coronary artery calcification was diagnosed in 75/200 (37.5%), aorto-iliac aneurysms in 8/200 (4%) of patients and incidentally detected embolism in 1/200 patient. Pancreatic and liver tumours were less frequent (incidence 1.5% and 1%, respectively). Incidental findings requiring deferred medical workup and/or treatment were detected in 175/200 patients (87.5%). The findings with the highest prevalence were liver steatosis followed by colon diverticulosis and prostate hyperplasia. Findings of little to no clinical importance were reported in 117 (58.5%) patients. These included uncomplicated renal cysts, spinal degeneration and renal vascular anomalies. Almost every second patient presenting with ED had an incidental finding which required immediate treatment. Conclusions Incidental findings not directly related to ED were common among patients undergoing CTA scans for suspected arterial obstructions. Coronary artery calcification was the leading finding requiring further medical workup and/or treatment. Thus, the benefit of CTA investigations extends beyond the anatomic description of arterial obstructions of erection-related arteries.

Abstract. Background: Elevated levels of C-reactive protein (CRP) are known to be associated with cardiovascular (CV) morbidity and mortality in older adults, however, there seems to be heterogeneity of this association across subsets of individuals. We aim to assess the effects of interactions between CRP and one of the following traditional CV risk factors regarding all-cause mortality in unselected elderly men and women: age, sex, body mass index, diabetes, and hypertension. Patients and methods: Three hundred and forty-four general practitioners all over Germany enrolled 6,817 unselected participants, aged 65 years or older, and performed thorough examinations, including CRP measurement at baseline (getABI study). All-cause mortality was determined in the following seven years. Cox regression analyses were done using uni- and multivariable models. Results: At baseline 4,172 participants of this cohort had a CRP value of ≤ 3 mg/L (low level CRP group), 2,645 participants had a CRP value of > 3 mg/L (high level CRP group). The unadjusted hazard ratio for all-cause death of the high level CRP group compared to the low level CRP group was 1.49 (95 % confidence interval [95 %CI] 1.34 to 1.66). After adjustment for sex, age, education, peripheral artery disease/media sclerosis, other prior vascular events, smoking status, diabetes, systolic blood pressure, antihypertensive medication, body mass index, cholesterol, and statin use, the hazard ratio was 1.34 (95 %CI 1.20 to 1.50). Significant interactions with CRP were found for sex (adjusted hazard ratio 1.38, 95 %CI 1.11 to 1.72), age (0.75, 95 %CI 0.60 to 0.94), and baseline systolic blood pressure (0.64, 95 % CI 0.51 to 0.81). The interactions of CRP with body mass index and of CRP with diabetes were not significant. Conclusions: In older German adults, there seem to be effect modifications by age, sex, and arterial hypertension regarding the effect of CRP in the prediction of all-cause mortality.

Abstract. Background: To assess the risk of peripheral artery disease (PAD) in older adults and the contribution of traditional and novel risk factors to the incidence of PAD. Patients and methods: 344 general practitioners (GPs), trained by vascular specialists all over Germany, enrolled 6,880 unselected participants aged 65 years or older (getABI study). The onset of PAD was determined by a regression method in the course of repeated measurements of the ankle brachial index (ABI) over seven years. PAD onset was defined by the declining linear regression ABI line reaching 0.9 or by PAD symptoms. Results: The cumulative PAD incidence over seven years was 12.9%, corresponding to an incidence rate of 20.3 per 1000 person years (95% confidence interval [95%CI] 18.8 to 21.7). Logistic regression analysis showed that traditional risk factors contributed significantly to the risk of PAD: current smoker status (odds ratio 2.65, 95%CI 2.08 to 3.37), diabetes (1.35, 95%CI 1.13 to 1.62), and low-density lipoprotein >130 mg/dl (1.26, 95%CI 1.07 to 1.48). Three novel risk factor candidates showed significant impact on PAD incidence: elevated sensitive C-reactive protein level (1.23, 95%CI 1.05 to 1.45), impaired estimated glomerular filtration rate (1.27, 95%CI 1.03 to 1.56), and elevated homocysteine level (1.19, 95%CI 1.01 to 1.41). Conclusions: Older adults in Germany have a PAD risk of 12.9% per seven years. Potentially modifiable traditional PAD risk factors yield high impact on PAD incidence. Novel risk factor candidates may contribute to the risk of PAD

