99 results on '"Creager, Mark A."'
Search Results
2. Long-Term Patient Outcomes After Femoropopliteal Peripheral Vascular Intervention in Patients With Intermittent Claudication.
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Altin, S. Elissa, Parise, Helen, Hess, Connie N., Rosenthal, Ning A., Creager, Mark A., Aronow, Herbert D., and Curtis, Jeptha P.
- Abstract
In patients with intermittent claudication (IC), short-term amputation rates from clinical trial data following lower extremity femoropopliteal (FP) peripheral vascular intervention (PVI) are <1% with unknown longer-term rates. The aim of this study was to identify revascularization and amputation rates following PVI in the FP segment and to assess 4-year amputation and revascularization rates after FP PVI for IC. From 2016 to 2020, 19,324 patients undergoing FP PVI for IC were included from the PINC AI Healthcare Database and evaluated by treatment level (superficial femoral artery [SFA], popliteal artery [POP], or both). The primary outcome was index limb amputation (ILA) assessed by Kaplan-Meier estimate. The secondary outcomes were index limb major amputation and repeat revascularization. HRs were estimated using Cox proportional hazard regression. The 4-year index limb amputation rate following FP PVI was 4.3% (95% CI: 4.0-4.7), with a major amputation rate of 3.2% (95% CI: 2.9-3.5). After POP PVI, ILA was significantly higher than SFA alone (7.5% vs 3.4%) or both segment PVI (5.5%). In multivariate analysis, POP PVI was associated with higher ILA rates at 4 years compared with isolated SFA PVI (HR: 2.10; 95% CI: 1.52-2.91) and index limb major amputation (HR: 1.98; 95% CI: 1.32-2.95). Repeat FP revascularization rates were 15.2%; they were highest in patients undergoing both SFA and POP PVI (18.7%; P < 0.0001) compared with SFA (13.9%) and POP (17.1%) only. IC patients undergoing FP PVI had 4-year rates of index limb repeat revascularization of 16.7% and ILA rates of 4.3%. Further risk factors for amputation requires further investigation. [Display omitted] [ABSTRACT FROM AUTHOR]
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- 2023
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3. The Impact of Diabetes Mellitus on the Outcomes of Revascularization for Chronic Limb-Threatening Ischemia in the BEST-CLI Trial.
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Ochoa Chaar, Cassius Iyad, Malas, Mahmoud, Doros, Gheorghe, Schermerhorn, Marc, Conte, Michael S., Alameddine, Dana, Siracuse, Jeffrey J., Yadavalli, Sai Divya, Dake, Michael D., Creager, Mark A., Tan, Tze-Woei, Rosenfield, Kenneth, Menard, Mathew T., Farber, Alik, and Hamdan, Allen
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- 2024
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4. Vascular basis for the treatment of myocardial ischemia study: trial design and baseline characteristics
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Stone, Peter H., Lloyd-Jones, Donald M., Johnstone, Michael, Carlson, William, Rubenstein, Joel, Creager, Mark, Frei, Balz, Sopko, George, Clark, Maureen E., Maccallum, Gail, Kinlay, Scott, Orav, John, and Selwyn, Andrew P.
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Myocardial ischemia -- Drug therapy ,Myocardial ischemia -- Research ,Antioxidants -- Patient outcomes ,Health - Published
- 2004
5. Bolus recombinant urokinase versus heparin in deep venous thrombosis: a randomized controlled trial
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Goldhaber, Samuel Z., Hirsch, Denise R., MacDougall, Regina C., Polak, Joseph F., and Creager, Mark A.
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Urokinase -- Health aspects ,Heparin -- Health aspects ,Venous thrombosis -- Drug therapy ,Health - Published
- 1996
6. Propionyl-L-carnitine improves exercise performance and functional status in patients with claudication
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Hiatt, William R., Regensteiner, Judith G., Creager, Mark A., Hirsch, Alan T., Cooke, John P., Olin, Jeffrey W., Gorbunov, Georgij N., Isner, Jeffrey, Lukjanov, Yurij V., Tsitsiashvili, Mihail Sh., Zabelskaya, Tatyana F., and Amato, Antonino
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Intermittent claudication -- Care and treatment ,Carnitine -- Health aspects ,Health ,Health care industry - Published
- 2001
7. Frequency of deep venous thrombosis in asymptomatic patients with coronary artery bypass grafts
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Reis, Steven E., Polak, Joseph F., Hirsch, Denise R., Cohn, Lawrence H., Creager, Mark A., Donovan, Barbara C., and Goldhaber, Samuel Z.
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Coronary artery bypass -- Complications ,Venous thrombosis -- Risk factors ,Health - Abstract
Deep venous thrombosis (DVT), (formation of a clot in a deep vein, usually in the thigh or pelvic area), can be a complication of orthopedic and general surgery patients. These clots may travel to the lungs and can be fatal. The rate of DVT after coronary artery bypass graft (CABG) surgery is not known because the edema (swelling from fluid retention), redness, and tenderness caused by vein harvesting make DVT difficult to diagnose. Now, high resolution ultrasonography with color Doppler imaging of the veins provides a noninvasive method of detecting DVT. Twenty-nine patients who underwent CABG surgery were examined using ultrasound to determine the incidence of DVT. Almost half had DVT that could not be detected clinically. The causes of DVT in these patients are probably similar to those in other surgical patients, including poor circulation, damage to the lining of the blood vessels, and an increased tendency for the blood to coagulate provoked by anesthetics and lack of mobility. However, CABG patients may face increased risk because of immobilization of the legs during and after surgery. The results indicate that the causes of DVT in CABG patients are different from those in patients undergoing other types of surgery. Routine postoperative treatment with aspirin does not prevent DVT, and patients who do not wear graded elastic compression stockings are probably at greater risk. (Consumer Summary produced by Reliance Medical Information, Inc.)
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- 1991
8. 2021 ACC/AHA/SVM/ACP Advanced Training Statement on Vascular Medicine (Revision of the 2004 ACC/ACP/SCAI/SVMB/SVS Clinical Competence Statement on Vascular Medicine and Catheter-Based Peripheral Vascular Interventions): A Report of the ACC Competency Management Committee.
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Creager, Mark A., Hamburg, Naomi M., Calligaro, Keith D., Casanegra, Ana I., Freeman, Rosario, Gordon, Phyllis A., Gornik, Heather L., Kim, Esther S.H., Leeper, Nicholas J., Merli, Geno J., Niazi, Khusrow, Olin, Jeffrey W., Quiroz, Rene, Rrapo Kaso, Elona, Wasan, Suman, Waxler, Andrew R., White, Christopher J., White Solaru, Khendi, Williams, Marlene S., and Writing Committee Members
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VARICOSE veins , *AORTIC dissection , *THROMBOLYTIC therapy , *ANKLE brachial index , *VASCULAR medicine , *MEDICAL personnel , *CLINICAL competence , *MANAGEMENT committees , *MEDICAL sciences - Published
- 2021
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9. Pathogenic mechanisms of atherosclerosis: effect of lipid lowering on the biology of atherosclerosis
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Ganz, Peter, Creager, Mark A., Fang, James C., McConnell, Michael V., Lee, Richard T., Libby, Peter, and Selwyn, Andrew P.
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Atherosclerosis -- Development and progression ,Lipid metabolism -- Physiological aspects ,Diet in disease -- Research ,Health ,Health care industry - Abstract
Numerous trials have demonstrated that cholesterol-lowering therapy leads to marked reductions in cardiovascular and overall mortality and in the need for coronary revascularization. Angiographic regression trials have shown that cholesterol lowering can reduce progression and, in some instances, achieve regression of coronary atherosclerotic lesions. However, recent studies have contradicted the traditional view that the clinical course of coronary artery disease is closely linked to the severity of coronary artery stenosis. It is now apparent that stenoses responsible for myocardial infarction or unstable angina are typically mild rather than severe. These observations suggest that regression may not be the principal mechanism by which cholesterol lowering affects cardiovascular risk. Two mechanisms--plaque stabilization and improved endothelial function--have been examined in this regard. Basic studies suggest that cholesterol lowering favorably alters those features of atherosclerosis that promote plaque stability. Recent clinical studies have clearly established that aggressive lipid-lowering therapy improves endothelial function and reduces myocardial ischemia in patients with hypercholesterolemia.
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- 1996
10. Utility of leg ultrasonography in suspected symptomatic isolated calf deep venous thrombosis
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Simons, Grant R., Skibo, Lorraine K., Polak, Joseph F., Creager, Mark A., Klapec-Fay, Josephine M., and Goldhaber, Samuel Z.
