Nationwide Trends in Prevalent Cardiovascular Risk Factors and Diseases in Young Adults: Differences by Sex and Race and In-Hospital Outcomes.

OBJECTIVES: Prevalence and trends in all cardiovascular disease (CVD) risk factors among young adults (18-39 years) have not been evaluated on a large scale stratified by sex and race. The aim of this study was to establish the prevalence and temporal trend of CVD risk factors in US inpatients younger than 40 years of age from 2007 through 2014 with racial and sex-based distinctions. In addition, the impact of these risk factors on inpatient outcomes and healthcare resource utilization was explored. METHODS: A cross-sectional nationwide analysis of all hospitalizations, comorbidities, and complications among young adults from 2007 to 2014 was performed. The primary outcomes were frequency, trends, and race- and sex-based differences in coexisting CVD risk factors. Coprimary outcomes were trends in all-cause mortality, acute myocardial infarction, arrhythmia, stroke, and venous thromboembolism in young adults with CVD risk factors. Secondary outcomes were demographics and resource utilization in young adults with versus without CVD risk factors. RESULTS: Of 63 million hospitalizations (mean 30.5 [standard deviation 5.9] years), 27% had at least one coexisting CVD risk factor. From 2007 to 2014, admission frequency with CVD risk factors increased from 42.8% to 55.1% in males and from 16.2% to 24.6% in females. Admissions with CVD risk were higher in male (41.4% vs 15.9%) and white (58.4% vs 53.8%) or African American (22.6% vs 15.9%) patients compared with those without CVD risk. Young adults in the Midwest (23.9% vs 21.1%) and South (40.8% vs 37.9%) documented comparatively higher hospitalizations rates with CVD risk. Young adults with CVD risk had higher all-cause in-hospital mortality (0.4% vs. 0.3%) with a higher average length of stay (4.3 vs 3.2 days) and charges per admission ($30,074 vs $20,124). CONCLUSIONS: Despite modern advances in screening, management, and interventional measures for CVD, rising trends in CVD risk factors across all sex and race/ethnic groups call for attention by preventive cardiologists.

Variation in Amputation Risk for Black Patients: Uncovering Potential Sources of Bias and Opportunities for Intervention.

BACKGROUND: Differences in amputation rates for limb ischemia between white and black patients have been extensively studied. Our goal was to determine whether biases in provider decision-making contribute to the disparity. We hypothesized that the magnitude of the disparity is affected by surgeon and hospital factors. STUDY DESIGN: Analysis of the New York Statewide Planning and Research Cooperative System database was performed for 1999 to 2014. Black and white patients with ICD9 codes for peripheral vascular disease, who received either an amputation or salvage procedure, were included. The primary endpoint was treatment choice. RESULTS: We analyzed 215,480 inpatient admissions. The overall amputation rate was 38.0%, and blacks were significantly more likely to receive amputations than whites on unadjusted (42.6% vs 28.6%, p < 0.001), and multivariable analyses (odds ratio [OR] 1.45, 95% CI 1.31 to 1.60, p < 0.001). This difference was more pronounced among high total vascular volume surgeons (OR 1.74, 95% CI 1.50 to 2.00, p < 0.001), but not among those with low total vascular volume (OR 1.06, 95% CI 0.90 to 1.24, p = 0.49); high volume hospitals (OR 1.57, 95% CI 1.39 to 1.78, p < 0.001), but not among those with low amputation volume (OR 0.96, 95% CI 0.73 to 1.27, p < 0.80); and surgeons who treat fewer black patients (OR 1.58, 95% CI 1.44 to 1.73, p < 0.001) vs surgeons who see more black patients (OR 1.43, 95% CI 1.30 to 1.57, p < 0.0.001). CONCLUSIONS: Black patients are significantly more likely to receive an amputation than a salvage procedure when presenting with significant peripheral vascular diseases. High procedural volume does not seem to reduce unequal treatment; diversity of surgeon practice does.

The association of race with quality of health in peripheral artery disease following peripheral vascular intervention: The Q-PAD Study.