Die Haufigkeit der PAVK nimmt weltweit zu und auch in der Bundesrepublik steigt die Zahl der stationar behandelten Patienten kontinuierlich an. Die Knochel- und Zehendruckmessungen mit Bestimmung des ABI bzw. TBI sind zuverlassige Methoden zur Diagnostik. Klinisch relevante Begleiterkrankungen sind die KHK, Herz- und chronische Niereninsuffizienz, und der Diabetes mellitus. Patienten mit asymptomatischer und symptomatischer PAVK haben eine deutlich erhohte Morbiditat und Mortalitat.

Untersuchungen haben gezeigt, dass einige Sportarten zur Stressbewaltigung, bei emotionalen Problemen und sogar in depressiven Episoden hilfreich sein konnen. Nun wurde der Effekt verschiedener Sportarten auf die mentale Verfassung untersucht.

Die Ergebnisse internationaler Studien belegen eine hohere Behandlungsqualitat und Kosteneinsparungen in der ambulanten Therapie chronischer Wunden durch den Einsatz integrativer Versorgungsmodelle. Das „Wundkompetenznetz Mittlerer Oberrhein“ wurde 2006 mit dem Ziel gegrundet, ein strukturiertes poststationares Wundmanagement und Behandlungsalgorithmen sektorenubergreifend einzufuhren. Mittlerweile sind die Daten von 450 behandelten Patienten verfugbar. In einer Ist-Analyse sollen Informationen uber den Datenbestand des Wundnetzes und deren statistische Verwertbarkeit zur Berechnung von Kosteneffizienz und potenzieller Determinanten uberpruft werden. Inkomplette oder nicht auswertbare Datensatze offenbarten Defizite beim sektorenubergreifenden Informationsaustausch. Die Einfuhrung einer uberarbeiteten Datenbank TOMORROW verbesserte die Dokumentation und Auswertbarkeit. Die damit erfolgte Analyse einer Patientenstichprobe (n = 123) ergab pro Patient durchschnittliche Behandlungskosten von 1551,2 €/Jahr mit einem Ungleichgewicht der Verteilung. Wahrend 75 % der Patienten deutlich unter dem Durchschnittswert von 1551 €/Jahr lagen, wiesen 10 % der Patienten Versorgungskosten von uber 2779 €/Jahr mit einem Durchschnitt von 9248,7 €/Jahr auf (63 % der Gesamtkosten). Adipositas und Multimorbiditat waren statistisch mit hoheren Therapiekosten assoziiert. Fur Lebensalter und Geschlecht konnte keine Relation mit den Versorgungskosten errechnet werden. Individuelle Behandlungsergebnisse und -kosten differieren in der ambulanten Wundtherapie stark. Sie sind mit Faktoren und Masnahmen assoziiert, deren Kenntnis Kosteneinsparungen moglich erscheinen lasst. Voraussetzung ist ein hoher Dokumentationsstandard.

Eine Behandlung mit oralen Antikoagulanzien wie Warfarin schutzt Menschen im Alter uber 50 Jahren offenbar vor Krebs, wie eine neue grose norwegische Beobachtungsstudie zeigte.

Nach einer erfolgreichen Brustkrebsbehandlung haben die Patientinnen weitere Gesundheitsrisiken zu uberwinden. Dazu gehoren beispielsweise die Osteoporose, vorzeitige Menopausesymptome und signifikante Herzkrankheiten, wie eine aktuelle Studie aus Brasilien gezeigt hat.

Die VITAL-Studie ist eine der grosten Studien, in der die Zusammenhange zwischen der Substitution von Vitamin D und Omega-3-Fettsauren zur Pravention von Krebs und Herz-Kreislauf-Erkrankungen untersucht wurden.

