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The article discusses role of low-density lipoprotein cholesterol in lowering with evolocumab and outcomes in patients with peripheral artery disease. Topics discussed include ways in which lowering low-density lipoprotein cholesterol to very low levels reduces major adverse cardiovascular event; consistent relative reductions in patients with and without peripheral artery disease; and major adverse cardiovascular events in patients with symptomatic lower extremity peripheral artery disease.

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]

Background: Smoking has a well-documented detrimental effect on risk for myocardial infarction and stroke, but less information is available regarding peripheral artery disease (PAD), particularly among women. Objective: To prospectively assess the association of current smoking status, cumulative smoking exposure, and smoking cessation with incident symptomatic PAD in women. Design: Prospective cohort study. Setting: U.S. female health care professionals in the Women's Health Study. Participants: 39 825 women with no cardiovascular disease who were prospectively followed for a median of 12.7 years. Measurements: Incidence of symptomatic PAD. Cox proportional hazards models were used to compare PAD risk across smoking categories. Results: 178 confirmed PAD events occurred. Across the 4 smoking categories (never, former, <15 cigarettes/d, and ⩾15 cigarettes/d), age-adjusted incidence rates were 0.12, 0.34, 0.95, and 1.63 per 1000 person-years of follow-up, respectively. Multivanate adjustment had little effect on this relationship (adjusted hazard ratios [HRs], 3.14 [95% Cl, 2.01 to 4.90], 8.93 [Cl, 5.02 to 15.89], and 16.95 [Cl, 10.77 to 26.67], respectively, vs. women who never smoked). Additional adjustment for high-sensitivity C-reactive protein and soluble intercellular adhesion molecule-i levels among women with available blood samples (28 314 participants, 117 events) attenuated risk estimates (HR. 5.58 [I, 2.61 to 11.93] for smoking <15 cigarettes/d and 9.52 [Cl, 5.17 to 17.53] for smoking ⩾15 cigarettes/d). Lifetime exposure showed a strong dose-response relationship; fully adjusted HRs for smoking abstinence of fewer than 10, 10 to 29, and 30 or more pack-years were 2.52 (Cl, 1.49 to 4.25), 6.75 (Cl, 4.33 to 10.52), and 11.09 (Cl, 6.94 to 17.72), respectively. Compared with current smokers, the adjusted HRs for fewer than 10 years, 10 to 20 years, more than 20 years, or lifelong abstinence were 0.39 (Cl, 0.24 to 0.66), 0.28 (Cl, 0.17 to 0.46), 0.16 (Cl, 0.10 to 0.26), and 0.08 (Cl, 0.05 to 0.12), respectively. Limitation: The use of symptomatic PAD as the a priori primary end point excludes asymptomatic disease. Conclusion: Among initially healthy women, smoking is a potent risk factor for symptomatic PAD and was associated with subclinical inflammation. Smoking cessation substantially reduces risk for PAD, but an increased occurrence of PAD persists even among former smokers who maintain abstinence. [ABSTRACT FROM AUTHOR]

The article presents the nature and scope of the clinical performance measures for adults with peripheral artery disease(PAD) which was developed by the Peripheral Artery Disease Performance Measures Writing Committee in the U.S. It says that the performance measures deal with lower extremity and aortic disease, as covered by the ACC/AHA 2005 guidelines for the patients with PAD. Mandatory sequential steps in the development of performance systems, PAD guidelines, and outcome measures are cited.

Prostanoids, which promote vasodilation and reduce platelet aggregation, have been proposed as candidate therapies for intermittent claudication due to peripheral arterial disease (PAD). However, studies of these medications have yielded inconsistent results. This study tested the hypothesis that iloprost, an oral prostacyclin analogue, would improve walking distance and quality of life in patients with intermittent claudication. The study was a multi-center, randomized, double-blind, placebo-controlled trial comparing three doses of oral iloprost (50 μg, 100 μg, or 150 μg twice daily), pentoxifylline, or placebo in 430 patients with intermittent claudication. The primary outcome measure was improvement in absolute claudication distance (ACD) after 6 months. Secondary outcomes included initial claudication distance and quality of life assessment. Placebo increased ACD by 3.3%, and iloprost increased peak ACD by 7.7%, 8.8% and 11.2% at the 50 μg, 100 μg, and 150 μg twice-daily doses, respectively (all insignificant relative to placebo). Pentoxifylline increased ACD by 13.9% relative to placebo (p = 0.039). Neither iloprost nor pentoxifylline enhanced quality of life. These results indicate that oral iloprost is not effective in improving exercise performance or quality of life in patients with PAD who have intermittent claudication. [ABSTRACT FROM AUTHOR]

