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Resumen: El término enfermedad arterial periférica (EAP) se considera un término general que engloba una serie de síndromes arteriales no coronarios causados por la alteración de la estructura y la función de la aorta y las arterias periféricas debida principalmente a la ateroesclerosis, aunque hay otros procesos fisiopatológicos, como el tabaco, la diabetes, la hipertensión arterial y la hiperlipidemia. Para su diagnóstico contamos con métodos no invasivos, como el índice tobillo-brazo, que nos permite hacer además pronóstico y seguimiento de los pacientes con esta patología. Es importante realizar el diagnóstico diferencial, mediante la anamnesis y la exploración física, con otras patologías que generan claudicación intermitente, tales como patología radicular o patología osteomuscular. En cuanto al tratamiento médico, contamos con la modificación de los factores de riesgo, como primera medida, y posteriormente entramos en los fármacos antiagregantes y anticoagulantes, así como la terapia hipolipemiante con estatinas. Abstract: The term peripheral arterial disease (PAD) is considered a general term that encompasses a series of non-coronary arterial syndromes caused by alterations in the structure and function of the aorta and peripheral arteries, mainly due to atherosclerosis, although there are other physiopathological processes such as smoking, diabetes, arterial hypertension and hyperlipidaemia. For its diagnosis we have non-invasive methods such as the ankle-arm index that also allows us to make a prognosis and follow-up of patients with this pathology. It is important to make the differential diagnosis through anamnesis and physical examination, with other pathologies that generate intermittent claudication such as radicular pathology or musculoskeletal pathology. In terms of medical treatment, the first step is the modification of risk factors, followed by antiplatelet and anticoagulant drugs and lipid-lowering therapy with statins.

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BackgroundStrong evidence implicates inflammation in the development of atherosclerotic heart disease but less is known about peripheral arterial disease (PAD). Our objective was to test the hypothesis that a composite index of inflammatory burden is associated with PAD.MethodsCross-sectional analysis of a randomly-selected group of 903 community-dwelling men in the MrOS cohort recruited between 2000 and 2002. Using blood samples, we measured seven cytokines and related these levels to prevalent PAD (ankle-brachial index (ABI)

Copyright of Revista de Ciencias Médicas de Pinar del Río is the property of Editorial Ciencias Medicas and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Peripheral arterial disease is a systemic vascular atherosclerotic disease that results from lumen narrowing causing a decrease in blood flow to the lower limbs. Its diagnosis can be made through noninvasive tests, such as the ankle-arm index. Objective: To evaluate the cases of peripheral arterial disease in the region of Proença-a-Nova by performing the ankle-arm index, taking into account the risk factors. Methodology: 55 individuals were studied, of which 27 individuals (49.1%) were male and 28 (50.9%) female, with ages ranging from 45 to 89 years and average of 64 ± 9.94 years. Results: Regarding risk factors, most do not exercise regularly (69.1%), coinciding with the absence of intermittent claudication (69.1%). The most present risk factor was hypertension (52.7%). Regarding the ankle-arm index, most have values within the normal range and 12 with mild peripheral arterial disease. There were no cases of moderate or severe disease. Conclusion: In this sample there is a higher percentage of cases with mild peripheral arterial disease in individuals who do not engage in regular physical activity, former smokers, diabetics, dyslipidemics and those with cardiovascular disease. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Atencao Primaria a Saude is the property of Revista de Atencao Primaria a Saude and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Patients with altered ankle-arm index have risk of cardiovascular events in the next 10 years (cerebral or cardiac infarction). It is known that the glycosylated hemoglobin and each of the components of the metabolic syndrome increases the cardiovascular risk. Material and methods: We performed a cross-sectional, multicenter, population-based study in 105 individuals with metabolic syndrome recently diagnosis in four primary care centers in Mexico City. The cardiovascular risk was evaluated using ankle-arm index. results: We studied 105 patients. The linear correlation analysis showed simple factor of increased risk (odds ratio [OR] 3.9 [95% CI: 1.05 -14.31]) with glycosylated hemoglobin < 6.5 % and with ankle-arm index < 0.9. When the glycosylated hemoglobin was > 6.5 or 7 there was no statistically significant difference. Correlation of the mean arterial pressure (MAP) with the ankle-arm index: OR 7.2 for mean arterial blood pressure > 88 mm Hg OR: 5.6 (95% CI: 1.43 - 23.45) and with mean arterial pressure > 100 mm Hg. Conclusions: Cardiovascular risk increases if the glycosylated hemoglobin is less than 6.5 %, or if the mean arterial pressure is greater than 88 mm Hg, in patients with newly diagnosed metabolic syndrome. [ABSTRACT FROM AUTHOR]

