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The aim of this study was to evaluate the greatest drivers for development of lower extremity peripheral artery disease (PAD) in relation to coronary, precerebral, or cerebral artery disease This prospective study (Malmö Diet and Cancer study) included 26,681 participants. The diagnosis of incident PAD, coronary artery disease (CoAD), atherothrombotic ischemic stroke (IS) free from atrial fibrillation or flutter, and carotid artery disease (CaAD) was validated. A modified Lunn-McNeil competing risk analysis was performed to compare the Hazard Ratio (HR) strength of PAD in relation to CoAD, IS, or CaAD. The estimated population attributable risk fractions (PAF) for each atherosclerotic manifestation were estimated by first fit an age and sex adjusted Cox proportional hazard regression, and then estimate the PAF using the Direct method. Male sex, age, and hypertension were risk factors for development of all atherosclerotic manifestations. Current smoking accounted for 45.6% (95% CI 41.1–47.2), 16.1%, 14.0%, and 23.3% of the risk for development of PAD, CoAD, IS, and CaAD, respectively. Hypertension was more associated with development of PAD than CoAD (p = 0.009). Smoking and diabetes mellitus were positively associated with all four manifestations, but these associations were significantly stronger for PAD than the other three manifestations. Smoking and diabetes mellitus had a larger impact on incident PAD than incident coronary, cerebral or precerebral artery manifestations. Since the lower extremity arteries are the easiest to access and examine, they may be considered as the first arterial bed to examine in patients at increased risk for atherosclerotic manifestations. [ABSTRACT FROM AUTHOR]

Background/Objectives: Acute mesenteric ischemia (AMI) is life-threatening and difficult to diagnose in time. Unlike many cardiovascular diseases, the association between lifestyle factors such as diet, alcohol consumption, and physical activity and AMI is unknown. Methods: This study is a prospective cohort study with 28,098 middle-aged participants with a mean follow-up time of 23.1 years. Baseline characteristics were obtained with questionnaires regarding physical activity, lifestyle, and diet. The primary endpoint was a diagnosis of AMI identified through the Swedish National Patient Register. Follow-up times were decided by the date of diagnosis, death, or end of follow-up, 2022-12-31. Results: The total number of patients with AMI was 140. Current smoking (adjusted hazard ratio [aHR] 3.02, 95% confidence interval [CI] 1.91–4.79) and those with the highest alcohol consumption (aHR 2.53, 95% CI 1.27–5.03) had a higher risk of developing AMI. Participants with high physical activity, 25.1–50.0 metabolic equivalent task hours per week (MET-h/week), had a lower risk (aHR 0.51, 95% CI 0.27–0.95). Diet quality and dietary components did not affect the risk of AMI. Conclusions: Smoking and higher alcohol consumption were associated with higher risk, while physical activity was associated with lower risk of AMI in this prospective cohort. Diet quality and dietary components were less relevant for the prediction of AMI than these traditional risk factors of atherosclerotic disease. [ABSTRACT FROM AUTHOR]

Background: Acute mesenteric venous thrombosis (MVT) is rarely suspected as primary diagnosis in emergency departments and still carries an in-hospital mortality rate of above 20%. Objectives: The aim of this study was to find differences in clinical and laboratory markers between patients with acute MVT and a control group of suspected but confirmed as not having any type of acute mesenteric ischaemia (AMI). Design: Data was retrieved from the AMESI (Acute MESenteric Ischaemia) study. This international, multicenter prospective case-control study from 32 sites collected data on patients with suspected AMI during a 10-month period. Methods: Independent factors associated with acute MVT were evaluated in a multivariable logistic regression analysis and expressed as odds ratios (OR) with 95% confidence intervals (CI). Results: D-dimer was not significantly higher in MVT (n = 73) compared to non-AMI (n = 287) patients (median 7.0 mg/L vs 4.5 mg/L, P =.092). After entering BMI, atherosclerotic disease, history of venous thromboembolism, CRP, and D-dimer as covariates in a multi-variable logistic regression analysis, absence of atherosclerotic disease (OR 0.096, 95% CI 0.011-0.84; P =.034) and elevated D-dimer (OR 2.59/one SD increment, 95% CI 1.07-6.28; P =.034) were associated with MVT. The discriminative ability of D-dimer for MVT as assessed by area under the curve in the receiver operating characteristics analysis was 0.63 (95% CI 0.49-0.78). Conclusion: Elevated D-dimer was associated with MVT, but the discriminative ability of D-dimer was poor. There is an urgent need to find a more accurate plasma biomarker for this condition. TRIAL REGISTRATION: NCT05218863 (registered 19.01.2022). Plain Language Summary: Acute mesenteric vein thrombosis is rare, but life-threatening. The symptoms are abdominal pain and are not distinct from other acute abdominal conditions. A blood test identifying or leading to easier diagnosis is warranted. This multicenter international study has included patients with thrombosis in the mesenteric veins as well as suspected diseases, but not confirmed conditions, of disturbed circulation to the gastrointestinal tract. Elevation of the blood marker D-dimer was found to be associated with the condition of acute mesenteric vein thrombosis, but was not enough discriminative in relation to those patients with suspected disease only. There is an urgent need to find a more accurate blood marker for deep vein thrombosis of the abdomen. [ABSTRACT FROM AUTHOR]