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Venous thrombosis -- Diagnosis ,Duplex ultrasonography -- Diagnostic use ,Health ,Health care industry - Published
- 1995
11. Carotid arterial compliance in patients with congestive heart failure secondary to idiopathic dilated cardiomyopathy
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Lage, Silvia G., Kopel, Liliane, Monachini, Maristela C., Medeiros, Caio J., Pileggi, Fulvio, Polak, Joseph F., and Creager, Mark A.
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Congestive heart failure -- Physiological aspects ,Cardiac output -- Measurement ,Heart enlargement -- Physiological aspects ,Cardiomyopathy, Dilated -- Physiological aspects ,Health - Abstract
Conduit artery distensibility affects the pulsatile component of afterload and may contribute to impaired left ventricular function in patients with congestive heart failure (CHF). The objective of this study were to (1) determine whether arterial distensibility is reduced in patients with CHF, and (2) determine whether decreased arterial compliance is related to an abnormality in vascular wall structure (i.e., wall thickness or excessive levels of circulating neurohumoral vasoconstrictors, or both). The study participants included 40 patients with CHF secondary to idiopathic dilated cardiomyopathy and 33 age-matched healthy volunteers. High-resolution ultrasonography was performed to directly visualize the common carotid artery and measure its diameter and wall thickness. Its elastic properties were determined by relating changes in arterial diameter to changes in pressure generated with each heart beat. Carotid artery distensibility was less (14.1 [+ or -] 1.1 vs 25.3 [+ or -] 1.6 [10.sup.-6] * [N.sup.-1] * [m.sup.2], p (Am J Cardiol 1994;74:691-695)
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- 1994
12. Efficacy and safety of repeated boluses of urokinase in the treatment of deep venous thrombosis
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Goldhaber, Samuel Z., Polak, Joseph F., Feldstein, Michael L., Meyerovitz, Michael F., and Creager, Mark A.
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Venous thrombosis -- Drug therapy ,Urokinase -- Dosage and administration ,Health - Abstract
The only Food and Drug Administration-approved thrombolytic regimen for treatment of deep venous thrombosis (DVT) is a 24- to 72-hour continuous infusion of intravenous streptokinase. This approach to DVT thrombolysis is not entirely satisfactory because of the bleeding complications that may accompany this therapy. In the current study, we treated 27 patients with DVT with a novel dosing regimen of urokinase: 1,000,000 U administered as a 10-minute bolus, with a total of 3 boluses given over approximately 24 hours. Patients were given heparin overnight between bolus urokinase doses. Efficacy was assessed by comparing baseline and prehospital discharge vascular imaging studies, which constituted either venous ultrasound or contrast venography. A vascular-imaging panel of physicians, unaware of the sequence of paired studies, found that 14 patients (52%) had clot lysis (6 slight, 6 moderate and 2 marked), 9 (33%) had no change, and 4 (15%) had more extensive thrombosis after treatment (1 slight, 2 moderate and 1 marked). There were no bleeding complications. At 48 hours after starting urokinase, mean plasma fibrinogen levels had decreased 61% from baseline, and the mean bleeding time had increased 28% from baseline (but remained within the normal range). Because of the promising efficacy and safety that were found in this case series, it is concluded that further testing of bolus urokinase is warranted against anticoagulation alone. (Am J Cardiol 1994;73:75-79)
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- 1994
13. Baroreceptor reflex function in congestive heart failure
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Creager, Mark A.
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Congestive heart failure -- Physiological aspects ,Nervous system, Sympathetic -- Physiological aspects ,Reflexes, Abnormal -- Physiological aspects ,Health - Published
- 1992
14. Prediction of major cardiac events after peripheral vascular surgery using dipyridamole echocardiography
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Tischler, Marc D., Lee, Thomas H., Hirsch, Alan T., Lord, Christopher P., Goldman, Lee, Creager, Mark A., and Lee, Richard T.
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Echocardiography -- Evaluation ,Peripheral vascular diseases ,Blood vessels ,Dipyridamole ,Health - Abstract
Patients undergoing peripheral vascular surgery are at increased risk of postoperative cardiac complications. To evaluate the role of dipyridamole echocardiography in predicting major cardiac events, 109 unselected patients undergoing elective peripheral vascular surgery were prospectively studied. Preoperative dipyridamole echocardiograms were interpreted by an echocardiographer unaware of all clinical data. Patients were followed up until hospital discharge by research physicians without knowledge of dipyridamole echocardiography results. Outcomes were classified using strict predefined criteria by reviewers unaware of other clinical and echocardiographic data. Of the 109 patients, 9 (8%) had positive studies defined as development of new regional wall motion abnormalities or worsening of preexistent wall motion abnormalities. Of these 9 patients, 7 had postoperative events, including 3 cardiac deaths, 1 nonfatal myocardial infarction, 2 with unstable angina, and 1 with pulmonary edema. Only 1 event occurred among the 100 patients with negative studies. The sensitivity and specificity of dipyridamole echocardiography for predicting cardiac events after vascular surgery were 88 and 98%, respectively; the positive and negative predictive values were 78 and 99%. The relative risk of having a cardiac event if dipyridamole echocardiography was abnormal was 78 (95% confidence interval, 11 to 564; p, Peripheral vascular disease is generally considered to be disease affecting the blood vessels of the extremities. Patients undergoing surgery for peripheral vascular disease are at risk for postoperative complications, including heart attack and other cardiac events. Dipyridamole thallium scintigraphy (radiographic imaging) and ambulatory electrocardiographic monitoring (24-hour recordings of the electrical activity of the heart) are used before surgery to identify patients who face increased risk of complications. These methods are imprecise and may lead to unnecessary invasive testing and high-risk procedures. Dipyridamole thallium scintigraphy predicts major cardiac events about 30 percent of the time, or up to 43 percent when clinical results are added. Ambulatory monitoring produces only slightly better results. Dipyridamole echocardiography, a more precise imaging technique, was evaluated in 109 patients prior to surgery for peripheral vascular disease. This technique was found to predict postsurgical cardiac events 78 percent of the time. The results of this procedure were able to identify patients who would not suffer cardiac events 98 percent of the time. High-dose dipyridamole may produce adverse effects in some patients. Consequently, the less specific but safer method of ambulatory monitoring may be a better alternative for screening patients with peripheral vascular disease prior to surgery. A cost-benefit analysis is required to determine which of the two methods is more effective. (Consumer Summary produced by Reliance Medical Information, Inc.)
- Published
- 1991
15. Long-term prognosis of myocardial ischemia detected by Holter monitoring in peripheral vascular disease
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Raby, Khether E., Goldman, Lee, Cook, Francis E., Rumerman, Joanna, Barry, Joan, Creager, Mark A., and Selwyn, Andrew P.
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Peripheral vascular diseases -- Prognosis ,Coronary heart disease -- Prognosis ,Coronary heart disease -- Diagnosis ,Ambulatory electrocardiography -- Evaluation ,Peripheral vascular diseases -- Care and treatment ,Health - Abstract
To assess the long-term prognostic significance of myocardial ischemia, as measured by ambulatory electrocardiographic monitoring, in patients with occlusive peripheral arterial disease, 176 eligible patients scheduled for elective peripheral arterial surgery at Brigham and Women's Hospital were prospectively studied. All patients were monitored preoperatively without alterations to baseline medications. Prospective follow-up was obtained during routine medical care as provided by blinded, independent physicians and by subsequent telephone contact with the patients. Thirty-two patients (18%) had a total of 75 episodes of myocardial ischemia, 73 (97%) of which were asymptomatic. During a mean follow-up period of 615 days, there were 9 cardiac deaths, 1 occuring in-hospital after peripheral vascular surgery, and 13 nonfatal myocardial infarctions, 4 occuring in-hospital after peripheral vascular surgery. Cardiac events occured in 12 of 32 patients with ischemia (38%), including 6 cardiac deaths, and in 10 of 144 patients without ischemia (7%), including 3 cardiac deaths (risk ratio 5.4, 95% confidence interval 2.6 to 11.4). The sensitivity of ischemia was 55%, the specificity was 87%, the positive predictive value was 38%, and the negative predictive value was 93%. In a multivariate Cox proportional-hazards model controlling for age, gender, coronary risk factors, history of angina, myocardial infarction, coronary artery disease and antianginal medications, the presence of ischemia was the only independent predictor of outcome. In patients with peripheral arterial disease, who often are unable to perform adequate exercise testing, ambulatory monitoring for myocardial ischemia is a significant independent predictor of 1- to 2-year prognosis. (Am J Cardiol 1990;66:1309-1313), Coronary artery disease (CAD) is a progressive condition in which the blood vessels supplying the heart are partially or completely blocked, resulting in diminished blood flow to the heart (myocardial ischemia). Studies have shown that there is a strong correlation between abnormalities in the electrical activity of the heart (as determined by ambulatory electrocardiographic monitoring) and other markers of MI (myocardial infarction, or heart attack), such as exercise testing, and angiography (X-ray of vessels). One of the benefits of employing ambulatory monitoring is that it can be used in patients with peripheral vascular disease (impaired circulation to the arms and legs) who can not perform standard exercise tests. Of 274 patients who were scheduled to undergo surgery for peripheral vascular disease, ambulatory electrocardiographic monitoring was performed on 176 patients. The patients had peripheral vascular disease of varying severity. The records were analyzed by physicians, who had no knowledge of the patients' status, for the presence or absence of myocardial ischemia. Only 23 patients attempted exercise testing. No changes in medication were made during the monitoring period. Other putative predictors of cardiovascular function were noted, such as number of risk factors, and history of angina or heart attack. Postsurgical follow-up was conducted to determine the incidence of heart attack and cardiac death. Statistical analysis indicated that the presence or absence of myocardial ischemia was the best predictor of future heart attack or cardiac death, even when other confounding factors, such as cholesterol level and smoking history, were considered. In patients unable to perform exercise testing, ambulatory electrocardiographic monitoring presents a reliable, noninvasive method for acquiring information on the presence or absence of myocardial ischemia. (Consumer Summary produced by Reliance Medical Information, Inc.)