Introduction. Chronic arterial insufficiency is closely associated with the incidence of metabolic syndrome (particularly with diabetes mellitus) which, in the Mexican population, represents a serious problem of public health. Doppler ultrasound (DU) is a noninvasive, accessible, and high-availability diagnostic technique but requires a trained operator. purpose. Identify the characteristics of Doppler ultrasound reports and propose a systematic wording, and complementary elements to include in the exploration. Material and methods. Sixty reports from Doppler arterial studies of pelvic members in diabetic patients (clinical diagnosis: arterial insufficiency) performed in the year 2010 at the Hospital General de Mexico Ultrasound Department were selected and reviewed at random. results. The greatest percentage of arterial segments evaluated was that of the tibial, peroneal, dorsal, and plantar arteries (73.3 % of cases) followed by the femoral artery in slightly more than 50% of cases. None of the reports mentioned extending the evaluation to the infrarenal abdominal aorta or to the common iliac arteries, nor were spectrum characteristics at sites of localized stenosis or the presence of inward or out- ward collateral flow reported. The evaluation of segmental pressures and calculation of the ankle-arm index were never conducted. Conclusion. We propose including, routinely, calculation of the ankle-arm index, reporting sites of stenosis [and] their length, and estimating the approximate percentage, as well as local hemodynamic repercussions. In cases of severe stenosis detect sites of inward or outward collateral low. [ABSTRACT FROM AUTHOR]

Background: The metabolic syndrome is associated with coronary artery disease (CAD) and with peripheral artery disease (PAD), but the underlying mechanisms explaining these associations have not yet been completely clarified. The aim was to investigate (i) whether endothelial dysfunction can explain the association between the metabolic syndrome and CAD and ⁄ or the severity of PAD, as measured by the ankle–arm index (AAIx); and (ii) whether any such mediation is independent of that from low-grade inflammation. Materials and methods We studied 539 subjects (232 men) aged 59Æ4 ± 6Æ9 years, with an increased risk of type 2 diabetes and cardiovascular diseases. Endothelial dysfunction and inflammation scores were calculated from three markers of endothelial dysfunction (soluble E-selectin, soluble vascular cell adhesion molecule-1 and von Willebrand factor) and six of inflammation (C-reactive protein, interleukin 6, soluble intercellular adhesion molecule-1, serum amyloid A, ceruloplasmin and haptoglobin). The association between the metabolic syndrome and CAD and ⁄ or PAD, and the mediating role of endothelial dysfunction herein was examined with logistic and linear regression analyses, all adjusted for age, sex and smoking. Results: Subjects with the metabolic syndrome (n = 289; 54%) had higher prevalence of CAD [OR (95%CI) = 1Æ75 (1Æ14; 2Æ69)] and lower AAIx [b (95% CI) = )0Æ036 ()0Æ056; )0Æ016)]. Endothelial dysfunction explained 6% of the association between the metabolic syndrome and CAD, and 19% of the association with AAIx, whereas low-grade inflammation explained 26% and 28% of these associations, respectively. Together, the two scores explained 24% and 36% of the association between the metabolic syndrome and CAD and AAIx, respectively. Conclusions: Endothelial dysfunction explains part of the association between the metabolic syndrome and the severity of PAD, but is not involved in the association between the metabolic syndrome and CAD. This indicates that the pathophysiologies of coronary and peripheral artery disease are essentially distinct. [ABSTRACT FROM AUTHOR]