Introduction: The potential utility of inflammatory and hemodynamic plasma biomarkers for the prediction of incident lower extremity arterial disease (LEAD), carotid artery stenosis (CAS), isolated atherosclerotic disease without concomitant abdominal aortic aneurysm (AAA), and isolated AAA without concomitant atherosclerotic disease has not yet been integrated in clinical practice. The main objective of this prospective study was to find predictive plasma biomarkers for cardiovascular disease and to evaluate differences in plasma biomarker profiles between asymptomatic and symptomatic CAS, as well as between isolated atherosclerotic disease and isolated AAA. Methods: Blood samples collected at baseline from participants in the prospective Malmö Diet and Cancer study (MDCS) cardiovascular cohort (n = 5550 middle-aged individuals; baseline 1991–1994) were used for plasma biomarker analysis. Validation of each incident cardiovascular diagnosis was performed by random sampling. Cox regression analysis was used to calculate hazard ratios (HRs) per one standard deviation increment of each respective log-transformed plasma biomarker with 95% confidence intervals (CI). Results: Adjusted lipoprotein-associated phospholipase A2 (Lp-PLA2) activity (HR 1.33; CI 1.17–1.52) and mass (HR 1.20; CI 1.05–1.37), C-reactive protein (CRP) (HR 1.55; CI 1.36–1.76), copeptin (HR 1.46; CI 1.19–1.80), N-terminal pro-B-type natriuretic peptide (N-BNP) (HR 1.28; 1.11–1.48), and cystatin C (HR 1.19; 95% 1.10–1.29) were associated with incident symptomatic LEAD. Adjusted N-BNP (HR 1.59; CI 1.20–2.11), mid-regional proadrenomedullin (HR 1.40; CI 1.13–1.73), cystatin C (HR 1.21; CI 1.02–1.43), and CRP (HR 1.53; CI 1.13–1.73) were associated with incident symptomatic but not asymptomatic CAS. Adjusted HR was higher for Lp-PLA2 (mass) for incident isolated AAA compared to for isolated atherosclerotic disease. Conclusions: Plasma biomarker profile data support that subclinical vascular inflammation and cardiovascular stress seem to be relevant for the development of atherosclerotic disease and AAA. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate outcomes of management without surgical revascularization in patients with acute lower limb ischemia (ALI) in a population-based setting. Design: Retrospective observational population-based study. Materials: Patients from Malmö, Sweden, hospitalized for ALI between 2015 and 2018. Methods: In-hospital, surgical, radiological, and autopsy registries were scrutinized for descriptive data on ALI patients managed by endovascular and open vascular surgery, conservative vascular therapy, primary major amputation, and palliative care. Results: Among 161 patients, 73 (45.3%) did not undergo any operative revascularization. Conservative vascular therapy, primary amputation, and palliative care were conducted in 25 (15.5%), 26 (16.1%), and 22 (13.7%) patients, respectively. Conservatively treated patients had Rutherford class ≥ IIb ischemia and embolic occlusion in 33% and 68% of cases, respectively. Their median C-reactive protein level at admission was 7 mg/L (interquartile range 2 – 31 mg/L). Among conservatively treated patients, anticoagulation therapy in half to full dose was given to 22 (88%) patients for six weeks or longer, and analgesics in low or moderate doses were given to twelve (48%) patients at discharge. The major amputation rate at 1 year was 8% among conservatively treated patients, and four patients with foot embolization had not undergone amputation at 1 year. Conclusion: Patients selected for initial conservative therapy of ALI with anticoagulation alone may have a good outcome, even when admitted with Rutherford class IIb ischemia. A low C-reactive protein level at admission seems to be a favorable marker when choosing conservative therapy. A prospective, preferably multicenter, study with a predefined protocol in these conservatively treated patients is warranted to better define the dose and length of anticoagulation therapy. [ABSTRACT FROM AUTHOR]

Background: Emergency computed tomography angiography (CTA) is the most important imaging modality to visualize arterial occlusions in patients with acute lower limb ischaemia (ALI). Extravascular incidental findings (EVIFs) have received less attention. Purpose: The aims of this study were to evaluate the incidence of EVIFs of immediate clinical relevance in patients with ALI undergoing CTA and evaluate the association between EVIFs and emergency revascularization and amputation-free survival at 1 year. Methods: Retrospective cohort study. Emergency CTA in patients with ALI between 2015 and 2018 were independently scrutinized by two senior radiologists. EVIFs were classified into immediate (category I), potential (category II) or no clinical relevance (category III). Multi-variable binary logistic regression analysis was expressed in Odds ratios (OR) with 95% confidence intervals (CI). Results: The intra-class correlation (ICC) coefficient for EVIF category I between the raters was 0.94 (95% CI 0.92–0.96). Among 118 patients with ALI, 78 patients underwent emergency revascularization. Forty-six EVIFs (34 patients) were category I, of which 63% were found in the chest, including pleural effusion (n = 12), pneumonia (n = 8) and cardiac thrombus (n = 4). Ascites (n = 4) and cancer disease (n = 4) were other category I findings. Category I EVIFs were associated with reduced rate of emergency revascularization (OR 0.26, 95% CI 0.10–0.66) and increased rate of combined major amputation/mortality at 1 year (OR 2.9, 95% CI 1.1–8.2) in adjusted analysis. Conclusion: It is important to evaluate EVIFs in emergency CTA in patients with ALI since these findings are both common and associated with reduced emergency revascularization and amputation-free survival at 1 year. [ABSTRACT FROM AUTHOR]

Atherosclerosis constitutes the leading cause of death worldwide, surpassing violence. Given the physiopathological complexity it presents, it is important to recognize the genetic and atherogenic alterations associated with its development biology, which is useful for the prevention and control of obstructive vascular disease. The genetic inheritance pattern and the availability of candidate genes, such as PCSK9, APOB, APOA5, APOC3, ApoE, ABCA1, LPA, involved in the synthesis and metabolism of lipoproteins, show the possibility of establishing biomarkers related to alterations in plasma levels, demonstrating their risk association in different populations, which allows the identification of potential therapeutic targets. [ABSTRACT FROM AUTHOR]