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 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. [ABSTRACT FROM AUTHOR]

Comments on critical issues in peripheral arterial disease (PAD) detection and management. Epidemiology and prevalence of PAD; Risk factors associated with the disease; Treatment of commonly associated PAD risk factors; Increase in awareness of PAD and its consequences; Improvement in the identification of patients with symptomatic PAD.

Examines the occurrence of basic fibroblast growth factor (bFGF)-related proteinuria for intermittent claudication in patients with peripheral arterial disease. Intravenous administration of bFGF; Association of limb blood flow with exercise; Ways of improving claudication symptoms.

Presents a study to assess the feasibility of detecting peripheral arterial disease (PAD) in primary care clinics, patient and physician awareness of PAD, and intensity of risk factor treatment and use of antiplatelet therapies in primary care clinics. Design and setting; Patients; Main outcome measures; Results; Conclusions.

This article reports that peripheral arterial disease (PAD) and its most common manifestation, intermittent claudication (IC), are associated with considerable morbidity and mortality. The patient with PAD has well-documented risk factors for atherosclerosis. Because of these, combined with the systemic nature of atherosclerosis and the high cardiovascular event rate in these patients, all should be considered for secondary prevention strategies that include antiplatelet therapy and aggressive risk factor modification.

Presents information on the peripheral arterial disease. Symptoms of atheroma; Factors associated with the development of peripheral arterial disease; Comparison between the effectiveness of antiplatelet agents and control treatments in reducing the rate of cardiovascular events and local arterial occlusion in people with peripheral arterial disease.

The article presents a study which examines the efficacy of vorapaxar, a novel antagonist of protease-activated receptor-1, in patients with peripheral artery diseases. It concludes that the risk of cardiovascular death, myocardial infarction or stroke in patients with peripheral artery disease were not reduced by vorapaxar. It mentions that the novel antagonist, however, lessened acute limb ischemia and peripheral revascularization.

Background--Whether individuals with peripheral artery disease (PAD) identifed by screening ankle-brachial index benefit from preventive therapies to reduce cardiovascular risk is unknown. We aimed to determine the number of US adults with PAD who are not receiving preventive therapies and whether treatment is associated with reduced mortality in PAD subjects without known cardiovascular disease. Methods and Results--We analyzed data from the National Health and Nutrition Examination Survey (NHANES) 1999 to 2004 with mortality follow-up through December 31, 2006. We defined PAD as an ankle-brachial index ≤0.90. Of 7458 eligible participants ≥40 years, weighted PAD prevalence was 5.9±0.3% (mean±SE), corresponding to ≈7.1 million US adults with PAD. Statin use was reported in only 30.5±2.5%, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker use in 24.9±1.9%, and aspirin use in 35.8±2.9%, corresponding to 5.0 million adults with PAD not taking statins, 5.4 million not taking angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and 4.5 million not receiving aspirin. After adjustment for age, sex, and race/ethnicity, PAD was associated with all-cause mortality (hazard ratio, 2.4; 95% confidence interval, 1.9 to 2.9; P<0.0001). Even after exclusion of individuals with known cardiovascular disease, subjects with PAD had higher mortality rates (16.1±2.1%) than subjects without PAD or cardiovascular disease (4.1±0.3%), with an adjusted hazard ratio of 1.9 (95% confidence interval, 1.3 to 2.8; P=0.001). Among PAD subjects without cardiovascular disease, use of multiple preventive therapies was associated with 65% lower all-cause mortality (hazard ratio, 0.35; 95% confidence interval, 0.20 to 0.86; P=0.02). Conclusions--Millions of US adults with PAD are not receiving secondary prevention therapies. Treatment with multiple therapies is associated with reduced all-cause mortality. [ABSTRACT FROM AUTHOR]