Background: In 1998 Baden-Wuerttemberg (BW), a federal state in southwest Germany with 10.8 million inhabitants, implemented a structured medical concept for the treatment of acute stroke. Methods: Since 2004 participation in the BW stroke database is mandatory for all hospitals in BW involved in acute stroke care. The stroke database includes all inpatients ≥18 years of age who have suffered an ischemic or hemorrhagic stroke within 7 days before hospitalization. This article presents methodological aspects and first results of the BW stroke database in the time period from 2007 to 2011. Results: Annual inclusion numbers increased continuously (29,422 vs. 35,724, p < 0.001). Median age of stroke onset was stable over time. The proportion of stroke patients ≥80 years increased from 36.9 to 38.8% (p < 0.001). Rates of patients treated in neurology departments rose from 50.7 to 60.9% (p < 0.001) and numbers of patients treated in stroke units rose from 59.1 to 68.4% (p < 0.001). Admission via emergency medical systems increased from 42.8 to 49.7% (p < 0.001) and arrival within 3 h increased from 29.8 to 34.4% (p < 0.001). Conclusion: We present results from a large, prospective and consecutive stroke patient database. This first analysis demonstrates a continuous increase of absolute and relative numbers of stroke patients who arrive within 3 h after onset, are hospitalized in neurology departments and treated in stroke units, and are aged ≥80 years.

Die Behandlung von Patienten mit peripherer arterieller Verschlusskrankheit (PAVK) der unteren Extremitaten ist eine komplexe Aufgabe, die nur durch interdisziplinare Bemuhungen zu bewerkstelligen ist. Neben der endovaskularen und chirurgischen arteriellen Revaskularisation kommt der medikamentosen Behandlung eine hohe Bedeutung zu. Die Ziele der medikamentosen Behandlung liegen einerseits in der Behandlung der Symptome der PAVK und andererseits in der Verhinderung der Progression der systemischen Atherothrombose. Der vorliegende Beitrag fasst den aktuellen Stand hinsichtlich der sekundarpraventiven medikamentosen Behandlung von PAVK-Patienten zusammen und gibt einen Einblick in die Moglichkeiten des Gehtrainings zur Behandlung von Patienten mit Claudicatio intermittens.

The number of patients suffering from PAD is increasing worlwide and the rate of hospitalized patients in Germany is continously increasing. The diagnosis can be made reliably by ankle- and toe-pressure measurements with calculating the ABI and TBI. Clinical relevant comorbidities are CAD, heart insuffiency , chronic renal failure and diabetes. The prognosis of asymptomatic and symptomatic patients is characterized by an increased cardiovascular morbidity and mortality.

Hintergrund und Fragestellung: Bisher lagen fur die hausarztliche Versorgung in Deutschland keine detaillierten Daten zum Angebot an Lebensstilberatung und anderen kardiovaskular-praventiven Masnahmen vor. Ziele dieser Studien war die Analyse solcher Praventionsangebote und die Identifikation forderlicher und hinderlicher Faktoren. Methodik: Von 2000 zufallig ausgewahlten baden-wurttembergischen Hausarzten nahmen 260 (13 %) an der Studie teil und wurden zur Lebensstilberatung und anderen Praventionsmasnahmen, deren Barrieren sowie ihrer personlichen Einstellung befragt. Die mit der Lebensstilberatung assoziierten Faktoren wurden mittels Chi²-Tests und logistischer Regressionsanalyse untersucht. Ergebnisse: Die befragten Arzte hatten eine generell positive Einstellung gegenuber Gesundheitsforderung und Pravention. Vier von zehn Arzten fuhrten Lebensstilberatungen bzgl. Ernahrung, korperlicher Aktivitat, Tabak- und Alkoholkonsum bei der Mehrheit ihrer Patienten durch. In Praxen mit Arztinnen (Odds Ratio, OR: 1,98), in denen der Arzt von seinem Angebot an Lebensstilberatung uberzeugt war (OR: 3,55) und in denen Fragebogen zur Erfassung von Risikofaktoren im Wartezimmer auslagen (OR: 2,26; alle p Schlussfolgerung: Offenbar herrscht eine Diskrepanz zwischen dem Potenzial und der Umsetzung von kardiovaskular-praventiven Masnahmen im hausarztlichen Setting. Spezielle Schulungen der Arzte sowie verbesserte finanzielle und organisatorische Rahmenbedingungen konnten zu einer Verbesserung des Praventionsangebotes beitragen.