- Published
- 1990
16. Therapeutic anticoagulation after index peripheral endovascular intervention in patients with claudication.
- Author
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Lee, Christopher, Ramkumar, Niveditta, Young, Michael N., Goodney, Philip P., Creager, Mark A., and Henkin, Stanislav
- Abstract
Antiplatelet agents are commonly used after peripheral endovascular intervention (PVI). However, the effect of full-dose anticoagulation on outcomes after PVI is not well-established. We sought to investigate whether full-dose anticoagulation after PVI is associated with adverse events. We utilized the Vascular Quality Initiative to study patients undergoing index PVI for claudication (2010-2019), stratified by the presence or absence of an anticoagulant on discharge. The primary outcomes were 2-year patency, major adverse limb events (MALE), and mortality. We built a propensity score adjusting for comorbidities and employed inverse probability weighting to estimate the association of anticoagulation with outcomes. We identified 26,240 patients; 9.1% were discharged on an anticoagulant. Patients receiving any anticoagulation had a significantly higher risk of mortality (adjusted hazard ratio [aHR], 1.61; 95% confidence interval [CI], 1.35-1.92), but not MALE, or patency loss. Patients receiving a vitamin K antagonist had a significantly higher risk of patency loss (aHR, 1.32; 95% CI, 1.09-1.60), MALE (aHR, 1.33; 95% CI, 1.13-1.57), and mortality (aHR, 1.46; 95% CI, 1.27-1.69). Patients on an oral Factor Xa inhibitors had a significantly lower risk of patency loss (aHR, 0.61; 95% CI, 0.41-0.93) but increased mortality (aHR, 1.51; 95% CI, 1.19-1.92). Therapeutic anticoagulation after PVI is associated with higher risk of all-cause mortality. Although oral Factor Xa inhibitors are associated with decreased risk of patency loss, vitamin K antagonists are associated with higher risk of patency loss, MALE, and death. Further prospective studies are necessary to study the safety and efficacy of full-dose anticoagulation after PVI. [Display omitted] [ABSTRACT FROM AUTHOR]
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- 2023
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17. She Was One of Us. Remembering Dr. Lauren Gilstrap.
- Author
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Lala, Anuradha, Stevenson, Lynne W., Creager, Mark A., and Mentz, Robert J.
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- 2022
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18. Challenges and Controversies in Peer Review: JACC Review Topic of the Week.
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Kusumoto, Fred M., Bittl, John A., Creager, Mark A., Dauerman, Harold L., Lala, Anuradha, McDermott, Mary M., Turco, Justine Varieur, Taqueti, Viviany R., and Fuster, Valentin
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SCIENTIFIC communication , *IMPLICIT bias , *TASK forces , *COVID-19 pandemic , *INFORMATION dissemination - Abstract
The process of peer review has been the gold standard for evaluating medical science, but significant pressures from the recent COVID-19 pandemic, new methods of communication, larger amounts of research, and an evolving publication landscape have placed significant pressures on this system. A task force convened by the American College of Cardiology identified the 5 most significant controversies associated with the current peer-review process: the effect of preprints, reviewer blinding, reviewer selection, reviewer incentivization, and publication of peer reviewer comments. Although specific solutions to these issues will vary, regardless of how scientific communication evolves, peer review must remain an essential process for ensuring scientific integrity, timely dissemination of information, and better patient care. In medicine, the peer-review process is crucial because harm can occur if poor-quality data or incorrect conclusions are published. With the dramatic increase in scientific publications and new methods of communication, high-quality peer review is more important now than ever. [Display omitted] • Peer review of medical science is critical to providing clinicians with fairly vetted and accurate information. • The current process of peer review is often opaque, slow, and susceptible to conscious and unconscious bias. • Peer-review processes must evolve to incorporate contemporary methods of communication and respond to increasing clinical demands. [ABSTRACT FROM AUTHOR]
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- 2023
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19. Peripheral Revascularization in Patients With Peripheral Artery Disease With Vorapaxar: Insights From the TRA 2°P–TIMI 50 Trial.
- Author
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Bonaca, Marc P., Creager, Mark A., Olin, Jeffrey, Scirica, Benjamin M., Jr.Gilchrist, Ian C., Murphy, Sabina A., Goodrich, Erica L., Braunwald, Eugene, and Morrow, David A.
- Abstract
Objectives The aim of this study was to determine whether the reduction in peripheral revascularization with vorapaxar in patients with peripheral artery disease (PAD) is directionally consistent across indications, including acute limb ischemia, progressively disabling symptoms, or both. Background The protease-activated receptor–1 antagonist vorapaxar reduces peripheral revascularization in patients with PAD. Methods The TRA 2°P–TIMI 50 (Thrombin Receptor Antagonist in Secondary Prevention of Atherothrombotic Ischemic Events–Thrombolysis in Myocardial Infarction 50) trial randomized 26,449 patients with histories of myocardial infarction, stroke, or symptomatic PAD to vorapaxar or placebo on a background of standard therapy. A total of 5,845 patients had a known history of PAD at randomization. Peripheral revascularization procedures reported by the site were a pre-specified outcome. We explored whether the benefit of vorapaxar was consistent across indication and type of procedure. Results Of the 5,845 patients with known PAD, a total of 934 (16%) underwent at least 1 peripheral revascularization over 2.5 years (median). More than one-half (55%) were for worsening claudication, followed by critical limb ischemia (24%), acute limb ischemia (16%), and asymptomatic severe stenosis (4%). Vorapaxar significantly reduced peripheral revascularization (19.3% for placebo, 15.4% for vorapaxar; hazard ratio: 0.82; 95% confidence interval: 0.72 to 0.93; p = 0.003), with a consistent pattern of efficacy across indication. Conclusions Vorapaxar reduces peripheral revascularization in patients with PAD. This benefit of vorapaxar is directionally consistent across type of procedure and indication. (Trial to Assess the Effects of Vorapaxar [SCH 530348; MK-5348] in Preventing Heart Attack and Stroke in Patients With Atherosclerosis [TRA 2°P - TIMI 50] [P04737]; NCT00526474 ) [ABSTRACT FROM AUTHOR]
- Published
- 2016
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20. Surgery for aortic dilatation in patients with bicuspid aortic valves: A statement of clarification from the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines.
- Author
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Hiratzka, Loren F., Creager, Mark A., Isselbacher, Eric M., Svensson, Lars G., Nishimura, Rick A., Bonow, Robert O., Guyton, Robert A., and Sundt, Thoralf M.
- Abstract
Two guidelines from the American College of Cardiology (ACC), the American Heart Association (AHA), and collaborating societies address the risk of aortic dissection in patients with bicuspid aortic valves and severe aortic enlargement: The “2010 ACCF/AHA/AATS/ACR/ASA/SCA/SCAI/SIR/STS/SVM Guidelines for the Diagnosis and Management of Patients With Thoracic Aortic Disease” ( J Am Coll Cardiol . 2010;55:e27-130) and the “2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease” ( J Am Coll Cardiol . 2014;63:e57-185). However, the 2 guidelines differ with regard to the recommended threshold of aortic root or ascending aortic dilatation that would justify surgical intervention in patients with bicuspid aortic valves. The ACC and AHA therefore convened a subcommittee representing members of the 2 guideline writing committees to review the evidence, reach consensus, and draft a statement of clarification for both guidelines. This statement of clarification uses the ACC/AHA revised structure for delineating the Class of Recommendation and Level of Evidence to provide recommendations that replace those contained in Section 9.2.2.1 of the thoracic aortic disease guideline and Section 5.1.3 of the valvular heart disease guideline. [ABSTRACT FROM AUTHOR]
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- 2016
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21. Antithrombotic Therapy and Major Adverse Limb Events in Peripheral Artery Disease: A Step Forward.