Background: The ankle brachial index (ABI) is a known measure of lower-limb peripheral artery disease (PAD), as well as a marker for other cardiovascular disease events. Objective: Our goal was to compare the prevalence of abnormal ABI scores (ABI ≤ 0.9) between: consecutive patients with acute ischaemic stroke (IS), primary care patients with refractory hypertension (rHT), and patients at intermediate cardiovascular risk (ICVR). Also, to determine the prognostic value of abnormal ABI for stroke recurrence in patients with IS. Methods: We compared 116 consecutive patients with IS with 190 rHT and 150 ICVR patients. Clinical data and ultrasonographic findings were recorded. Stroke recurrence and risk of new vascular events were assessed after 18 months of follow-up. Results: Low ABI was more frequent in rHT (35.8%) than in the IS (24.1%) and ICVR (24.7%) groups ( P = 0.031). Amongst patients with IS, ABI ≤ 0.9 was associated with vascular risk factors (VRF) ≥3 (33.8% vs. 7.1%, P = 0.001) and large-artery atherosclerosis (LAA) (43.5% vs. 19.4%, P = 0.015). Multivariate analyses (logistic regression) only identified VRF > 3 as independently associated with low ABI (OR : 6.46; 1.81-23.02; P = 0.004). Abnormal ABI was associated with stroke recurrence (32.1% vs. 13.6%, P = 0.027) and the appearance of any major vascular event (50.0% vs. 17.0%, P < 0.001). In the logistic regression analysis, adjusted for VRF, age, and LAA, ABI remained as an independent predictor of vascular events (HR 3.99; 1.90–8.41 P < 0.001). Conclusion: Abnormal ABI was associated with classical risk factors, especially hypertension. The measurement of ABI amongst patients with IS appeared to be useful to identify high-risk patients and plan adequate prevention therapies. [ABSTRACT FROM AUTHOR]

Background Low-grade inflammation has been hypothesized to underlie the coronary artery disease (CAD) risk associated with the metabolic syndrome, but the evidence is not conclusive. For peripheral arterial disease (PAD; as measured by the ankle-arm index), this association has not been studied before. The aim was to study whether the association between the metabolic syndrome and CAD or the severity of PAD can be explained by low-grade inflammation. Methods The Cohort study Diabetes and Atherosclerosis Maastricht population includes 574 subjects, with an increased risk of type 2 diabetes, of whom 560 were included in the analyses (343 males; age: 59·5 ± 7·0 years). The inflammation markers that were measured were C-reactive protein, interleukin 6, soluble vascular cell adhesion molecule-1, soluble intercellular adhesion molecule-1 and serum amyloid A. All analyses were adjusted for age, sex and smoking. Results Logistic regression showed that the metabolic syndrome was significantly associated with CAD [odds ratio (OR) = 1·86, 95% CI: 1·21; 2·84, P = 0·004]. Further adjustment for inflammatory status, as captured in a combination of the inflammation markers (using an averaged Z-score), resulted in significant associations of both the metabolic syndrome and inflammatory status with CAD [ORmetabolic syndrome (95% CI) = 1·58 (1·01; 2·46), P = 0·044; ORinflammation (95% CI) = 1·59 (1·14; 2·21), P = 0·007]. Linear regression analysis showed similar results for the ankle-arm index. Conclusions The association between the metabolic syndrome, on the one hand, and prevalence of CAD or the severity of PAD, on the other, can be partly but not completely, 26% and 29% respectively, explained by low-grade inflammation. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To determine whether postprandial lipid levels are markers of clinical and subclinical macrovascular disease in a select group of patients with type 2 diabetes. Methods: We recruited 119 local patients with type 2 diabetes and moderate metabolic control (HbA1c <8%). The patients were being treated with dietary measures and/or oral antihyperglycemic therapy. No patient was receiving lipid-lowering therapy. A history of cardiovascular events was recorded and the ankle–arm index was measured to assess subclinical peripheral artery disease. The patients underwent a lipid analysis after a 12-h fast and 4h after a mixed breakfast (50g of fat, 40g of carbohydrates). Results: The patients with clinical and subclinical macrovascular disease had a greater history of smoking, a longer disease duration, and higher serum creatinine levels. The groups with macroangiopathy had lower postprandial concentrations of HDL cholesterol (p <0.05) and a trend towards lower fasting levels of HDL cholesterol (p =0.08) and higher fasting and postprandial levels of triglycerides (p =0.07). Multivariate analysis showed the presence of vascular (both clinical and subclinical) disease to be significantly associated with smoking (OR 3.06; 95% CI, 1.15–8.4), disease duration (for each year, OR 1.12; 95% CI, 1.03–1.22) and postprandial levels of triglycerides (for each 50mg, OR 1.73; 95% CI, 1.13–2.65). Conclusions: In our diabetic patients, the postprandial level of triglycerides 4h after a fatty breakfast, though not fasting lipids, plus smoking and disease duration were independently associated to clinical and subclinical macrovascular disease. [Copyright &y& Elsevier]