Black patients have a higher prevalence of peripheral artery disease (PAD) than white patients, and also tend to have a greater extent and severity of disease, and poorer outcomes. The association of race with quality of health (QOH) after peripheral vascular intervention (PVI), however, is less well-known. In our study, we hypothesized that after PVI, black patients experience worse QOH than white patients. We retrospectively assessed racial differences in health status using responses to the Peripheral Arterial Questionnaire (PAQ) at baseline (pre-PVI) and up to 6 months following PVI among 387 patients. We used the PAQ summary score (which includes physical limitation, symptoms, social function and quality of life) as a measure of QOH. We compared QOH scores at baseline and at follow-up after PVI between black ( n=132, 34.1%) and white ( n=255, 65.9%) patients. We then computed the change in score from baseline to follow-up for each patient (the delta) and compared the median delta between the two groups. Multivariable regression was used to model the delta QOH after controlling for factors associated with race or with the delta QOH. There was no significant difference in mean QOH by race either at baseline ( p=0.09) or at follow-up ( p=0.45). There was no significant difference in the unadjusted median delta by race (white 25.3 vs black 21.5, p=0.28) and QOH scores improved significantly at follow-up in both groups, albeit the improvement was marginally lower in black compared with white patients after adjustment for baseline confounders ( b = -6.6, p=0.05, 95% CI -13.2, -0.11).

Elevated Levels of Adhesion Proteins Are Associated With Low Ankle-Brachial Index.

Inflammation plays a pivotal role in peripheral artery disease (PAD). Cellular adhesion proteins mediate the interaction of leukocytes with endothelial cells during inflammation. To determine the association of cellular adhesion molecules with ankle-brachial index (ABI) and ABI category (≤1.0 vs >1.0) in a diverse population, 15 adhesion proteins were measured in the Multi-Ethnic Study of Atherosclerosis (MESA). To assess multivariable associations of each protein with ABI and ABI category, linear and logistic regression was used, respectively. Among 2364 participants, 23 presented with poorly compressible arteries (ABI > 1.4) and were excluded and 261 had ABI ≤ 1.0. Adjusting for traditional risk factors, elevated levels of soluble P-selectin, hepatocyte growth factor, and secretory leukocyte protease inhibitor were associated with lower ABI ( P = .0004, .001, and .002, respectively). Per each standard deviation of protein, we found 26%, 20%, and 19% greater odds of lower ABI category ( P = .001, .01, and .02, respectively). Further investigation into the adhesion pathway may shed new light on biological mechanisms implicated in PAD.

Serum Uric Acid, Gender, and Low Ankle Brachial Index in Adults With High Cardiovascular Risk.

Uric acid (UA) has been reported to be associated with cardiovascular disease (CVD) in caucasians. However, it is unclear whether this association remains significant in a Chinese population. The present study aimed to investigate the association between UA and low ankle brachial index (ABI), a measurement of peripheral arterial disease, in Chinese patients. A total of 6262 hospital-based patients with high CVD risk were enrolled. Low ABI was defined as ABI ≤0.9 in either side. Low ABI was detected in 1390 (22.2%) patients. Higher UA was significantly associated with higher risk of low ABI and modified by gender (P = .0045). After adjusting for age, body mass index, total cholesterol, triglyceride, low-density lipoprotein, high-density lipoprotein, fasting glucose, hypertension, and smoking, participants in the highest quartile of UA exhibited 37% (odds ratio [OR]:1.37, 95% confidence interval [CI]: 1.03-1.82) higher risk of low ABI compared to those in the lowest quartile in men, while OR (95% CI) was 1.69 (1.29-2.22) for women. However, when kidney function was further adjusted, the associations were attenuated in both men and women and were significant only in women. The results were suggestive of higher UA associating with higher risk of low ABI in women, and the association was largely driven by kidney function, especially in men.

Text messaging to motivate exercise among Latino adults at risk for vascular disease: a pilot study, 2013.