Little is known about physical activity in adults at differing risk of cardiovascular disease (CVD). Here, we describe and compare the physical activity and patterns of association with physical activity by CVD risk status based on data from computer-assisted telephone interviews of 2002 men and women aged 50–70 years in Germany. Physical activity preferences, settings, and health-related attitudes were assessed and groups were compared using chi-square and non-parametric tests. Stratified multi-variable regression models identified factors associated with regular physical activity (at least once a week for 6 months). The proportion of respondents engaging in regular physical activity ranged from 53.8% to 60.6% across the groups (P=0.08). Respondents with and without CVD/CVD risk factors varied modestly regarding the type and settings for physical activity. However, models stratified by CVD risk demonstrated different patterns of association with regular physical activity. Socioeconomic status, f...

Der Beitrag stellt die wesentlichsten Aspekte der neuen S3-Leitlinie zur Diagnostik und Therapie der peripheren arteriellen Verschlusskrankheit (PAVK) dar 1 . Diese betreffen die Definition und Epidemiologie der PAVK, die Diagnostik mittels klinisch-angiologischer Methoden, apparativer angiologischer sowie bildgebender Verfahren, die Therapie mittels konservativer, interventioneller und chirurgischer Methoden sowie die Nachsorge der Patienten. In Kernaussagen werden Empfehlungen gegeben, deren Empfehlungsgrad von der wissenschaftlichen Evidenz, d. h. von den Ergebnissen klinisch-wissenschaftlicher Studien und anderer Literaturberichte abgeleitet wurde.

Short periods of ischemia, as in intermittent claudication, cause alterations in neutrophil activation and deformability, which may impair the microcirculation. The aim of this study was to evaluate the effect of pentoxifylline (PTX) on neutrophil function in patients with unilateral intermittent claudication. In 15 patients with predominantly unilateral peripheral arterial occlusive disease, lactate, proportion of activated neutrophils (by nitro blue tetrazolium test), neutrophil filterability (by St. George's filtrometer), and stimulated as well as unstimulated radical generation were assessed in the femoral venous blood of the diseased and healthy leg. The values were obtained at rest, immediately after claudication, and 15 minutes after claudication. After 14 days of treatment with PTX (3×400 mg/die p.o.) the measurements were repeated. Pentoxifylline reduced the effects of ischemia on neutrophil function, whereas the same exercise level before and after treatment was reached as measured by lactate production. Ischemia induced elevation in the proportion of activated neutrophils (+43%,p

The IV infusions of both prostaglandin E1 (PGE1) and pentoxifylline showed good efficacy in prolonging the claudication distance and maximum walking range of patients with intermittent claudication, and the Doppler pressures were used as parameters of efficacy. IV PGE1 was significantly superior after 4 weeks' therapy as to both claudication distance and maximum walking range. The ankle pressure indices were significantly elevated in both groups at the end of therapy. The therapeutic effect proved to persist in both groups after a 12 month follow-up, with adverse reactions occurring in two patients treated with PGE1 and in six patients treated with pentoxifylline. The study supports the view that the intravenous infusion of PGE1 is an efficacious and well-tolerated therapy for intermittent claudication.

The clinical efficacy of a hemodialysate (HD)/ultrafiltrate of frozen calf blood administered as a 20% intravenous infusion was evaluated in 138 hospitalized patients with intermittent claudication due to peripheral arterial obstructive disease (PAOD) (Fontaine II classification) in a randomized, placebo-controlled, double-blind study comparing parallel groups in five centers. The extent of improved pain-free walking distance (PFWD responders) (58%) and maximal walking distance (MWD responders) (53%) in the HD-treated patients was significantly greater than in the placebo-treated subjects (34% and 44% respectively). There were no significant changes at any stage of the study in the ankle/arm pressure ratio at rest and after standard treadmill exercise. These results confirm that there is a favorable clinical response to HD in patients with PAOD stage II (Fontaine) with no evidence of increase in blood flow.