Abstract: Background: Low ankle–arm systolic blood pressure index is strongly correlated with various cardiovascular risk factors. However, although the potential hazards of resulting coronary artery disease (CAD) are well established, no data is available regarding how ankle–arm index (AAI) and CAD severity are related. Methods: This study enrolled 477 patients and all patients underwent coronary angiography and AAI measurements. Based on AAI values, patients were divided into study (AAI value of <0.9, 126 patients) and control groups (AAI value of ≧0.9, 351 patients). Results: Among baseline characteristics, the study group showed a significantly older and higher female ratio than the control group. The presence of hypertension, diabetes mellitus (DM), current smoking status and LDL-cholesterol level differed significantly between these two groups. Mean number of lesions and target vessel involvement were significant different between the study and control group (2.6±1.1 vs. 1.9±1.0, p <0.0001; 2.0±0.8 vs. 1.6±0.7, p <0.0001). Percentages of lesion sites on ostial and proximal portions were markedly high in the study group than in the control group. Significant differences also emerged in the complex stenotic lesions (B2 or C) and lesion morphology (calcified, chronic total occlusion, irregular, bifurcation and diffuse) of these two groups. Multivariate logistic regression analysis, showed that AAI is a statistically significant independent predictor for lesion site, complex stenotic lesions and lesion morphology with Odds ratios (ORs) of, respectively, 1.728, 2.880 and 2.71. Conclusions: The AAI is a useful non-invasive tool for the prediction of CAD severity. [Copyright &y& Elsevier]

Abstract: Peripheral artery disease correlates with preclinical carotid atherosclerosis in Western populations. However, little is known about this correlation in Asian populations. In a cross-sectional population-based study, we examined the correlation between peripheral arterial disease and carotid intima-media thickness (IMT) among 726 Japanese men aged 60–79 years. None of them had a history of clinical peripheral arterial disease. The ankle-to-arm systolic blood pressure index (AAI) was used as a surrogate estimate of peripheral arterial disease. Compared to men with AAI≥0.90, those with AAI<0.90 were 1–4 years older, and had lower mean body mass index and higher prevalence of current smokers. The mean AAI correlated inversely and linearly with maximum IMT in the common and internal carotid arteries (CCA and ICA), and men with AAI<0.90 had higher prevalence of maximum ICA IMT ≥1.5mm than did those with AAI≥0.90. The multivariate odds ratio (95% confidence interval) of maximum ICA IMT ≥1.5mm was 2.9 (1.0–8.4), while that of maximum CCA IMT≥1.1mm was 1.4 (0.5–3.8) for men with AAI<0.90 versus≥1.30. The sensitivity was 65% and the specificity was 98% for low AAI to detect ICA IMT ≥1.5mm. Low AAI is a strong correlate for internal carotid atherosclerosis and the AAI measurement may be of use to screen for preclinical peripheral atherosclerosis among Japanese elderly men. [Copyright &y& Elsevier]