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Bonaca, Marc P and Creager, Mark A
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- 2018
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22. International study of ketanserin in Raynaud's phenomenon
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Coffman, Jay D., Clement, Dennis L., Creager, Mark A., Dormandy, John A., Janssens, Monique M.-L., McKendry, Robert J.R., Murray, Gordon D., and Nielsen, Steen L.
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Raynaud's disease -- Drug therapy ,Connective tissue diseases -- Drug therapy ,Health ,Health care industry - Abstract
PURPOSES: The effects of ketanserin on primary or secondary Raynaud's phenomenon due to connective tissue disease were studied in a large, international group of patients. PATIENTS AND METHODS: The study population consisted of 222 patients from 10 countries. After a run-in period of one month of placebo theraphy, patients were randomly assigned in a double-blind manner to receive ketanserin 40 mg three times daily (n = 113) or placebo (n = 109) for three months. Total finger blood flow was measured in 41 patients in a warm and cool room before and during treatment. Vasospastic episodes were assessed by diaries and global evaluations. RESULTS: A significant reduction of 34% in frequency of episodes occurred with ketanserin, compared to 18% with placebo (p = 0.011). There was a 1% reduction in duration of episodes with ketanserin therapy, compared to a 2% increase with placebo therapy, but this finding was not statistically significant (p = 0.29). No different was observed in severity of attacks. Global evaluations by investigators (p = 0.03) and patients (p
- Published
- 1989
23. COCATS 4 Task Force 9: Training in Vascular Medicine.
- Author
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Creager, Mark A., Gornik, Heather L., Gray, Bruce H., Hamburg, Naomi M., Iobst, William F., Mohler, Emile R., and White, Christopher J.
- Subjects
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VASCULAR medicine , *COMPUTED tomography , *VASCULAR catheters , *HEART diseases , *SYMPTOMS , *CONTRAST media - Published
- 2015
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24. Association of monocyte tumor necrosis factor α expression and serum inflammatory biomarkers with walking impairment in peripheral artery disease.
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Pande, Reena L., Brown, Jonathan, Buck, Stewart, Redline, Whitney, Doyle, Jeanne, Plutzky, Jorge, and Creager, Mark A.
- Abstract
Objective Inflammation contributes to the development of peripheral artery disease (PAD) and may contribute to intermittent claudication by adversely affecting vascular and skeletal muscle function. We explored the association of inflammation to maximal walking time (MWT) in patients with claudication. Methods Circulating inflammatory biomarkers, including tumor necrosis factor α (TNF-α), C-reactive protein (CRP), interleukin-6 (IL-6), and soluble intercellular adhesion molecule 1 (sICAM), were measured in 75 subjects with intermittent claudication as well as in 43 healthy subjects. Real-time polymerase chain reaction was used to quantify mRNA expression of TNF-α, IL-6, interferon-γ, and CD36 from peripheral blood monocytes. Treadmill testing was performed in PAD subjects to assess MWT. Results Compared with healthy subjects, PAD subjects had higher levels of circulating TNF-α ( P < .0001), CRP ( P = .003), sICAM ( P < .0001), and IL-6 ( P < .0001). Expression of both IL-6 ( P = .024) and CD36 ( P = .018) was greater in PAD subjects than in healthy subjects. Among subjects with PAD, higher gene expression of TNF-α was associated inversely with MWT ( P = .01). MWT was also associated inversely with greater levels of circulating TNF-α ( P = .028), CRP ( P = .024), IL-6 ( P = .03), and sICAM ( P = .018). Conclusions Systemic inflammation, as indicated by TNF-α inflammatory gene expression in peripheral blood monocytes and by circulating biomarker levels, is associated with impairment in walking time in patients with PAD and intermittent claudication. [ABSTRACT FROM AUTHOR]
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- 2015
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25. Thirty-day vein remodeling is predictive of midterm graft patency after lower extremity bypass.
- Author
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Gasper, Warren J., Owens, Christopher D., Kim, Ji Min, Hills, Nancy, Belkin, Michael, Creager, Mark A., and Conte, Michael S.
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VEIN transplantation ,LONGITUDINAL method ,LEG blood-vessel surgery ,ARTERIAL physiology ,PREOPERATIVE period ,BLOOD sampling ,BIOMARKERS - Abstract
Objective: Successful adaptation of a vein graft to an arterial environment is incompletely understood. We sought to investigate whether early vein graft remodeling is predictive of subsequent patency. Methods: A prospective longitudinal study was conducted of 67 patients undergoing lower extremity bypass with autogenous vein between February 2004 and April 2008. Preoperative blood samples were drawn for biomarkers. During the bypass operation, a 5-cm index segment of the graft was registered for serial lumen diameter measurements at 0, 1, 3, 6, 9, and 12 months using duplex ultrasound imaging. The imaging substudy analysis included patients with at least two ultrasound assessments. Results: Patients (55% male) were a median age of 70 years (interquartile range [IQR], 59-76 years), 40% had diabetes mellitus, 49% had critical limb ischemia, 75% were taking a statin, and 91% were taking an antiplatelet medication. Median follow-up was 32 months (IQR, 15-47 months). The median baseline high-sensitivity C-reactive protein level (hsCRP) was 3.2 mg/L (IQR, 1.4-9.7 mg/L). The average intraoperative, postimplantation vein lumen diameter was 3.9 ± 1.0 mm, increasing to 4.7 ± 1.1 mm at 1 month, an average 24% ± 27% change per patient. By 3 months, the average lumen diameter was 5.1 ± 1.6 mm, with little subsequent change observed to 12 months. Nonwhite race, baseline hsCRP ≥5 mg/L, statin use, and initial lumen diameter were significantly associated with early (0- to 1-month) vein remodeling in a multivariable regression model. The primary patency rate for the cohort was 60% ± 6.3% at 2 years. Initial lumen diameter of the index segment was not associated with primary patency, whereas larger lumen diameter achieved at 1 month (≥5.1 mm) was positively associated with primary patency (log-rank, P = .03). Early (30-day) remodeling behavior was used to divide patients into “poor remodelers” (<−5% lumen diameter change, n = 6), “modest remodelers” (−5% to 25% change, n = 29), and “robust remodelers” (>+25% change, n = 30). Early remodeling category was significantly associated with primary patency rate at 2 years (log-rank, P = .02). A multivariable Cox proportional hazards model showed that modest remodelers (hazard ratio, 3.9; 95% confidence interval, 1.02-15; P = .04) and poor remodelers (hazard ratio, 13; 95% confidence interval; P = .008) had significantly higher hazard ratios for graft failure than robust early remodelers. Conclusions: Early remodeling of the arterialized vein appears to predict midterm bypass graft patency. In addition to baseline diameter, race, inflammation, hsCRP, and statin use are associated with early adaptive remodeling, but the mechanisms for these observations are not understood. [Copyright &y& Elsevier]
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- 2013
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26. An integrated biochemical prediction model of all-cause mortality in patients undergoing lower extremity bypass surgery for advanced peripheral artery disease.
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Owens, Christopher D., Kim, Ji Min, Hevelone, Nathanael D., Gasper, Warren J., Belkin, Michael, Creager, Mark A., and Conte, Michael S.