In 2013, we administered a 15-item survey to determine the extent of text message usage among Latino adults in Kansas; for a subset of the survey participants, we also conducted a 6-week pilot trial to determine the effect of text messaging on exercise behaviors. Among the 82 survey participants, 78% had unlimited text messaging. At baseline, all trial participants were at the stage of contemplation; at 6 weeks, one (9%) trial participant remained at the contemplation stage and the other 10 (91%) participants progressed to the action/maintenance/termination stage. Use of text messaging to motivate exercise is feasible and potentially efficacious among Latinos.

Cardiovascular disease risk profile and microvascular complications of diabetes: comparison of Indigenous cohorts with diabetes in Australia and Canada.

BACKGROUND: Indigenous populations of Australia and Canada experience disproportionately high rates of chronic disease. Our goal was to compare cardiovascular (CVD) risk profile and diabetes complications from three recent comprehensive studies of diabetes complications in different Indigenous populations in Australia and Canada. METHODS: We compared participants from three recent studies: remote Indigenous Australians (2002-2003, n = 37 known diabetes), urban Indigenous Australians (2003-2005, n = 99 known diabetes), and remote Aboriginal Canadians (2001-2002, n = 188 known diabetes). RESULTS: The three groups were similar for HbA1c, systolic BP, diabetes duration. Although leaner by body-mass-index criteria, remote Indigenous Australians displayed a more adverse CVD risk profile with respect to: waist-hip-ratio (1.03, 0.99, 0.94, remote Indigenous Australians, urban Indigenous Australians, remote Canadians, p < 0.001); HDL-cholesterol (0.82, 0.96, 1.17 mmol/L, p < 0.001); urine albumin-creatinine-ratio (10.3, 2.4, 4.5 mg/mmol); and C-reactive protein. With respect to diabetes complications, microalbuminuria (50%, 25%, 41%, p = 0.001) was more common among both remote groups than urban Indigenous Australians, but there were no differences for peripheral neuropathy, retinopathy or peripheral vascular disease. CONCLUSIONS: Although there are many similarities in diabetes phenotype in Indigenous populations, this comparison demonstrates that CVD risk profiles and diabetes complications may differ among groups. Irrespective, management and intervention strategies are required from a young age in Indigenous populations and need to be designed in consultation with communities and tailored to community and individual needs.

Community-based survey of amputation derived from the physically disabled person's certification in Kitakyushu City, Japan.

BACKGROUND: There were no recent reports of community-based surveys on the incidence, level and causes of amputation in Japan. OBJECTIVES: To identify any changes in the incidence, level, causes of amputation and gender distribution. STUDY DESIGN: A community-based survey. METHODS: The subjects were Kitakyushu-citizens amputated between 2001 and 2005 and selected based on medical certificates for the physically disabled person's certificate. RESULTS: The incidence of amputation (/100,000 population per year) was 6.9 overall, 1.4 for upper limbs and 5.8 for lower limbs. The average age at amputation was 63.5 ± 20.1 years and the male:female ratio was 1.9:1. The most frequent levels of amputations were partial hand amputation (84.4%) for upper limbs, and transtibial amputation (42.3%) and transfemoral amputation (36.8%) for lower limbs. The major causes were injuries (54.3%) for upper limbs, and peripheral vascular disorder (49.0%) and diabetes mellitus with peripheral circulatory complications (28.6%) for lower limbs. CONCLUSIONS: The incidence of amputation was 6.9 overall, 1.4 for upper limbs and 5.8 for lower limbs, and the male:female ratio was 1.9:1. In comparison to a previous survey the percentages of amputation due to peripheral circulatory disorders and injuries increased and decreased, respectively, and the rate of female amputations increased. CLINICAL RELEVANCE: This study provides useful data about change of the recent epidemiology of amputation in Kitakyushu, Japan. These data are essential to perform clinical practices in amputation rehabilitation, including prescription of prosthesis, general fatigue for aged amputees, and complication of peripheral circulatory disorders.

Health care disparity in the care of the vascular patient.