Abstract: Background and Objective: To investigate which method of ankle–arm index (AAI) measurement in terms of selected arteries and blood pressure devices yields the highest reproducibility. Study Design and Setting: In this cross-sectional study, duplicate AAI measurements were obtained at the right and left side in 320 postmenopausal women. Analyses were done as proposed by Bland and Altman and intraclass correlation coefficients were calculated. Results: The mean and standard deviation (SD) of the first and second systolic blood pressure (SBP) measurement separately did not differ from the mean and SD of the duplicate SBP measurements averaged. Coefficients of repeatability and intraclass correlation coefficients were comparable when the ankle SBP was measured in the posterior tibial artery or dorsalis pedis artery. Coefficients of repeatability as well as the intraclass correlation were better when the SBP in the brachial artery was measured with Doppler than with Dinamap. Conclusions: To achieve the best reproducibility and smallest systematic difference in the AAI, single SBP measurements should be obtained by Doppler in the brachial artery, posterior tibial artery and dorsalis pedis artery. The AAI should be calculated for each foot separately by dividing the highest ankle SBP by the highest arm SBP. [Copyright &y& Elsevier]

: ObjectivesThis study was designed to evaluate the relationship between elevated creatinine levels and cardiovascular events.: BackgroundEnd-stage renal disease is associated with high cardiovascular morbidity and mortality. The association of mild to moderate renal insufficiency with cardiovascular outcomes remains unclear.: MethodsWe analyzed data from the Cardiovascular Health Study, a prospective population-based study of subjects, aged >65 years, who had a serum creatinine measured at baseline (n = 5,808) and were followed for a median of 7.3 years. Proportional hazards models were used to examine the association of creatinine to all-cause mortality and incident cardiovascular mortality and morbidity. Renal insufficiency was defined as a creatinine level ≥1.5 mg/dl in men or ≥1.3 mg/dl in women.: ResultsAn elevated creatinine level was present in 648 (11.2%) participants. Subjects with elevated creatinine had higher overall (76.7 vs. 29.5/1,000 years, p < 0.001) and cardiovascular (35.8 vs. 13.0/1,000 years, p < 0.001) mortality than those with normal creatinine levels. They were more likely to develop cardiovascular disease (54.0 vs. 31.8/1,000 years, p < 0.001), stroke (21.1 vs. 11.9/1,000 years, p < 0.001), congestive heart failure (38.7 vs. 17/1,000 years, p < 0.001), and symptomatic peripheral vascular disease (10.6 vs. 3.5/1,000 years, p < 0.001). After adjusting for cardiovascular risk factors and subclinical disease measures, elevated creatinine remained a significant predictor of all-cause and cardiovascular mortality, total cardiovascular disease (CVD), claudication, and congestive heart failure (CHF). A linear increase in risk was observed with increasing creatinine.: ConclusionsElevated creatinine levels are common in older adults and are associated with increased risk of mortality, CVD, and CHF. The increased risk is apparent early in renal disease. [Copyright &y& Elsevier]

: ObjectivesThe present study was designed to examine the associations of coronary calcification assessed by electron beam computed tomography (CT) with measures of extracoronary atherosclerosis.: BackgroundAlthough measures of extracoronary atherosclerosis have been used to predict coronary events, it is not yet known to what extent those measures reflect coronary atherosclerosis.: MethodsThe Rotterdam Coronary Calcification Study is a population-based study in subjects age 55 years and over. Participants of the study underwent an electron beam CT scan. Coronary calcification was quantified according to the Agatston calcium score. Measures of extracoronary atherosclerosis included common carotid intima media thickness (IMT), carotid plaques, ankle-arm index (AAI) and aortic calcification. We used the first 2,013 participants for the present analyses. Age-adjusted geometric mean calcium scores were computed for categories of extracoronary measures using analyses of variance.: ResultsGraded associations with coronary calcification were found for the carotid and aortic measures. Associations were strongest for carotid plaques and aortic calcification; coronary calcification increased from the lowest category (no plaques) to the highest category 9-fold and 11-fold in men and 10-fold and 20-fold in women, respectively. A nonlinear association was found for AAI with an increase in coronary calcification only at lower levels of AAI.: ConclusionsIn this population-based study, graded associations were found between coronary calcification and common carotid IMT, carotid plaques and aortic calcification. A nonlinear association was found between coronary calcification and the AAI. [Copyright &y& Elsevier]