Since prostaglandin E1 was first used for the treatment of critical limb ischemia, the best route of administration—intraarterial (i.a.) or intravenous (i.v.)—has not yet been determined. The aim of this study was to compare the effects of i.a. and i.v. prostaglandin E1 (PGE1) infusions on transcutaneous partial pressure of oxygen (tcPO2) on a within-patient basis in patients with critical limb ischemia. In a randomized, crossover study, 20 patients with critical limb ischemia were treated with a 30-minute i.a. infusion of 10 µg PGE1 in 25 ml saline and a 60-minute i.v. infusion of 40 µg PGE1 in 125 ml saline. During i.a. infusion of PGE1, the mean tcPO2 (forefoot) decreased significantly from 12.2 mmHg to 3.3 mmHg (−73%,p

Objective We aimed to investigate whether the post-exercise ankle brachial index (ABI) performed by primary care physicians offers useful information for the prediction of death or cardiovascular events, beyond the traditional resting ABI. An additional focus was on patients with intermittent claudication and normal resting ABI. Methods Using data from the 5-year follow-up of 6468 elderly patients in the primary care setting in Germany (getABI study) we used multivariate Cox regression models adjusted for age, gender and conventional risk factors to determine the association of resting ABI and/or post-exercise ABI and all-cause mortality/morbidity. Results Mean post-exercise ABI in the total cohort was 0.977 and resting ABI was 1.034. For post-exercise ABI, a threshold value of 0.825 had nearly the same sensitivity (28.6%) and specificity (85.7%) as the conventionally used resting ABI with a cut-off value of 0.9 to predict death. Compared to patients with normal post-exercise ABI, a low post-exercise ABI was associated with an almost identical risk increase for mortality (hazard ratio [HR] 1.56, 95% confidence interval [CI] 1.30–1.86) as a low resting ABI (HR 1.65; CI 1.39–1.97) and/or myocardial infarction/stroke. Slight differences were observed for coronary/carotid revascularisation and peripheral revascularisation/amputation. In combined models it could not be shown that post-exercise ABI yielded relevant additional information for the prognosis of mortality and/or myocardial infarction/stroke, not even in the subgroup analysis of patients with intermittent claudication and normal resting ABI. Conclusions It could not be shown that the post-exercise ABI is a useful tool for the prognosis of mortality and/or myocardial infarction/stroke beyond the resting ABI.

Untersuchungen zeigen, dass rund die Halfte der Frauen im Klimakterium unter Schlafstorungen leidet. Offenbar sind damit auch Gefaserkrankungen assoziiert.

Boger RH, Endres HG, Schwedhelm E, Darius H, Atzler D, Luneburg N, von Stritzky B, Maas R, Thiem U, Benndorf RA, Diehm C (Institute of Clinical Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg; Ruhr University Bochum; Vivantes Berlin-Neukolln Medical Center, Berlin; Sanofi-Aventis Pharma GmbH, Berlin; Institute of Clinical Pharmacology and Toxicology, University of Erlangen; Ruhr University Bochum, Herne; Klinikum Karlsbad-Langensteinbach, Affiliated Teaching Hospital of the Ruprecht-Karls-University of Heidelberg, Germany) Asymmetric dimethylarginine as an independent risk marker for mortality in ambulatory patients with peripheral arterial disease. J Intern Med 2010; 269: 349–361. Background. Asymmetric dimethylarginine (ADMA) is an endogenous inhibitor of nitric oxide (NO) synthesis causing endothelial dysfunction, an early sign of atherogenesis. Symmetric dimethylarginine (SDMA) does not inhibit NO synthases. Peripheral arterial disease (PAD) is a systemic indication of atherosclerosis. Methods. We assessed the associations between both ADMA and SDMA blood levels and major cardiovascular and cerebrovascular events or death from any cause within a 5-year follow-up in the multicentre getABI trial. From a cohort of 6821 primary care patients, aged ≥65 years, all 1260 patients with prevalent PAD were compared with a random sample of 1187 non-PAD controls. A total of 11 544 patient-years were documented. Multivariate risks were calculated by Cox proportional hazard models, adjusting for PAD, renal dysfunction and other important cardiovascular risk factors. Results. We documented 390 deaths, 296 cardiovascular events and 98 cerebrovascular events. Increased ADMA levels in the 4th quartile were significantly associated with total mortality [hazard ratio (HR) 1.41; 95% CI 1.14–1.74] and with cardiovascular events (HR 1.32; 95% CI 1.03–1.69), but there was a nonsignificant association with cerebrovascular events (HR 1.50; 95% CI 0.98–2.29). Increased SDMA was only just significantly associated with mortality (HR 1.27; 95% CI 1.01–1.59). In PAD patients compared with non-PAD controls, only mean SDMA concentration was considerably increased (0.52 μmol L−1 vs. 0.48 μmol L−1; P