Peripheral vascular care continues to mature into a well-developed multidisciplinary subspecialty. Continued growth as a collaborative subspecialty will require delivering the highest quality medical care to all Americans. US census projections predict that greater than one half of all American citizens will identify themselves as ethnic or racial minorities by 2050. Evolving research has established significant health care disparity, or preventable differences in disease incidence and vascular procedure outcomes associated with socioeconomic, gender, language, geographic, racial, and ethnic variables. As a necessary step in the evolution of vascular care, practitioners, societies, and vascular departments should begin to adopt proven practices that enhance our ability to deliver equal care to an increasingly diverse American population.

Natural course and funduscopic findings of polypoidal choroidal vasculopathy in a Japanese population over 1 year of follow-up.

PURPOSE: To evaluate the natural course and possible funduscopic risk factors for polypoidal choroidal vasculopathy in a Japanese population. METHODS: The records of 42 eyes from 41 patients (27 men and 14 women) diagnosed as having polypoidal choroidal vasculopathy located in the macula between November 1999 and October 2005 were retrospectively reviewed. The funduscopic findings at the first visit were evaluated. The changes in the best-corrected visual acuity (BCVA) from the baseline to 12 months were analyzed. The lesion types (clustered vs. nonclustered) found on indocyanine green angiography were compared for changes in the BCVA from the initial visit to 12 months. RESULTS: The mean age of the subjects was 73.8 ± 8.0 years. The mean logarithm of the minimum angle of resolution (LogMAR) BCVA was 0.48 ± 4.0 at baseline and deteriorated to 0.75 ± 5.7 after 12 months, which was statistically significant (P = 0.00075). The mean LogMAR BCVA in the patients showing "nonclustered" polypoidal choroidal lesions on indocyanine green angiography was maintained for 12 months, while that of the "clustered" group decreased significantly during the same period (P = 0.0014). CONCLUSION: Polypoidal choroidal vasculopathy did not show a favorable outcome in terms of the mean BCVA 12 months after the initial visit. The clustered polypoidal choroidal lesions on indocyanine green angiography may be related to poor prognosis of polypoidal choroidal vasculopathy over the natural course.

Hemostatic cardiovascular risk factors, common carotid-intima medial thickness and peripheral arterial disease in South Asians and African Caribbeans: a substudy to the Ethnic-Echocardiographic Heart of England Screening (E-ECHOES) study.

OBJECTIVE: To determine whether ethnic differences exist in inflammatory (interleukin-6 and C-reactive protein) and hemostatic biomarkers (soluble P-selectin [sP-sel], von Willebrand factor [VWF], and fibrin D-dimer) between South Asian (people originating from India, Pakistan, and Bangladesh) and African Caribbean (Black Caribbean and Black African) groups, the two largest minority ethnic groups in the UK; and to determine associations between these biomarkers and common carotid intima-media thickness and peripheral artery disease (PAD). PATIENTS AND METHODS: We recruited 572 subjects (356 South Asian and 216 Black) aged ≥ 45 years as a substudy to a community screening project, the Ethnic-Echocardiographic Heart of England Screening (E-ECHOES) study. All subjects completed an interviewer-led questionnaire, anthropometric measurements were taken, and blood sampling was performed if consent was granted. Ankle brachial pressure index (ABPI) was calculated, and the common carotid intima-media thickness (CCIMT) was measured. PAD was defined as ABPI < 0.9. ELISA was used to quantify inflammatory and hemostatic biomarkers. RESULTS: The incidence of hypertension (> 70%) and diabetes (> 27%) was high, but non-significantly different between the two ethnic groups. South Asians had higher platelet count and sP-sel levels than African Caribbeans (P < 0.0001 for both), despite there being no significant difference in antiplatelet medication. African Caribbeans had higher D-dimer levels (P = 0.0052). Among South Asians, VWF correlated with ABPI (P = 0.047) and mean (P = 0.002) and maximum CCIMT (P = 0.011) on univariate analysis, and remained an independent predictor of mean and maximum CCIMT on multivariate analysis with traditional cardiovascular risk factors (P = 0.034 and P = 0.046, respectively). In African Caribbeans, D-dimer levels were was higher in PAD than in normal ABPI participants (P = 0.04), and was associated with ABPI in both univariate analysis (P = 0.014) and multivariate analysis (P < 0.0001) with traditional cardiovascular risk factors. CONCLUSION: Ethnic differences are evident in inflammatory and hemostatic factors, as well as in their associations with CCIMT and PAD. These may reflect differences in cardiovascular risk factors or pathophysiologic processes that characterize each ethnic group.