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PERIPHERAL vascular disease treatment ,CARDIOVASCULAR diseases risk factors ,CORONARY disease ,CORONARY artery bypass ,C-reactive protein ,CELL adhesion molecules ,PREDICTION models ,CLINICAL biochemistry - Abstract
Background: Patients with advanced peripheral artery disease (PAD) have a high prevalence of cardiovascular (CV) risk factors and shortened life expectancy. However, CV risk factors poorly predict midterm (<5 years) mortality in this population. This study tested the hypothesis that baseline biochemical parameters would add clinically meaningful predictive information in patients undergoing lower extremity bypass operations. Methods: This was a prospective cohort study of patients with clinically advanced PAD undergoing lower extremity bypass surgery. The Cox proportional hazard model was used to assess the main outcome of all-cause mortality. A clinical model was constructed with known CV risk factors, and the incremental value of the addition of clinical chemistry, lipid assessment, and a panel of 11 inflammatory parameters was investigated using the C statistic, the integrated discrimination improvement index, and Akaike information criterion. Results: The study monitored 225 patients for a median of 893 days (interquartile range, 539-1315 days). In this study, 50 patients (22.22%) died during the follow-up period. By life-table analysis (expressed as percent surviving ± standard error), survival at 1, 2, 3, 4, and 5 years, respectively, was 90.5% ± 1.9%, 83.4% ± 2.5%, 77.5% ± 3.1%, 71.0% ± 3.8%, and 65.3% ± 6.5%. Compared with survivors, decedents were older, diabetic, had extant coronary artery disease, and were more likely to present with critical limb ischemia as their indication for bypass surgery (P < .05). After adjustment for the above, clinical chemistry and inflammatory parameters significant (hazard ratio [95% confidence interval]) for all-cause mortality were albumin (0.43 [0.26-0.71]; P = .001), estimated glomerular filtration rate (0.98 [0.97-0.99]; P = .023), high-sensitivity C-reactive protein (hsCRP; 3.21 [1.21-8.55]; P = .019), and soluble vascular cell adhesion molecule (1.74 [1.04-2.91]; P = .034). Of the inflammatory molecules investigated, hsCRP proved most robust and representative of the integrated inflammatory response. Albumin, eGFR, and hsCRP improved the C statistic and integrated discrimination improvement index beyond that of the clinical model and produced a final C statistic of 0.82. Conclusions: A risk prediction model including traditional risk factors and parameters of inflammation, renal function, and nutrition had excellent discriminatory ability in predicting all-cause mortality in patients with clinically advanced PAD undergoing bypass surgery. [Copyright &y& Elsevier]
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- 2012
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27. Sex-based differences in the inflammatory profile of peripheral artery disease and the association with primary patency of lower extremity vein bypass grafts.
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Hiramoto, Jade S., Owens, Christopher D., Kim, Ji Min, Boscardin, John, Belkin, Michael, Creager, Mark A., and Conte, Michael S.
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SEX differences (Biology) ,INFLAMMATION ,PERIPHERAL vascular diseases ,ARTERIAL diseases ,BODY mass index ,HYPERTENSION ,C-reactive protein ,BIOMARKERS ,COHORT analysis - Abstract
Objective: This study was conducted to determine if there are sex-based differences in the inflammatory phenotype of patients undergoing lower extremity bypass (LEB) and if they correlate with clinical outcomes. Methods: This was a retrospective analysis of a prospective cohort of 225 patients (161 men and 64 women) who underwent autogenous vein LEB between February 2004 and May 2008. Fasting baseline blood samples were obtained before LEB, and the inflammatory biomarkers high-sensitivity C-reactive protein (CRP) and fibrinogen were assessed. All patients underwent ultrasound graft surveillance. CRP levels were dichotomized at 5 mg/L and fibrinogen levels at 600 mg/dL. Results: There were no significant differences in age, race, history of hypertension or diabetes mellitus, body mass index, or coronary artery disease between men and women. Men were more likely to be current smokers (P = .02), have a history of hypercholesterolemia (P = .02), and be taking statins (P = .02). Women were more likely to present with critical limb ischemia (P = .03) and had higher median baseline CRP levels (5.15 mg/L; interquartile range [IQR], 1.51-18.62 mg/L) than men (2.70; IQR, 1.24-6.98 mg/L; P = .02). Median follow-up was 893 days (IQR, 539-1315 days). A multivariable Cox proportional hazards model for primary vein graft patency showed a significant interaction between sex and CRP (P = .03) and fibrinogen (P = .02). After adjustment for key covariates, primary vein graft patency was significantly less in women with CRP >5 mg/L compared with women with CRP <5 mg/L (P = .02). No such difference was seen in men (P = .95). Primary graft patency was also decreased in women with fibrinogen >600 mg/dL vs women with fibrinogen <600 mg/dL (P = .002); again, this pattern was not evident in men (P = .19). Conclusions: Women undergoing LEB for advanced peripheral artery disease have a different inflammatory phenotype than men. Elevated baseline levels of CRP and fibrinogen are associated with inferior vein graft patency in women but not in men. These findings indicate an important interaction between sex and inflammation in the healing response of vein grafts for LEB. Women with elevated preoperative CRP and fibrinogen levels may benefit from more intensive postoperative graft surveillance protocols. [Copyright &y& Elsevier]
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- 2012
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28. ACCF/AHA/ACR/SCAI/SIR/SVM/SVN/SVS 2010 performance measures for adults with peripheral artery disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures, the American College of ...
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Olin, Jeffrey W., Allie, David E., Belkin, Michael, Bonow, Robert O., Casey, Donald E., Creager, Mark A., Gerber, Thomas C., Hirsch, Alan T., Jaff, Michael R., Kaufman, John A., Lewis, Curtis A., Martin, Edward T., Martin, Louis G., Sheehan, Peter, Stewart, Kerry J., Treat-Jacobson, Diane, White, Christopher J., Zheng, Zhi-Jie, Masoudi, Frederick A., and DeLong, Elizabeth
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- 2011
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29. ACCF/AHA/ACR/SCAI/SIR/SVM/SVN/SVS 2010 performance measures for adults with peripheral artery disease: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Performance Measures, the American College of ...
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Olin, Jeffrey W., Allie, David E., Belkin, Michael, Bonow, Robert O., Casey, Donald E., Creager, Mark A., Gerber, Thomas C., Hirsch, Alan T., Jaff, Michael R., Kaufman, John A., Lewis, Curtis A., Martin, Edward T., Martin, Louis G., Sheehan, Peter, Stewart, Kerry J., Treat-Jacobson, Diane, White, Christopher J., and Zheng, Zhi-Jie
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- 2010
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30. Novel adipokines, high molecular weight adiponectin and resistin, are associated with outcomes following lower extremity revascularization with autogenous vein.
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Owens, Christopher D., Kim, Ji Min, Hevelone, Nathanael D., Hamdan, Allen, Raffetto, Joseph D., Creager, Mark A., and Conte, Michael S.
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PROTEIN hormones ,LIPOTROPIN ,HEALTH outcome assessment ,REVASCULARIZATION (Surgery) ,CORONARY artery bypass ,BIOMARKERS ,GLOMERULAR filtration rate ,CONFIDENCE intervals - Abstract
Objective: A significant portion of patients undergoing lower extremity bypass surgery (LEB) for peripheral arterial disease (PAD) will have cardiovascular or graft-related events. It has been previously demonstrated that systemic inflammation is associated with PAD and its clinical outcomes. We hypothesized that serum biomarkers of insulin resistance and inflammation would identify a subgroup at elevated risk for graft failure, limb loss, and mortality. Methods: This was a prospective longitudinal study of patients (n = 225) undergoing LEB using autogenous vein. Baseline blood samples were obtained prior to surgery in the fasting state. High-sensitivity C-reactive protein (hsCRP) and the adipokines resistin and high-molecular weight adiponectin (HMWA) were measured by enzyme-linked immunosorbent assay (ELISA). Median follow-up was 893 days. The major endpoints of primary patency (PP) and amputation-free survival (AFS) were examined using multivariable methods. Endpoints were screened against biomarkers and patient characteristics for univariate associations. Promising explanatory variables (P < .1) were included in multivariable Cox proportional hazard models. Results: The mean age of subjects was 67.6 years; 71.6% were male and 87.1% were Caucasian. One hundred thirty-three (59.1%) subjects underwent bypass for critical limb ischemia (CLI) and 73 (32.4%) had tissue loss. Patients with CLI and diabetes demonstrated elevated resistin and hsCRP levels. HMWA levels correlated with CLI and with a measure of insulin resistance (HOMA-IR) but not with clinical diabetes. Baseline biomarkers were higher in those presenting with tissue loss and in patients with postoperative events (mortality, limb loss). After multivariable analysis (including CLI, diabetes, age, estimated glomerular filtration rate [eGFR], adiponectin, resistin, and CRP), resistin (hazard ratio [HR] 1.75, 95% confidence interval [CI], 1.07-2.85; P = .025) and CRP (HR 2.39, 95% CI, 1.30-4.39; P = .005) were independently predictive of reduced AFS. However, only resistin maintained its significance when restricted to the diabetic cohort (HR 2.10, 95% CI, 1.10-3.99; P = .025). Higher levels of HMWA were found to be associated with primary graft patency (HR 0.73 for graft failure; 95% CI, 0.55 to 0.97; P = .031) in a multivariable model adjusting for diabetes, CRP, African-American race, CLI, high-risk conduits, and redo bypass procedures. Conclusion: These findings suggest that serum biomarkers of insulin resistance and inflammation may be predictive of clinical outcomes following LEB. Improving the systemic milieu of insulin resistance and inflammation in these high-risk patients may lead to reduced morbidity and mortality. [Copyright &y& Elsevier]
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- 2010
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31. People Have the Power: Fibromuscular Dysplasia Complications.