In einer aktuellen Studie wurden die Auswirkungen von elektromagnetischen Feldern in Elektroautos auf die Schrittmacher- und Defibrillatorenfunktion untersucht.

Objectives To briefly inform on the conclusions from a conference on the next 10 years in the management of peripheral artery disease (PAD). Design of the Conference International participation, invited presentations and open discussion were based on the following issues: Why is PAD under-recognised? Health economic impact of PAD; funding of PAD research; changes of treatment options? Aspects on clinical trials and regulatory views; and the role of guidelines. Results and Conclusions A relative lack of knowledge about cardiovascular risk and optimal management of PAD patients exists not only among the public, but also in parts of the health-care system. Specialists are required to act for improved information. More specific PAD research is needed for risk management and to apply the best possible evaluation of evidence for treatment strategies. Better strategies for funding are required based on, for example, public/private initiatives. The proportion of endovascular treatments is steadily increasing, more frequently based on observational studies than on randomised controlled trials. The role of guidelines is therefore important to guide the profession in the assessment of most relevant treatment.

Summary Background: Studies in the primary care setting are of high interest for assessing the management situation of patients with manifestations of atherothrombosis. Aims: Therefore, we documented diagnostic procedures, characteristics, and management of patients with symptomatic and asymptomatic peripheral arterial disease (PAD). Materials & Methods: Prospective cross-sectional study in primary care practices throughout Germany. Results: A total of 671 patients with newly diagnosed PAD were included (mean age 69.1 years; 62.1% men). Cardiovascular risk factors were highly prevalent in the total PAD group: arterial hypertension in 84.2%, hyperlipidaemia in 75.5%, present smoking in 45.0% and diabetes mellitus in 47.3%. Atherothrombotic comorbidities were also frequent: coronary artery disease in 44.9% and cerebrovascular disease in 28.1%. For confirmation of diagnosis, patients were referred to specialists in 66.9% of cases. Overall, ankle brachial index was measured in 89.0%, and a clinical PAD score assessed in 66.6% (agreement of both measures with Cohen’s kappa only, κ = 0.039; p = 0.209). Drug treatment of risk factors (as secondary prophylaxis) in line with current guidelines was reported in a high percentage of patients: 88.6% with any antiplatelet drug, 69.3% with statins, 62.4% with angiotensin converting enzyme inhibitors, 23.5% with AT1 receptor blockers and 43.9% with beta-blockers. Between asymptomatic and symptomatic PAD, differences in the risk factor/comorbidity profiles were small; however, the latter group received intensified treatment. Conclusion: Our findings confirm that patients with PAD pose a substantial challenge to physicians because of their high number of comorbidities. Compared with previous studies, management of such patients appears to have improved.

Altere Frauen, die regelmasig korperlich trainieren, haben ein um 65 % niedriges Mortalitatsrisiko im Vergleich zu Frauen, die kaum trainieren.

Kurzlich wurden erstmals Daten zur Haufigkeit von Erektionsstorungen bei Patienten mit Gicht publiziert.

Das individuelle Gesundheitsverhalten spielt eine bedeutende Rolle in der Pravention von Herz-Kreislauf-Erkrankungen, insbesondere im mittleren und hoheren Erwachsenenalter. Bisher ist die Datenlage zu gesund-heitsbezogenen Verhaltensmustern von Mannern und Frauen dieser Altersgruppe jedoch noch luckenhaft.