Clinical characteristics of polypoidal choroidal vasculopathy in Chinese patients.

PURPOSE: To describe the clinical characteristics of polypoidal choroidal vasculopathy (PCV) in a large number of Chinese patients. METHODS: This study enrolled 204 consecutive patients (246 eyes) in our department who were diagnosed as having polypoidal choroidal vasculopathy PCV. Patients underwent ophthalmologic examinations including best-corrected visual acuity (BCVA) testing, ophthalmoscopy, fundus photography, fluorescein angiography, indocyanine green angiography, and optic coherence tomography. RESULTS: Mean patient age was 66.1 years and 60.3% were men. Of the cases, 79.4% were unilateral and 51.2% of BCVA was less than 35 letters. In 171 eyes (69.5%), polypoidal lesions were located in the macula area. Among them, polypoidal lesions were located in the foveal area in 29 eyes (11.8%), in the parafoveal area in 50 eyes (20.3%), and in the extrafoveal area in 88 eyes (35.8%), in both the foveal and parafoveal area in three eyes (1.2%), and in both the parafoveal and extrafoveal area in one eye (0.4%). In 37 eyes (15.0%), PCV lesions were under the temporal retinal vascular arcade; in 11 eyes (4.5%), PCV lesions were found peripapillary. PCV lesion formation was single in 88 eyes (35.8%), cluster in 145 eyes (59.0%), string in two eyes (0.8%), and branch in two eyes (0.8%). In nine eyes (3.6%), the formation of PCV lesions showed both single and cluster shape in the same eye. There were 54.5% with drusen, 44.7% with serous PED, 20.7% with hemorrhagic PED, and 39.0% with neuroretinal detachment. CONCLUSIONS: The majority of Chinese PCV patients were male, unilateral, and showed macular polyps. Drusen, serous PED, hemorrhagic PED, and neuroretinal detachment on OCT were commonly seen.

Factors predictive of visual acuity outcomes 1 year after photodynamic therapy in Japanese patients with polypoidal choroidal vasculopathy.

PURPOSE: The purpose of this study was to determine the factors predictive of visual acuity (VA) outcomes 1 year after photodynamic therapy (PDT) for polypoidal choroidal vasculopathy. METHODS: We prospectively studied 220 eyes of 210 Japanese patients with polypoidal choroidal vasculopathy treated with primary application of PDT. A stepwise logistic regression model was used to estimate the independent factors predictive of better VA and improvement of VA 1 year after the primary PDT. RESULTS: Visual acuities at the various follow-up evaluations improved significantly compared with baseline (P = 0.001 for all comparisons). The VA improved and decreased more than 0.3 logarithm of minimum angle of resolution unit 1 year after the primary PDT in 55 (25%) and 21 (10%) eyes, respectively. Stepwise logistic regression analysis showed that younger age, smaller greatest linear dimension, better baseline VA, and less baseline hemorrhage were significant and independent factors predictive of better VA 1 year after PDT, and younger age, smaller greatest linear dimension, better baseline VA, less hemorrhaging, and the presence of a serous macular detachment at baseline were significant and independent factors predictive of VA improvement. CONCLUSION: Photodynamic therapy stabilized eyes anatomically and functionally. Clinical characteristics at baseline were predictors of favorable VA outcomes after PDT. These findings may help establish the strategy of treatment for polypoidal choroidal vasculopathy.

Relationship of smoking and cardiovascular risk factors with polypoidal choroidal vasculopathy and age-related macular degeneration in Chinese persons.