Purpose: Comparison of the relative values of the ankle-arm index (AAI) at rest and after exercise, angiography, and duplex ultrasonography for the follow-up of percutaneous transluminal angioplasty (PTA) in patients with peripheral vascular disease. Methods: Thirty-two patients were prospectively followed after technically and clinically successful PTA of a femoropopliteal occlusion. The patency of the femoropopliteal artery was assessed for 1 year using AAI measurements at rest and after exercise; duplex ultrasonography at 4, 12, 24, 36, and 52 weeks; and angiography at 3 and 12 months after PTA. Results: Patency was highly dependent on the measurement technique. The cumulative patency after 1 year determined with the AAI at rest and during exercise, by angiography, and by duplex ultrasonography was 74%, 19%, 31%, and 32%, respectively. Seventy-five percent of the restenoses occurred at the site of the treated occlusion. Conclusion: Duplex ultrasonography is most suitable for this assessment, as it causes no patient discomfort and the specificity is better than AAI after exercise because vascular disease in other, proximal segments does not interfere with the results. [ABSTRACT FROM AUTHOR]

Objectives: We studied the prevalence of atherosclerosis among ischaemic stroke patients ≤60 years and controls at the time of the index stroke, and its association with occurrence of new cardiovascular events (CVEs) and mortality at a 5-year follow-up., Methods: Prevalent atherosclerosis was assessed for 385 patients and 260 controls in seven vascular areas by electrocardiogram (ECG), ankle-arm index (AAI) and measurement of right and left carotid and femoral intima-media thickness (cIMT and fIMT) and abdominal aorta plaques (AAP). Clinical end-points were any new CVE (stroke, angina, myocardial infarction or peripheral arterial disease) or death from any cause at 5-year follow-up. All results were sex- and age-adjusted; logistic regression and Cox proportional hazards models were applied., Results: Young patients ≤49 years had prevalent atherosclerosis in 1/2 of males and 1/3 of females. Compared with controls, young female patients showed significantly higher prevalent atherosclerosis, p = 0.024. Ischaemic ECG and mean cIMT were higher in young and middle-aged female patients ( p = 0.044, p = 0.020, p = 0.023 and p <0.001, respectively). Mean fIMT was higher in middle-aged female patients ( p <0.001). Cardiovascular events were associated with ischaemic ECG; AAI ≤0.9, fIMT ≥0.9 mm and increased number of areas with atherosclerosis (NAA) among patients, and with AAP, cIMT ≥0.9 mm, fIMT ≥0.9 mm and NAA among controls. Mortality was associated with higher age, ischaemic ECG and NAA among patients, and cIMT ≥0.9 mm among controls., Conclusion: Atherosclerosis is highly prevalent even in young stroke patients. Some areas and increasing NAA are associated with CVEs and death., Competing Interests: Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© European Stroke Organisation 2021.)

Se realizó un estudio descriptivo, de serie de casos, de 42 pacientes con afecciones cardiovasculares isquémicas y enfermedad arterial periférica asintomática ingresados en el Servicio de Cardiología Hospital Provincial Docente Clinicoquirúrgico "Saturnino Lora Torres" de Santiago de Cuba, desde enero hasta diciembre de 2012, con vistas a determinar la frecuencia de dicha enfermedad mediante la estimación del índice tobillo-brazo. En la serie prevaleció el valor bajo de dicho índice (64,0 %), seguido del normal (29,0 %). Cabe destacar que solo 7,0 % presentó calcificación arterial por encima de 1,3; datos reveladores del predominio de la enfermedad arterial periférica asintomática o subclínica