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1.
Medicine (Baltimore) ; 98(33): e16802, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415390

RESUMO

Impact of arterial stiffness on aortic morphology has not been well evaluated. We sought to investigate the association of brachial-ankle pulse wave velocity (baPWV) with aortic calcification and tortuosity.A total of 181 patients (65.4 ±â€Š10.4 years, males 59.7%) who underwent computed tomographic angiography and baPWV measurement within 1 month of study entry were retrospectively reviewed. Aortic calcification was quantified by the calcium scoring software system. Aortic tortuosity was defined as the length of the midline in the aorta divided by the length of linear line from the aortic root to the distal end of the thoraco-abdominal aorta. In simple correlation analyses, baPWV was correlated with aortic calcification (r = 0.36, P < .001) and tortuosity (r = 0.16, P = .030). However, these significances disappeared after controlling for confounders in multivariate analyses. Factors showing an independent association with aortic calcification were age (ß = 0.37, P < .001), hypertension (ß = 0.19, P = .003), diabetes mellitus (ß = 0.12, P = .045), smoking (ß = 0.17, P = .016), and estimated glomerular filtration rate (ß = -0.25, P = .002). Factors showing an independent association with aortic tortuosity were age (ß = 0.34, P < .001), body mass index (ß = -0.19, P = .018), and diabetes mellitus (ß = -0.21, P = .003).In conclusion, baPWV reflecting arterial stiffness was not associated with aortic calcification and tortuosity. Traditional cardiovascular risk factors were more influential to aortic geometry. Further studies with a larger sample size are needed to confirm our results.


Assuntos
Aorta/patologia , Artérias/anormalidades , Instabilidade Articular/fisiopatologia , Dermatopatias Genéticas/fisiopatologia , Calcificação Vascular/fisiopatologia , Malformações Vasculares/fisiopatologia , Rigidez Vascular/fisiologia , Idoso , Índice Tornozelo-Braço , Aorta/fisiopatologia , Artérias/patologia , Artérias/fisiopatologia , Índice de Massa Corporal , Angiografia por Tomografia Computadorizada , Feminino , Humanos , Instabilidade Articular/patologia , Masculino , Pessoa de Meia-Idade , Análise de Onda de Pulso , Estudos Retrospectivos , Dermatopatias Genéticas/patologia , Calcificação Vascular/patologia , Malformações Vasculares/patologia
2.
Anticancer Res ; 39(6): 3255-3264, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31177176

RESUMO

BACKGROUND/AIM: Chemotherapy-induced cardiotoxicity may be observed during treatment or may cause severe cardiac failure as the main cause of death, even several years after therapy implementation. Herein, the aim was to establish the early diagnosis of cardiotoxicity through the periodic evaluation of the left ventricular (LV) and vascular remodeling parameters, in patients with acute lymphoblastic leukemia (ALL). MATERIALS AND METHODS: The study population included 35 patients diagnosed with ALL, evaluated before and 3 months after starting chemotherapy, measuring systolic and diastolic parameters of the LV and intima-media thickness (IMT), arterial stiffness aortic pulse wave velocity (PWVAo) and ankle-brachial index (ABI). RESULTS: After the first 2 cycles of chemotherapy, all patients experienced a drop in LV ejection fraction (LVEF) (p<0.001), and 12 patients suffered a decrease of LVEF<50%. The ABI (p<0.05) and the global longitudinal strain (GLS) (p<0.001) decreased, while IMT and PWVAo (p<0.001) increased, proving a subclinical deterioration of the LV function and vascular remodeling. CONCLUSION: Assessment of cardiovascular risk factors before chemotherapy initiation in ALL patients may be helpful for an early diagnosis of chemotherapy-induced cardiotoxicity, thus contributing to early treatment and a subsequent decrease of death caused by such cardiovascular complications.


Assuntos
Índice Tornozelo-Braço , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Doenças Cardiovasculares/diagnóstico , Ecocardiografia Doppler , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Adulto , Cardiotoxicidade , Doenças Cardiovasculares/induzido quimicamente , Doenças Cardiovasculares/fisiopatologia , Diagnóstico Precoce , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Contração Miocárdica/efeitos dos fármacos , Leucemia-Linfoma Linfoblástico de Células Precursoras/diagnóstico , Valor Preditivo dos Testes , Fatores de Risco , Volume Sistólico/efeitos dos fármacos , Fatores de Tempo , Resultado do Tratamento , Remodelação Vascular/efeitos dos fármacos , Rigidez Vascular/efeitos dos fármacos , Função Ventricular Esquerda/efeitos dos fármacos , Adulto Jovem
3.
Zhonghua Xin Xue Guan Bing Za Zhi ; 47(5): 381-387, 2019 May 24.
Artigo em Chinês | MEDLINE | ID: mdl-31142082