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Beckman, Joshua A. and Creager, Mark A.
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CARDIOVASCULAR diseases , *DYSPLASIA , *ANGIOGRAPHY , *STENOSIS , *CARDIAC research , *ARTERIAL occlusions - Published
- 2016
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32. Ethnic differences in the prevalence and treatment of cardiovascular risk factors in US outpatients with peripheral arterial disease: Insights from the Reduction of Atherothrombosis for Continued Health (REACH) Registry.
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Meadows, Telly A., Bhatt, Deepak L., Hirsch, Alan T., Creager, Mark A., Califf, Robert M., Ohman, E. Magnus, Cannon, Christopher P., Eagle, Kim A., Alberts, Mark J., Goto, Shinya, Smith, Sidney C., Wilson, Peter W.F., Watson, Karol E., and Steg, P. Gabriel
- Abstract
Background: Prior investigations to define ethnic-related differences in the risks, medical treatment, and outcomes of patients with peripheral arterial disease (PAD) have been limited. Methods: The impact of ethnicity on the risk factor profiles, use of evidence-based medical therapies, and 2-year cardiovascular outcomes were investigated in 2,168 individuals (blacks n = 237, Hispanics n = 115, whites n = 1,816) from the United States with PAD from the international Reduction of Atherothrombosis for Continued Health Registry. Results: Blacks and Hispanics were more likely to have diabetes mellitus and hypertension, whereas whites had a higher rate of diagnosed hypercholesterolemia. Control of blood pressure and cholesterol levels differed significantly in the groups at baseline: elevated blood pressure was present in 55% of blacks versus 48% of Hispanics versus 38% of whites (P < .01), whereas 41% of blacks versus 31% of Hispanics versus 25% of whites had elevated total cholesterol (P < .01). Aspirin use (62% of blacks vs 68% of Hispanics vs 72% of whites, P < .01) and statin use (72% of blacks vs 68% of Hispanics vs 77% of whites, P = .03) also varied significantly. In this context, rates by ethnicity for cardiovascular death, myocardial infarction, or stroke seemed to be no different at 2 years, at 8.8% for the total population: 11.6% for blacks, 8.5% for whites, and 5.0% for Hispanics (P = .32). Fewer blacks (0.6%) had undergone peripheral arterial bypass surgery compared with whites (3.4%) and Hispanics (5.2%) (P = .02). Conclusions: Ethnic-related differences have been documented in the prevalence and treatment of several atherosclerotic risk factors known to be associated with PAD, including a variation in the use of surgical revascularization procedures. [Copyright &y& Elsevier]
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- 2009
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33. Central Aortic Stiffness is Increased in Patients With Heart Failure and Preserved Ejection Fraction.
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Desai, Akshay S., Mitchell, Gary F., Fang, James C., and Creager, Mark A.
- Abstract
Abstract: Background: Hypertension is an important risk factor for the development of heart failure with preserved ejection fraction. Although heart failure in hypertensive patients is usually ascribed to intrinsic myocardial abnormalities, noncardiac factors may contribute. Methods and Results: Using arterial tonometry and Doppler echocardiography, we assessed arterial stiffness and cardiac diastolic function in 53 individuals with ejection fraction >=0.50, including 23 with hypertension but no heart failure, 16 with hypertension and heart failure, and 14 healthy, normotensive controls. Relative to healthy controls and hypertensives, subjects with heart failure had higher systolic blood pressure, body mass index, creatinine, and left ventricular mass. Diastolic function, as estimated by myocardial relaxation velocity, was not different among the 3 groups. Peripheral arterial stiffness was similar across all groups, but key measures of central aortic stiffness (carotid-femoral pulse wave velocity, characteristic impedance, forward wave amplitude) steadily increased with progression from healthy to hypertensive to heart failure despite adjustment for body mass index, systolic blood pressure, and renal function and were positively correlated with both left ventricular mass and filling pressure. Conclusions: We conclude that patients with heart failure and preserved ejection fraction have increased central aortic stiffness relative to age-matched healthy and hypertensive subjects without heart failure. These changes exceed differences in diastolic function and suggest that abnormal ventricular-vascular coupling may contribute to the pathophysiology of heart failure with preserved ejection fraction. [Copyright &y& Elsevier]
- Published
- 2009
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34. Cardiovascular risk profile and outcome of patients with abdominal aortic aneurysm in out-patients with atherothrombosis: Data from the Reduction of Atherothrombosis for Continued Health (REACH) Registry.
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Baumgartner, Iris, Hirsch, Alan T., Abola, Maria Teresa B., Cacoub, Patrice P., Poldermans, Don, Steg, Philippe Gabriel, Creager, Mark A., and Bhatt, Deepak L.
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CARDIOVASCULAR diseases risk factors ,ABDOMINAL aortic aneurysms ,THROMBOSIS ,MEDICAL records ,OUTPATIENT medical care ,HEALTH outcome assessment ,MYOCARDIAL revascularization ,PATIENTS - Abstract
Objective: Datasets regarding patients with abdominal aortic aneurysm (AAA) have almost universally been restricted to single geographic regions. We aimed to obtain data on the risk factor profile and cardiovascular (CV) co-morbidity among multi-ethnic patients with known AAA in the global REACH (REduction of Atherothrombosis for Continued Health) Registry. Methods: The REACH Registry is an international, prospective, observational out-patient registry enrolling out-patients ≥45 years of age with established coronary artery disease (CAD), cerebrovascular disease (CVD) or peripheral arterial disease (PAD) or with at least three atherothrombotic risk factors. This report includes observations pertaining to 68,236 out-patients enrolled in 44 countries. Main outcome measures: Gender, ethnic origin, CV risk factors, established atherosclerotic disease (CAD, CVD and PAD) at baseline, and CV outcome events at 1-year were compared in patients with and without AAA. Results: An AAA was reported in 1722 (2.5%) of 68,236 out-patients enrolled in the REACH Registry. Older age (73 ± 8 vs 68 ± 10, P < .0001), male gender (81% vs 63%, P < .0001), White ethnicity (79% vs 67%, P < .0001) and a history of smoking (81% vs 55%, P < .0001) were independently related to the diagnosis of AAA. There was a weaker association with hypertension or hypercholesterolemia, and an inverse relation with diabetes. Fatal and non-fatal coronary and cerebrovascular event rates were not different between the AAA and non-AAA cohorts, but individuals with AAA suffered increased rates of other cardiovascular deaths (1.39% vs 0.94%, P = .0135), hospitalizations for atherothrombotic events (14.1% vs 9.3%, P < .0001) due to increased rates of revascularization procedures, and new or worsening PAD (3.7% vs 1.3%, P < .0001) at 1-year follow-up. Conclusion: This study, the largest published to date, presents the CV risk profile and outcome of patients with an established diagnosis of AAA from a cohort of patients with either overt manifestations of CV disease or multiple risk factors, and further defines these patients in a multi-ethnic, global context. [Copyright &y& Elsevier]
- Published
- 2008
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35. Task Force 11: Training in Vascular Medicine and Peripheral Vascular Catheter-Based Interventions: Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society for Vascular Medicine
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Creager, Mark A., Cooke, John P., Olin, Jeffrey W., and White, Christopher J.
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- 2008
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36. Elevated C-reactive protein levels are associated with postoperative events in patients undergoing lower extremity vein bypass surgery.
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Owens, Christopher D., Ridker, Paul M., Belkin, Michael, Hamdan, Allen D., Pomposelli, Frank, Logerfo, Frank, Creager, Mark A., and Conte, Michael S.