Background— Our aim was to assess the mortality and vascular morbidity risk of elderly individuals with asymptomatic versus symptomatic peripheral artery disease (PAD) in the primary care setting. Methods and Results— This prospective cohort study included 6880 representative unselected patients ≥65 years of age with monitored follow-up over 5 years. According to physician diagnosis, 5392 patients had no PAD, 836 had asymptomatic PAD (ankle brachial index Conclusions— Asymptomatic PAD diagnosed through routine screening in the offices of primary care physicians carries a high mortality and/or vascular event risk. Notably, the risk of mortality was similar in symptomatic and asymptomatic patients with PAD and was significantly higher than in those without PAD. In the primary care setting, the diagnosis of PAD has important prognostic value.

Background Recommendations of clinical guidelines for the treatment of critical limb ischemia (CLI) are based on randomized controlled trials. Recent data from clinical practice are however lacking. Therefore a prospective observational study in patients with critical limb ischemia (CLI) in 3 hospitals with a specialized vascular medicine department was conducted to document the clinical course and outcome of patients with critical limb ischemia (CLI) in clinical practice. Methods 155 patients were stratified: 56 received endovascular intervention, 82 prostanoids and 17 antibiotic treatment. Patients with surgical revascularisation and primary amputation were excluded. All patients received structured wound treatment, analgesia and vascular risk factor treatment during hospital stay. Results Age 72.0 ± 12.7 years, hospitalisation 23.2 ± 20.3 days. 56.1% had Diabetes, 9.7% multiresistant staphylococcus aureus infection. 40% patients had rest pain, 60% ischemic tissue loss. At discharge 40.0% had no ulcers, 48.4% ongoing trophic alterations, 10.3% received major amputation and 4.5% had stable necrosis. After 18 month rate of major amputation was 6.3% (prostanoids), 14.5% (endovascular treatment; p = n.s. vs. prostanoids) and 26.7% (antibiotics; p = 0.0323 vs. prostanoids). Major amputations were not different in logistic regression analyses adjusting for baseline characteristics. Wound healing and mortality rate was not different between groups (26.8, 25.0 and 23.5%). Conclusion Structured therapy at specialized vascular centres in combination with interventional or conservative treatment is beneficial in patients with critical limb ischemia. Survival without amputation is higher than expected over 18 months.

Beinarterienstenosen sind oft hinweisend auf eine generalisierte Atherosklerose im arteriellen System. Sie konnen leicht und verlasslich durch Hausarzte oder arztliches Hilfspersonal diagnostiziert werden mit Doppler-Ultraschallmessungen und der Berechnung des Knochel-Arm-Index („ankle-brachial index“, ABI). Ein erniedrigter Wert (

Increased mortality in patients with anemia has been demonstrated in disabled, seriously ill or hospitalized patients. In industrialized nations with their aging societies, however, elderly but apparently healthy family-physician patients are an important demographic group from a public-health perspective. We therefore set out to evaluate the prevalence of anemia in this group and associations between anemia and 5-year all-cause mortality, adjusted for multiple other established risk factors and chronic diseases.This was a monitored, prospective cohort study in Germany with 344 representative family physicians who documented, consecutively, elderly patients (agedor= 65 years). Extensive fasting plasma parameters were collected at baseline. Anemia at inclusion was defined according to World Health Organization criteria (hemoglobin below 12 g/dl in women and 13 g/dl in men). All participants were followed up for death of any cause for 5.3 years.Among the 6880 individuals, 2905 men and 3975 women, aged 65-95 (mean age 72.5), mild anemia (hemoglobin levelsor=10 g/dl) was found in 6.1% of women and 8.1% of men. Among those patients, 36.1% of anemic men and 15.0% of anemic women died. In a Cox proportional hazards analysis, multiple adjusted for potential confounders including major comorbidities, a near doubling of the 5-year mortality risk in anemic men (hazard ratio [HR] 1.9; 95% confidence interval [CI] 1.5-2.4) was found, while in anemic women there was no risk increase at all (HR 1.1; 95% CI 0.8-1.6). Even if patients with the lowest hemoglobin concentration (11 g/dl for women,12 g/dl for men) are singled out for multiple-adjusted analysis, anemia in men was related to a significant mortality risk (HR 3.3; 95% CI 2.1-5.1), but not in women (HR 1.85; 95% CI 0.97-3.53).In typical elderly patients without severe comorbidities, mild anemia was significantly associated with greater mortality in men but not in women. Given the impact of sex on outcomes of older subjects with mild anemia, the current definition of anemia should be adjusted for elderly males towards a higher hemoglobin threshold. Interventional trials will be needed to determine whether a consistent correction of anemia improves mortality of older men.

