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An automated method for measuring arterial path length with devices that determine pulse wave velocity (PWV) in peripheral arteries is frequently applied. We aimed to compare arterial path length measurements based on mathematical height-based formulas with those measured manually and to assess whether the ankle-brachial difference (abD-PWV) measured with the VOPITB device is comparable to that obtained by manual measurements. In 245 patients, a metric measuring tape was used to determine the arterial path length from the suprasternal notch to the midpoint of the VOPITB cuffs wrapped around the extremities, and the results were compared with those obtained with height-based formulas. We examined the relationship between the abD-PWV measured with both methods. The arterial path length measured manually was shorter than that calculated automatically by 5 ± 2 and 30 ± 4 cm-of 13% and 21% for the arms and legs, respectively (difference of 13% and 21%). As a result, the abD-PWV calculated with the automatic method was greater (automatic abD-PWV vs. manual: 462 ± 90 vs. 346 ± 79 cm/s). The Blant Altman plot showed a percentage error of: 15,2%, 7,5% and 17,3% for heart-brachial, heart-ankle length and abD-PWV respectively. In conclusion there were significant differences between manual and automated arterial length measurements and it translates into difference abD-PWV calculate from both methods. However, the Bland-Alman plot showed that abD-PWV was comparable for both techniques. The advantages of height-based formulas for the calculation of arterial path lengths suggest that they may be the recommended method for measuring the abD-PWV., Competing Interests: Juan F Sánchez Muñoz-Torrero has property rights over the patented VOPITB invention (Oficina Española de Patentes y Marcas; number of concession: P201130872; publication number: 2400134) and consultant for MSD, Astra, Pfizer, Boehringer Ingelheim. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

The influence of raised fibrinogen levels on outcome in stable outpatients with peripheral arterial disease (PAD) has not been consistently investigated. We used data from the Factores de Riesgo y ENfermedad Arterial (FRENA) registry to compare ischemic events, major bleeding, and mortality in stable outpatients with PAD, according to their baseline plasma fibrinogen levels. Of 1363 outpatients with PAD recruited in FRENA, 558 (41%) had fibrinogen levels >450 mg/100 mL. Over 18 months, 43 patients presented with acute myocardial infarction, 37 had an ischemic stroke, 51 underwent limb amputation, 19 had major bleeding, and 90 died. Compared to patients with normal levels, those with raised fibrinogen levels had an over 2-fold higher rate of ischemic stroke (rate ratio [RR]: 2.30; 95% confidence interval [CI]: 1.19-4.59), limb amputation (RR: 2.58; 95% CI: 1.46-4.67), or death (RR: 2.27; 95% CI: 1.49-3.51) and an over 3-fold higher rate of major bleeding (RR: 3.90; 95% CI: 1.45-12.1). On multivariate analysis, patients with raised fibrinogen levels had an increased risk of developing subsequent ischemic events (hazard ratio [HR]: 1.61; 95% CI: 1.11-2.32) and major bleeding (HR: 3.42; 95% CI: 1.22-9.61). Stable outpatients with PAD and raised plasma fibrinogen levels had increased rates of subsequent ischemic events and major bleeding.

Aim: rs599839 polymorphism has been related with low levels of cholesterol and reduced coronary heart disease (CHD)., Methods: We investigated the frequency of this polymorphism in patients with heterozygous familial hypercholesterolemia (HeFH) in the Spanish familial hypercholesterolemia cohort, 230 with and 202 without CHD. Results & discussion: A lower G-allele prevalence was observed in HeFH patients with CHD with respect to controls, 35 versus 45%, respectively (p = 0.029), suggesting a protective effect. However, it was found that there was no association between rs599839 alleles and CHD in the multivariate analysis., Conclusion: The frequency of the protective G-allele of the rs599839 polymorphism was lower in HeFH patients with CHD compared with those HeFH patients without CHD. However, its role in HeFH may be masked by very high levels of cholesterol.

Background: The influence of atrial fibrillation (AF) on outcome in patients with symptomatic atherosclerotic disease has not been thoroughly studied., Methods: FRENA is an ongoing registry of stable outpatients with coronary (CAD), cerebrovascular (CVD), or peripheral (PAD) artery disease. With the aim to guide therapy, we assessed the incidence of subsequent myocardial infarction (MI), ischemic stroke or major bleeding in patients with AF, according to initial presentation., Results: As of June 2011, 3848 patients were recruited: 1436 had CAD, 1104 CVD, and 1308 had PAD. Of these, 470 (12%) had AF: 151 patients with CAD, 157 with CVD, and 162 with PAD. Over a mean follow-up of 16 ± 13 months, 19 patients with AF developed acute MI, 22 ischemic stroke and 7 bled. Among AF patients with CAD, the incidence of subsequent MI (5.00 events per 100 patient-years; 95% CI: 2.54-8.91) was non-significantly higher than that of stroke (1.48; 95% CI: 0.38-4.04) or major bleeding (1.47; 95% CI: 0.37-4.01). Among those with CVD, the incidence of stroke (5.61; 95% CI: 2.95-9.75) exceeded that of MI (no events) or major bleeding (0.51; 95% CI: 1.24-6.36). Among those with PAD, the incidence of MI (4.41; 95% CI: 2.15-8.10) and stroke (3.93; 95% CI: 1.82-7.46) were similar., Conclusions: CAD patients with AF are at a higher risk of subsequent MI than of stroke. Among those with CVD, the risk of stroke far exceeds that of MI. Those with PAD have a high and similar risk for both events., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Objective: Our study aimed to assess the prevalence and degree of control of dyslipemia, using the 2004 National Cholesterol Education Program criteria, as well as the use of cholesterol lowering drugs in a sample of diabetic patients followed up in primary care settings in Extremadura., Patients and Methods: In this crosssectional, multicenter study the prevalence and control of cardiovascular risk factors was assessed in a sample of 1022 patients having at least one cardiovascular risk factors who were recruited by general practitioners. A total of 988 subjects were avalaible for statistic analysis of dyslipemia; 320 patients had diabetes mellitus (DM); 178 had at least one cardiovascular disease without diabetes and 506 patients without those diseases were used as control., Results: Total cholesterol and low density lipoprotein (LDL) fraction were higher in the group control. High density lipoprotein (HDL)-cholesterol was lower in the group DM as compared to control. Triglycerides were higher in group DM. Women had higher HDL-cholesterol and lower triglycerides levels than men. Only 26.6% of diabetics subjetcs and 28.9% of group ECV were well controlled; 42.5% of the control group had LDL cholesterol < 130 mg/dl. 13.3% of diabetics patients suffering from coronary artery disease had LDL-cholesterol < 70 mg/dl. They were taking statins: DM, 56.6); ECV 61.6%; and control, 39.4%. From patients who did not take cholesterol lowering drugs 51.6% in group DM and 33.8% in group ECV would need to take them., Conclusions: The study shows a poor control of dyslipemia in diabetics subjects and high risk patients in spite of lower lipid levels when compared to lower risk population and a more frequent use of cholesterol lowering drugs. Nevertheless, statin use is still lower than currently recommended.