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C-reactive protein ,INFLAMMATION ,VEIN surgery ,BIOMARKERS - Abstract
Objectives: Inflammatory markers such as high-sensitivity C-reactive protein (hsCRP) are associated with an increased risk of cardiovascular events and with the severity of peripheral arterial disease. The effects of inflammation on the development of vein graft disease remain speculative. We hypothesized that high levels of inflammatory markers would identify patients at increased risk for adverse events (graft failure, major cardiovascular events) after lower extremity bypass surgery. Methods: Patients (n = 91) scheduled to undergo lower extremity bypass using autogenous vein were enrolled into a prospective study at two institutions. Exclusion criteria included the presence of major infection. A baseline plasma sample was obtained on the morning of lower extremity bypass. Biomarkers for inflammation included hsCRP, fibrinogen, and serum amyloid A (SAA). Values between patients with and without critical limb ischemia were compared. Proportions of events among dichotomized populations (upper limit of normal of each laboratory assay) were compared by log-rank test. Results: Of the patients undergoing lower extremity bypass, 69% were men, 53% were diabetic, 81% were smokers, and their mean ankle-brachial index was 0.51 ± 0.19. The indication for lower extremity bypass was critical limb ischemia in 55%. There were no perioperative deaths and two early graft occlusions. During a mean follow-up of 342 days (range, 36-694 days) there were four deaths, 27 graft-related events, and 10 other cardiovascular events. No relationships were found between events and demographics, comorbidities, baseline ankle-brachial index, or statin use. High-sensitivity CRP (P = .005), fibrinogen (P < .001), and SAA (P = .0001) levels were associated with critical limb ischemia at presentation. Among patients with an elevated hsCRP (>5 mg/L) immediately before surgery, major postoperative vascular events occurred in 60% (21/35), compared with a 32% (18/56) rate in those with a baseline CRP <5 mg/L (P = .004, log-rank test). On multivariable analysis, only elevated hsCRP correlated with adverse graft-related or cardiovascular events (P = .018). Conclusions: The inflammatory biomarkers of hsCRP, fibrinogen, and SAA correlate with peripheral arterial disease severity at presentation in patients undergoing lower extremity bypass. Patients with elevated hsCRP are at increased risk for postoperative vascular events, most of which are related to the vein graft. These findings suggest a potential relationship between inflammation and outcomes after lower extremity vein bypass surgery. [Copyright &y& Elsevier]
- Published
- 2007
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37. Early biomechanical changes in lower extremity vein grafts—distinct temporal phases of remodeling and wall stiffness.
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Owens, Christopher D., Wake, Nicole, Jacot, Jeffrey G., Gerhard-Herman, Marie, Gaccione, Peter, Belkin, Michael, Creager, Mark A., and Conte, Michael S.
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BLOOD vessels ,MEDICAL imaging systems ,PATIENTS ,SURGERY - Abstract
Background: The geometric and biomechanical changes that contribute to vein graft remodeling are not well established. We sought to measure patterns of adaptation in lower extremity vein grafts and assess their correlation with clinical outcomes. Methods: We conducted a prospective, longitudinal study of patients undergoing infrainguinal reconstruction with autogenous conduit. In addition to standard duplex surveillance, lumen diameter (of a defined index segment of the conduit) and pulse wave velocity (PWV) were assessed by ultrasound imaging at surgery and at 1, 3, and 6 months postoperatively. Graft dimensions and wall stiffness were correlated with clinical outcomes. Results: There were 92 patients and 96 limbs in this study. On average, vein graft lumen diameter increased during the first month of implantation from 0.37 ± .01 cm to 0.45 ± 0.02 cm (mean ± SEM; P = .002), representing a relative change of +21.6% (median ± 14%; range, −31 to +67%) during this period. Of the entire cohort, 72% of grafts demonstrated appreciable dilation of the index segment during the first month. Index segment lumen diameter did not change appreciably beyond 1 month, with the notable exception of arm vein conduits, which showed continued tendency to dilate. PWV increased during the first 6 months (17.2 ± 1.2 m/s to 23.2 ± 2.4 m/s; P = .008), reflecting a nearly 40% increase in conduit stiffness (2.0 ± .6 Mdynes/cm to 3.3 ± .8 Mdynes/cm, P = .01). The greatest relative increase (25%) in PWV occurred from months 1 to 3. Loss of primary patency occurred in 24 cases (19 revisions, 5 occlusions), with a mean reintervention time of 7.6 months. Grafts that demonstrated early positive remodeling (lumen dilatation) had a trend of increased primary patency (P = .08, log rank). Among the grafts that failed, a trend was noted toward greater wall stiffness at 1 month, 2.7 vs 1.5 Mdynes (P = .08). Conclusion: Vein graft remodeling appears to involve at least two distinct temporal phases. Outward remodeling of the lumen occurs early, and wall stiffness changes occur in a more delayed fashion. Early outward remodeling may be important for successful vein graft adaptation. [Copyright &y& Elsevier]
- Published
- 2006
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38. ACC/AHA Guidelines for the Management of Patients with Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic).
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Hirsch, Alan T., Haskal, Ziv J., Hertzer, Norman R., Bakal, Curtis W., Creager, Mark A., Halperin, Jonathan L., Hiratzka, Loren F., Murphy, William R.C., Olin, Jeffrey W., Puschett, Jules B., Rosenfield, Kenneth A., Sacks, David, Stanley, James C., Taylor, Lloyd M., White, Christopher J., White, John, White, Rodney A., Antman, Elliott M., Smith, Sidney C., and Adams, Cynthia D.
- Subjects
GUIDELINES ,VASCULAR diseases ,MEDICINE - Abstract
A Collaborative Report from the American Associations for Vascular Surgery/Society for Vascular Surgery,* Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients with Peripheral Arterial Disease)—Summary of Recommendations [Copyright &y& Elsevier]
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- 2006
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39. The Nonlipid Effects of Statins on Endothelial Function
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Beckman, Joshua A. and Creager, Mark A.
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- *
STATINS (Cardiovascular agents) , *CELLULAR mechanics , *ISOPENTENOIDS , *TERPENES - Abstract
Hydroxymethylglutaryl-coenzyme A reductase inhibitors or statins constitute one of the wonder drugs of the last 2 decades. Use of this hypolipidemic medication class reduces morbidity and mortality in patients with a wide variety of cholesterol levels. Beneficial effects of the medication are seen in advance of changes in lipids suggesting nonlipid mechanisms may play a role in mediating these benefits of statins. One important nonlipid mechanism by which statins may improve vascular outcomes is restoration of normal endothelial cell function. This review will discuss the nonlipid effects of statins on endothelial cell function to highlight other avenues of benefit conferred by these medications. [Copyright &y& Elsevier]
- Published
- 2006
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40. Arginine and Endothelial and Vascular Health.
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Gornik, Heather L. and Creager, Mark A.
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- *
VASCULAR endothelium , *ENDOTHELIUM , *NITRIC oxide , *THERAPEUTIC use of nitric oxide , *HOMEOSTASIS , *PHYSIOLOGY - Abstract
The vascular endothelium is a crucial regulator of vascular function and homeostasis. Nitric oxide (NO) is an important paracrine substance released by the endothelium to regulate vasomotor tone. Risk factors for atherosclerosis, as well as atherosclerosis per se, are associated with endothelial dysfunction and decreased bioavailablilty of NO. Indeed, endothelial dysfunction is integral to the pathogenesis of atherosclerosis and other cardiovascular diseases. Moreover, endothelial dysfunction relates to an increased risk of adverse cardiovascular outcomes. L-Arginine is an essential amino acid required by the constitutive enzyme, endothelial NO oxide synthase (eNOS), to produce NO. Administration of L-arginine improves endothelial function in animal models and in humans with hypercholesterolemia and with atherosclerosis. Clinical trials to date support potential clinical applications of L-arginine in the treatment of coronary artery disease and peripheral arterial disease, as well as in the prevention of in-stent restenosis. The mechanism of benefit of L-arginine on endothelial function is unclear, because intracellular concentrations of L-arginine far exceed that required by eNOS. One potential explanation of this ‘arginine paradox’ is that L-arginine restores endothelial function in atherosclerotic patients, in whom there are elevated levels of asymmetric dimethylarginine, an endogenous inhibitor of eNOS. Given the promising findings of early studies of L-arginine as a potential therapy for cardiovascular disorders, large-scale clinical trials are warranted. [ABSTRACT FROM AUTHOR]
- Published
- 2004
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41. ACC/ACP/SCAI/SVMB/SVS clinical competence statement on vascular medicine and catheter-based peripheral vascular interventions
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Creager, Mark A., Goldstone, Jerry, Hirshfeld Jr, John W., Kazmers, Andris, Kent, K. Craig, Lorell, Beverly H., Olin, Jeffrey W., Rainer Pauly, Rebecca, Rosenfield, Kenneth, Roubin, Gary S., Sicard, Gregorio A., White, Christopher J., Winters Jr, William L., Merli, Geno, Rodgers, George P., Tracy, Cynthia M., and Weitz, Howard H.
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- 2004
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42. The Mandate for Creation of a National Peripheral Arterial Disease Public Awareness Program: An Opportunity to Improve Cardiovascular Health.
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Hirsch, Alan T., Gloviczki, Peter, Drooz, Alain, Lovell, Marge, and Creager, Mark A.