This study evaluated the efficacy and safety of intramuscular administration of NV1FGF, a plasmid-based angiogenic gene delivery system for local expression of fibroblast growth factor 1 (FGF-1), versus placebo, in patients with critical limb ischemia (CLI). In a double-blind, randomized, placebo-controlled, European, multinational study, 125 patients in whom revascularization was not considered to be a suitable option, presenting with nonhealing ulcer(s), were randomized to receive eight intramuscular injections of placebo or 2.5 ml of NV1FGF at 0.2 mg/ml on days 1, 15, 30, and 45 (total 16 mg: 4 x 4 mg). The primary end point was occurrence of complete healing of at least one ulcer in the treated limb at week 25. Secondary end points included ankle brachial index (ABI), amputation, and death. There were 107 patients eligible for evaluation. Improvements in ulcer healing were similar for use of NV1FGF (19.6%) and placebo (14.3%; P = 0.514). However, the use of NV1FGF significantly reduced (by twofold) the risk of all amputations [hazard ratio (HR) 0.498; P = 0.015] and major amputations (HR 0.371; P = 0.015). Furthermore, there was a trend for reduced risk of death with the use of NV1FGF (HR 0.460; P = 0.105). The adverse event incidence was high, and similar between the groups. In patients with CLI, plasmid-based NV1FGF gene transfer was well tolerated, and resulted in a significantly reduced risk of major amputation when compared with placebo.

Ziel der vorliegenden Arbeit ist die Bewertung des klinischen Stellenwerts der Behandlung der PAVK mit Prostaglandinen unter besonderer Berucksichtigung der aktuellen Leitlinienempfehlungen. Bei der Claudicatio intermittens gibt es Hinweise auf die Wirksamkeit von Prostanoiden zur Verbesserung der Gehleistung und Lebensqualitat. Fur Prostaglandin E1 konnte in einer Metaanalyse eine klinisch relevante Verbesserung der schmerzfreien Gehstrecke belegt werden. Damit einher geht eine Verbesserung der Lebensqualitat. Eine Zulassung zu dieser Indikation liegt zurzeit nicht vor. Bei der kritischen Extremitatenischamie ist aufgrund der hohen Amputationsgefahr vorrangiges Behandlungsziel die endovaskulare oder operative Revaskularisation. Nur wenn diese Behandlung nicht in Betracht kommt, sind Prostanoide als konservative Therapieoption indiziert. Dabei kann bei etwa 50% der Betroffenen eine Verbesserung der Wundheilung, eine Reduktion der Schmerzen und auch eine Verminderung der Zahl hoher Amputationen erreicht werden. Diese Therapieempfehlungen finden sich in der uberwiegenden Anzahl der aktuellen Leitlinien.

In a controlled randomized trial at four centers, using a common protocol, 57 patients with advanced chronic arterial occlusive disease (21 in stage III, 36 in stage IV) were treated with prostaglandin E1 (PGE1) or adenosine triphosphate (ATP) for three weeks. Both substances were administered intraarterially over 60 min. Daily dose of PGE1 was 20 micrograms, of ATP 30 mg. Both produced a significant reduction in resting pain at the end of the treatment phase, in stage III significantly better with PGE1. There was also a clear reduction in the use of analgesics, significantly more so with PGE1. Healing or improvement of ulcers was significantly better with PGE1, while there was no significant differences between the two drugs as regards stage improvement. Three amputations had to be performed in the PGE1 group, nine in the ATP group, a significant difference. Side effects in the form of reddening, pain and swellings occurred in 15 patients of the PGE1 group and six of the ATP group. Final verdict by the treating doctor about the success of treatment was significantly more favorable for PGE1.