PURPOSE: Polypoidal choroidal vasculopathy (PCV) has been described as a distinct clinical entity from choroidal neovascularization (CNV) secondary to age-related macular degeneration (AMD). The present study aimed to determine risk factors for PCV and to compare associations with those for CNV secondary to AMD. DESIGN: Case-control study. PARTICIPANTS: Patients of Chinese ethnicity with clinically and angiographically diagnosed PCV (n = 123) or CNV secondary to AMD (n = 128) were recruited from a tertiary eye hospital in Singapore. Controls without signs of PCV, CNV secondary to AMD, or other retinal pathologic features (n = 1489) were selected from a population-based study. METHODS: Patients underwent an ophthalmologic examination including digital color fundus photography, stereoscopic fluorescein angiography (FA), and indocyanine green angiography (ICGA). Classification into PCV or CNV secondary to AMD was based on FA and ICGA findings. Risk factors were determined from a standardized interview, with blood pressure recorded using a digital automatic blood pressure monitor. MAIN OUTCOME MEASURES: Polypoidal choroidal vasculopathy or CNV secondary to AMD. RESULTS: Persons who smoked were more likely to have PCV (39.9% vs. 13.4%) or CNV secondary to AMD (45.0% vs. 12.3%) than those who did not smoke. After controlling for age, gender, diabetes, hypercholesterolemia, and hypertension, persons who smoked were 4 times more likely to have PCV (odds ratio [OR], 4.4; 95% confidence interval [CI], 2.5-7.7; P<0.001) and CNV secondary to AMD (OR, 4.9; 95% CI, 2.7-8.8; P<0.001). A significant, negative association also was found between diastolic blood pressure and CNV secondary to AMD (OR, 0.7; 95% CI, 0.5-0.9; P = 0.017, adjusted for age, gender, smoking, diabetes, and hypercholesterolemia), but diastolic blood pressure was not associated with PCV. CONCLUSIONS: Smoking but not other vascular risk factors is significantly associated with both PCV and CNV secondary to AMD in Chinese persons. The similarity of associations suggests that there may be common risk factors and pathological mechanisms.

Black race is associated with digital artery endothelial dysfunction: results from the Heart SCORE study.

AIMS: We evaluated whether black race is independently associated with arterial endothelial dysfunction. The pathophysiological basis for race-related differences in cardiovascular disease (CVD) risk has not been established. Endothelial dysfunction, which precedes obstructive atherosclerotic disease, may contribute to CVD disparities. Accordingly, we evaluated race-related differences in digital pulse amplitude tonometry (PAT) response to an endothelium-dependent vasodilatory stimulus. METHODS AND RESULTS: A total of 1377 subjects (41% black; mean age 58.5 ± 7.5 years; 67% female) enrolled in the Heart Strategies Concentrating on Risk Evaluation (Heart SCORE) study underwent assessment of digital pulse amplitude response to forearm occlusion-induced hyperaemia. The response was measured as a PAT ratio of hyperaemia:baseline pulse amplitude in a finger that was subject to hyperaemic stimulus divided by this same ratio in a control finger on the contralateral arm which did not undergo forearm occlusion, expressed as the natural logarithm. The average PAT ratio was significantly lower in blacks compared with whites (0.67 ± 0.44 vs. 0.80 ± 0.46, P < 0.001), signifying greater endothelial dysfunction in blacks. Black race was independently correlated with lower PAT ratio. This finding was consistent across all Framingham risk strata. Adjusted analyses showed significant gender-race interactions. With white women serving as the referent group, parameter estimates for lower PAT ratio in ascending order were as follows: black males (t = -6.93, P < 0.0001); white males (t = -3.31, P = 0.001); and black females (t = -1.12, P = 0.26). CONCLUSION: Our findings indicate that black race is independently associated with arterial endothelial dysfunction. Racial differences in CVD risk may be related, in part, to race-related differences in endothelial dysfunction.

Cardiovascular risk factors, inflammation, and corneal arcus: the singapore malay eye study.

