Peripheral artery disease and non-coronary atherosclerosis in Hispanics: another paradox?

Hispanic Americans (HA) are a significant and increasing segment of the population who must be considered in future health planning. HA, compared to European Americans (EA), have a lower prevalence of coronary artery disease, but higher burden of cardiovascular disease risk factors. It remains unclear if this observation termed the 'Hispanic Paradox' also exists for vascular beds outside the heart. We present a review of the literature which suggests that this paradox may also exist for arteries in the extremities and neck.

Central vein stenosis in an Asian hemodialysis population.

OBJECTIVE AND BACKGROUND: Central vein stenosis occurs commonly after instrumentation of the major thoracic veins. We aimed to investigate factors that contributed to this condition in an Asian hemodialysis population, and the results of intervention. PATIENTS AND METHODS: Hemodialysis patients diagnosed with central vein stenosis between January 2003 and December 2008, were identified from the records of the National University Hospital, Singapore. Eligible controls had a minimum of 2 years of hemodialysis via an arteriovenous fistula and/or central venous catheter, without clinical or radiological evidence of central vein stenosis. RESULTS: Central vein stenosis was diagnosed in 108 patients. The most common presenting features were arm swelling (32%) and failed hemodialysis catheter insertion (28%). The median frequency of permanent hemodialysis catheter insertion in those who subsequently developed venous stenosis (1.44 per patient per year) was 4 times that of controls (0.36 per patient per year; p<0.001). Ischemic heart disease (p = 0.03) and in certain patients, arteriovenous fistula surgery were associated with the development of central vein stenosis; whereas line sepsis, diabetes, and hypertension were not. Central vein angioplasty was attempted in 53 patients; the primary patency was 52% at 1 year. CONCLUSION: Central vein stenosis is associated with a higher frequency of hemodialysis catheter insertion and access surgery. Efforts to decrease permanent hemodialysis catheter use should reduce the incidence of central vein stenosis.

The epidemiology of subclavian stenosis and its association with markers of subclinical atherosclerosis: the Multi-Ethnic Study of Atherosclerosis (MESA).

BACKGROUND: Recent studies indicate that subclavian stenosis (SS), diagnosed by a large systolic blood pressure difference (SBPD) between the right and left brachial arteries, is associated with cardiovascular disease (CVD) risk factors and outcomes. We sought to describe the epidemiology of SS and determine its association with markers of subclinical CVD in the baseline cohort of the Multi-Ethnic Study of Atherosclerosis. METHODS: We defined SS by an absolute SBPD>or=15 mmHg. Peripheral artery disease (PAD) was defined by an ankle-brachial index100 vs. score=0; OR=1.43; 1.03-2.01). CONCLUSIONS: The subclavian stenosis is positively associated with other markers of subclinical atherosclerosis.