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HEART disease diagnosis ,VASCULAR disease diagnosis ,PUBLIC health - Abstract
BACKGROUND: There has been increasing recognition of the detrimental impact of peripheral arterial disease (PAD) on the health of Americans, and yet there is no common national program of public PAD education designed to diminish this effect. FORMAT: To heighten awareness of this problem, a 2-day PAD Public Education Strategy Meeting was recently attended by representatives of 17 professional societies and public health associations whose missions support the prevention, diagnosis, treatment, and rehabilitation of vascular diseases. This Public Education Strategy Meeting was intended to provide the rationale and structure to create a national PAD public awareness campaign to diminish the health effect of PAD, and to improve cardiovascular outcomes in the United States. This document: (i) Provides the rationale for creation of a national PAD public education program; (ii) reviews the development and success of national hypertension, hypercholesterolemia, and Women''s Heart Health public education programs as models of educational efficacy; (iii) elucidates how the work of many vascular professionals has led to a national consensus for creation of a national PAD public educational program; (iv) provides an overview of the National Heart, Lung and Blood Institute (NHLBI) PAD education meeting; and (v) outlines the “next steps” required to accomplish these goals. OUTCOME: This meeting achieved consensus that we share responsibility for developing accurate, unified messages to promote PAD awareness and improved care. Participants agreed that the creation of such messages should be linked to plans to disseminate them to all Americans at risk. A consensus was reached that such messages, when commonly created and offered to the public, are most likely to achieve the rewards in better health that all Americans deserve. The Vascular Disease Foundation, a not-for-profit foundation whose mission includes public education regarding the prevention, diagnosis, treatment, and rehabilitation of PAD, will devote its resources to guide a new coalition in this process and to create a national PAD awareness campaign. During 2003 and 2004, the coalition will create the organizational underpinnings and timeline for what will undoubtedly be a multiyear effort. CONCLUSION: Participants of the Public Education Strategy Meeting agreed to create a broad coalition to develop a National PAD Public Awareness Program, with the objectives to develop and disseminate public education messages on PAD. A successful national PAD education program will contribute to creation of a broader mandate to improve global cardiovascular health in the United States. [Copyright &y& Elsevier]
- Published
- 2004
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43. Mandate for creation of a national peripheral arterial disease public awareness program: An opportunity to improve cardiovascular health.
- Author
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Hirsch, Alan T., Gloviczki, Peter, Drooz, Alain, Lovell, Marge, Creager, Mark A., and for The Board of Directors of the Vascular Disease Foundation
- Abstract
Earlier this year, a 2-day Peripheral Arterial Disease (PAD) Public Education Strategy meeting was attended by representatives from various professional societies and public health associations. Marge Lovell, RN, CCRC, CVN, who also serves as the secretary for the Vascular Disease Foundation, and Patricia Lewis, MSN, RN, FNP, CVN, attended this meeting as SVN representatives. The purpose of this meeting was to develop a national PAD public awareness campaign focusing on the health impact of PAD with the goal to improve cardiovascular outcomes. The following article provides an overview of the rationale and mission of this consortium to develop and disseminate public education messages regarding PAD. This coalition will demonstrate a collaborative, multi-year partnership aimed to improve cardiovascular health.The American Radiological Nurses Association (ARNA) representative, Kathleen Gross MSN, RN,BC, CRN, joined SVN to offer nursing support and input into the early planning process. Nurses are recognized leaders in the development and implementation of patient education programs. In addition, SVN and ARNA members have previously participated in national PAD screening campaigns. The high level of support for nursing''s role in this particular endeavor was evident when Marge Lovell was appointed co-chair of the next phase of this campaign. She will share this role with Dr Alan Hirsch.Background: There has been increasing recognition of the detrimental effect of peripheral arterial disease (PAD) on the health of Americans, and yet there is no common national program of public PAD education designed to diminish this effect.Format: To heighten awareness of this problem, a 2-day PAD Public Education Strategy Meeting was recently attended by representatives of 17 professional societies and public health associations whose missions support the prevention, diagnosis, treatment, and rehabilitation of vascular diseases. This Public Education Strategy Meeting was intended to provide the rationale and structure to create a national PAD public awareness campaign to diminish the health effect of PAD and to improve cardiovascular outcomes in the United States. This document (1) provides the rationale for creation of a national PAD public education program; (2) reviews the development and success of national hypertension, hypercholesterolemia, and Women''s Heart Health public education programs as models of educational efficacy; (3) elucidates how the work of many vascular professionals has led to a national consensus for creation of a national PAD public educational program; (4) provides an overview of the National Heart, Lung, and Blood Institute PAD education meeting; and (5) outlines the “next steps” required to accomplish these goals.Outcome: This meeting achieved consensus that we share responsibility for developing accurate, unified messages to promote PAD awareness and improved care. Participants agreed that the creation of such messages should be linked to plans to disseminate them to all Americans at risk. A consensus was reached that such messages, when commonly created and offered to the public, are most likely to achieve the rewards in better health that all Americans deserve. The Vascular Disease Foundation, a not-for-profit foundation whose mission includes public education about the prevention, diagnosis, treatment, and rehabilitation of PAD, will devote its resources to guide a new coalition in this process and to create a national PAD awareness campaign. During 2003 and 2004, the coalition will create the organizational underpinnings and time line for what will undoubtedly be a multiyear effort.Conclusion: Participants of the Public Education Strategy Meeting agreed to create a broad coalition to develop a National PAD Public Awareness Program, with the objectives to develop and disseminate public education massages on PAD. A successful national PAD education program will contribute to creation of a broader mandate to improve global cardiovascular health in the United States. [Copyright &y& Elsevier]
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- 2004
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44. Critical Limb Ischemia and Intermediate-Term Survival.
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Beckman, Joshua A. and Creager, Mark A.
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- 2014
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45. Pathology of Arterial Disease in Limb Loss: The Clot Thickens.
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Creager, Mark A and Bonaca, Marc P
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ISCHEMIA , *PERIPHERAL vascular diseases , *THROMBOSIS - Published
- 2018
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46. High-Quality Peer Review of Clinical and Translational Research: A Practical Guide.
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Kusumoto, Fred M., Bittl, John A., Creager, Mark A., Dauerman, Harold L., Lala, Anuradha, McDermott, Mary M., Turco, Justine Varieur, Taqueti, Viviany R., and ACC’s Scientific Publications Committee’s Peer Review Work Group
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MEDICAL research , *TRANSLATIONAL research - Published
- 2021
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47. Updated Clinical Practice Guidelines on Heart Failure: An International Alignment.
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Antman, Elliott M., Bax, Jeroen, Chazal, Richard A., Creager, Mark A., Filippatos, Gerasimos, Halperin, Jonathan L., Houser, Steven, Lindenfeld, JoAnn, Pinto, Fausto J., Vardas, Panos, Walsh, Mary Norine, Williams, Kim A., and Zamorano, Jose L.
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- 2016
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48. New Quality Measure Core Sets Provide Continuity for Measuring Quality Improvement: Concerns Raised About Conflicting BP Measures.
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Chazal, Richard A. and Creager, Mark A.
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BLOOD pressure measurement , *MEDICAL quality control , *HEALTH insurance , *MEDICAL practice - Published
- 2016
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49. Venous Thromboembolism Associated With Pregnancy: JACC Focus Seminar.
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Nichols, Katherine M., Henkin, Stanislav, and Creager, Mark A.
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VENOUS thrombosis , *THROMBOEMBOLISM , *PREGNANCY , *PULMONARY embolism , *MATERNAL mortality , *SYMPTOMS , *DIAGNOSIS of blood diseases , *BLOOD disease treatment , *VEINS , *ANTICOAGULANTS , *THROMBOLYTIC therapy , *PREGNANCY complications , *BLOOD diseases - Abstract
Venous thromboembolism (VTE), composed of pulmonary embolism and deep venous thrombosis, is a significant cause of maternal mortality in the developed world. Normal physiological changes of pregnancy increase coagulability, which is compounded by patient-inherited and acquired risk factors. Depending on these risks and peripartum stage, the benefits of thromboprophylaxis can outweigh potential side effects. Diagnosis requires cautious clinical acumen because many symptoms of normal pregnancy mimic those of VTE and algorithmic tools used in the nonpregnant population are not equally applicable. Choice of imaging technique must account for potential risk to the fetus and altered test accuracy (sensitivity and specificity) in the setting of pregnancy. When VTE is diagnosed, anticoagulation is the backbone of treatment, with more advanced therapies being options for those with right ventricular dysfunction or unstable hemodynamics. Overall, pregnancy-associated VTE is complex, and management decisions should be individualized and informed by patient preferences. [ABSTRACT FROM AUTHOR]
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- 2020
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50. MY APPROACH to detecting and managing peripheral artery disease.
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Creager, Mark A.
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MYOCARDIAL infarction , *ATHEROSCLEROSIS , *PATIENTS , *THERAPEUTICS ,ARTERIAL abnormalities ,CARDIOVASCULAR disease related mortality - Published
- 2015
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