PURPOSE: To examine the relationship of corneal arcus with cardiovascular risk factors and inflammation in Malay adults living in Singapore. DESIGN: Population-based cross-sectional study. METHODS: A total of 3280 Malays aged 40-80 years (out of 4168 eligible participants; 78.7% response rate) had a standardized interview, systemic and ocular examinations, and laboratory investigations, including measurement of C-reactive protein (CRP), chronic kidney disease, and peripheral artery disease. Corneal arcus was defined from anterior segment images taken with a slit-lamp camera. RESULTS: Corneal arcus was seen in 2345 out of 3260 participants who had anterior segment images (73.2%). After adjustment for age, gender, total cholesterol, serum glucose, and current smoking, many cardiovascular risk factors significantly associated with corneal arcus, including male gender (odds ratio [OR] 1.65, 95% confidence interval [CI] 1.27-2.03), older age (per 10 years, OR 4.49, 95% CI 3.91-5.15), higher body mass index (per kg/m(2), OR 1.02, 95% CI 1.00-1.04), higher levels of CRP (per 10 mg/L, OR 1.36, 95% CI 1.13-1.64), total cholesterol (per mmol/L, OR 1.21, 95% CI 1.11-1.32), low-density lipoprotein cholesterol (per mmol/L, OR 1.94, 95% CI 1.38-2.74), presence of peripheral artery disease (OR 3.85, 95% CI 1.29-11.5), chronic kidney disease (OR 1.14, 95% CI 1.03-1.38), and current smoking (OR 1.29, 95% CI 1.02-1.69). CONCLUSIONS: This study confirms known associations of traditional cardiovascular risk factors with corneal arcus in an Asian population. Additionally, corneal arcus may be associated with systemic inflammatory markers, peripheral artery disease, and chronic kidney disease.

Association between resting heart rate and arterial stiffness in Korean adults.

BACKGROUND: Higher resting heart rate, a simple and useful indicator of autonomic balance and metabolic rate, has emerged as an independent predictor for atherosclerotic cardiovascular disease. AIM: To determine the association between resting heart rate and arterial stiffness measured by brachial-ankle pulse wave velocity (baPWV). METHODS: We examined the association between resting heart rate and baPWV in 641 Korean adults (366 men, 275 women) in a health examination program. A high baPWV was defined as greater than 1450 cm/s (>75th percentile). The odds ratios for high baPWVs were calculated using multivariable logistic regression analysis after adjusting for confounding variables across heart rate quartiles (Q1or=69 beats/min). RESULTS: Age-adjusted baPWV mean values increased gradually with heart rate quartile (Q1=1281, Q2=1285, Q3=1354, Q4=1416 cm/s). The odds ratios (95% confidence intervals) for high baPWVs in each heart rate quartile were 1.00, 1.28 (0.57-2.86), 2.63 (1.20-5.79) and 3.66 (1.66-8.05), respectively, after adjusting for age, sex, smoking status, alcohol intake, exercise, body mass index, hypertension medication, diabetes medication, hyperlipidaemia medication, mean arterial blood pressure, fasting plasma glucose, total cholesterol, triglycerides, high-density lipoprotein cholesterol, white blood cell count, aspartate aminotransferase, alanine aminotransferase, gamma-glutamyltransferase and uric acid. CONCLUSION: These findings indicate that a higher resting heart rate is independently associated with arterial stiffness. Accordingly, early detection of increased resting heart rate is important for preservation of arterial function and assessment of cardiovascular risk.

The influence of the obesity paradox and chronic kidney disease on long-term survival in a Japanese cohort with peripheral arterial disease.

BACKGROUND: This study analyzed risk factors for mortality in peripheral arterial disease (PAD), including body mass index (BMI) and estimated glomerular filtration rate (eGFR). Risk factors for long-term survival are unclear in patients with PAD. The origin of the obesity paradox, a paradoxical decrease in mortality with increasing BMI, is also uncertain in these patients. METHODS: A prospective cohort study was performed in 652 patients (aged 71.3 +/- 9.4 years old) with PAD. RESULTS: The 1-, 5-, 10- and 15-year survival rates were 94.5%, 70.4%, 45.2%, and 21.1%, respectively, in patients with intermittent claudication, and 72.7%, 27.2%, 11.6%, and 5.8%, respectively, in those with critical limb ischemia (CLI). In Cox multivariate analysis, a significant association with all-cause mortality was found for CLI (hazard ratio [HR], 1.931; 95% confidence interval [CI], 1.089-3.422; P = .024), diabetes (HR, 2.111; 95% CI, 1.247-3.572; P = .005), BMI (HR, 0.879; 95% CI, 0.804-0.962; P = .005), and eGFR (HR, 0.985; 95% CI, 0.971-0.998l; P = .028). These parameters were also significant risk factors for cardiovascular mortality. Fibrinogen (HR, 1.003; 95% CI, 1.001-1.005; P = .014) and cerebrovascular disease (HR, 1.730; 95% CI, 1.021-2.930; P = .045) were identified as risk factors for all-cause mortality. The adjusted HR for mortality of BMI <21.5 vs >or=21.5 kg/m(2) was 1.772 (95% CI, 1.378-2.279; P < .001). BMI had positive correlations with triglyceride and albumin concentrations and negative correlations with the fibrinogen level and chronic obstructive pulmonary disease (P = .005). CONCLUSIONS: Low BMI, eGFR, CLI, and diabetes are significant risk factors for mortality in PAD. The obesity paradox was verified and may be partly explained by low BMI mediated by malnutrition and systemic inflammation due to PAD or chronic obstructive pulmonary disease.

Extracranial carotid stenosis and peripheral arterial disease in Thai patients with coronary artery disease.

We assessed the prevalence of carotid stenosis (CS) and peripheral arterial disease (PAD) in patients with coronary artery disease (CAD) to determine the relationship between these conditions in a Thai population. All patients with coronary angiography during June 2008 and August 2009 were studied. Carotid duplex and ankle-brachial index (ABI) were performed. One hundred and seventy-seven patients were studied (95 men, mean age of 65). Carotid stenosis and PAD were diagnosed in 16 patients (9%) and 68 patients (38.4%), respectively. The presence of carotid bruit and older age were independent predictors of CS and PAD, respectively. There was no correlation between the presence of CS/PAD and the extent of coronary artery lesions. Although CS was uncommon in patients with CAD, the patients with cervical bruit should be screened for CS. Prevalence of PAD was high, confirming the presence of diffuse atherosclerosis in many patients with CAD.

Resting energy expenditure in patients with intermittent claudication and critical limb ischemia.

OBJECTIVE: The primary aim of this study was to compare the resting energy expenditure of patients with intermittent claudication and critical limb ischemia. A secondary aim was to identify predictors of resting energy expenditure. METHODS: One hundred patients limited by intermittent claudication and 40 patients with critical limb ischemia participated in this study. Patients were assessed on resting energy expenditure, body composition, ankle brachial index (ABI), and calf blood flow. RESULTS: Patients with critical limb ischemia had a lower resting energy expenditure than patients with intermittent claudication (1429 +/- 190 kcal/day vs 1563 +/- 229 kcal/day; P = .004), and higher body fat percentage (34.8 +/- 7.8% vs 31.5 +/- 7.8%; P = .037), higher fat mass (30.0 +/- 9.3 kg vs 26.2 +/- 8.9 kg;P = .016), and lower ABI (0.31 +/- 0.11 vs 0.79 +/- 0.23; P < .001). Resting energy expenditure was predicted by fat free mass (P < .0001), age (P < .0001), ABI (P < .0001), ethnicity (P < .0001), calf blood flow (P = .005), and diabetes (P = .008). Resting energy expenditure remained lower in the patients with critical limb ischemia after adjusting for clinical characteristics plus fat free mass (1473 +/- 27.8 kcal/day [mean +/- SEM] vs 1527 +/- 19.3 kcal/day; P = .031), but it was no longer different between groups after further adjustment for ABI and calf blood flow (1494 +/- 25.2 kcal/day vs 1505 +/- 17.7 kcal/day; P = .269). CONCLUSION: Resting energy expenditure is decreased with a progression in peripheral arterial disease (PAD) symptoms from intermittent claudication to critical limb ischemia. Furthermore, patients with critical limb ischemia who are most susceptible for decline in resting energy expenditure are older, African American patients with diabetes. The lower resting energy expenditure of patients with critical limb ischemia, combined with their sedentary lifestyle, suggests that they are at high risk for long-term positive energy balance and weight gain.