RESUMO

Objective: To explore the characteristics of postural blood pressure changes in elderly inpatients and the related factors of orthostatic hypotension (OH). Methods: This study was a clinical case control study. Two hundred and sixty-six elderly patients (≥60 years old), who were hospitalized between April 2016 and November 2017 in Geriatric Department of Peking University First Hospital, were included. They were divided into direct standing group and indirect standing group. Direct standing group involved 102 patients, they changed posture from supine directly to standing position, and the blood pressures at the moments of supine, immediately after standing and the first, second, and third minute after standing were recorded by continuous noninvasive arterial pressure (CNAP) system. Indirect standing group involved 164 patients, and they changed posture from supine to sitting for 3 minutes, and then changed to standing position. Blood pressures at the moments of supine, immediately after sitting, the third minute after sitting, immediately after standing and the third minute after standing was recorded by CNAP. Blood pressure changes after different postural changes mode and the rates of OH were compared. The related factors of OH was analyzed by binary logistic regression analysis. Results: The lowest systolic blood pressures (SBP) mostly occurred immediately after postural change: immediately after standing for direct standing group (86.3%(88/102)), and immediately after sitting for indirect standing group (59.1%(97/164)). The lowest diastolic blood pressures (DBP) mostly occurred immediately after standing in the two groups: 87.3%(89/102) for direct standing group and 43.3% (71/164) for indirect standing group. The maximum SBP drop (SBP of supine minus the lowest SBP during postural changes) of direct standing group was significantly higher than indirect standing group (median 20.5(14.0, 29.3) vs. 18.0(11.0, 26.0) mmHg (1 mmHg=0.133 kPa, P<0.05). The rates of OH occurred immediately and within 3 minutes from supine to standing position were significantly higher in direct standing group than in indirect standing group (65.7% (67/102) vs. 43.9% (72/164), and 70.6% (72/102) vs. 49.4% (81/164), both P<0.05). Binary logistic regression analysis showed that brachial-ankle pulse wave velocity was positively associated with OH after a transition from supine to standing position (immediately and within 3 minutes, OR=1.002 (95%CI 1.000-1.004), 1.003 (95%CI 1.001-1.006), P=0.014, 0.006) in direct standing group. Conclusions: OH is common in elderly hospitalized patients. The most obvious blood pressure changes are likely to occur immediately after position changes. Adding a sitting position during the transition of supine to standing position may decrease the amplitude of SBP drop. Brachial-ankle pulse wave velocity is associated with OH after the transition from the supine to standing position in the elderly inpatients.


Assuntos
Pressão Arterial , Hipotensão Ortostática , Idoso , Índice Tornozelo-Braço , Pressão Sanguínea , Determinação da Pressão Arterial , Estudos de Casos e Controles , Humanos , Hipotensão Ortostática/diagnóstico , Pessoa de Meia-Idade , Postura , Análise de Onda de Pulso
4.
Vnitr Lek ; 65(4): 326, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31091955

RESUMO

Extremitovascular arterial ischemic disease (lower extremity peripheral arterial disease - PAD) is an important manifestation of systemic atherosclerosis and other arterial diseases of vascular system. The lower the ankle-brachial pressure index, the greater the risk of serious acute instable organovascular events (e. g. acute myocardial infarction, stroke). Complex prevention and treatment of extremitovascular arterial disease is discussed in this article. Angiology/vascular medicine is the fastest growing field of internal medicine.


Assuntos
Aterosclerose , Complicações do Diabetes , Diabetes Mellitus , Doença Arterial Periférica , Índice Tornozelo-Braço , Humanos , Extremidade Inferior , Doença Arterial Periférica/terapia , Fatores de Risco
5.
Clin Podiatr Med Surg ; 36(3): 361-370, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31079603

RESUMO

The accurate assessment of peripheral perfusion is a critical step in caring for a diabetic patient with active ulceration. This article guides the provider through diagnostic and therapeutic options. The perfusion assessment begins with a physical examination and augmented using noninvasive tests. Although some of these tests can be performed at the bedside, often a dedicated vascular laboratory is required. Additional cross-sectional imaging studies or formal angiography should be performed as well. These tools aid in the creation of the best therapeutic plan, which aims to restore perfusion and allow for rapid wound healing via open or endovascular means.


Assuntos
Diabetes Mellitus/fisiopatologia , Pé Diabético/cirurgia , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/cirurgia , Índice Tornozelo-Braço , Circulação Sanguínea/fisiologia , Pressão Sanguínea/fisiologia , Pé Diabético/diagnóstico por imagem , Diagnóstico por Imagem , Procedimentos Endovasculares , Pé/irrigação sanguínea , Pé/diagnóstico por imagem , Humanos , Doença Arterial Periférica/fisiopatologia , Exame Físico , Pulso Arterial , Procedimentos Cirúrgicos Vasculares
6.
Clin Podiatr Med Surg ; 36(3): 469-481, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31079611

RESUMO

Reconstruction of the diabetic Charcot foot can be a challenge even for the most experienced foot and ankle surgeon. The first portion of this article discusses the preoperative evaluation with an emphasis on factors that can be modified before surgical reconstruction to help optimize surgical results. The second portion of the article focuses on intraoperative methods and techniques to help improve postoperative outcomes. Surgeons should strive to provide high-quality, cost-effective care by optimizing patient selection and perioperative care. Objective measures of patient outcomes will become increasingly important with the transition from volume-based to value-based care.


Assuntos
Artropatia Neurogênica/cirurgia , Pé Diabético/cirurgia , Índice Tornozelo-Braço , Antibacterianos/uso terapêutico , Pressão Sanguínea , Fosfatos de Cálcio/uso terapêutico , Pé Diabético/diagnóstico por imagem , Hemoglobina A Glicada/análise , Humanos , Consentimento Livre e Esclarecido , Anamnese , Procedimentos Ortopédicos , Exame Físico , Fator de Crescimento Derivado de Plaquetas/uso terapêutico , Cuidados Pós-Operatórios , Complicações Pós-Operatórias/prevenção & controle , Dedos do Pé/irrigação sanguínea , Vitamina D/sangue
8.
Medicine (Baltimore) ; 98(18): e15406, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31045795

RESUMO

BACKGROUND: Traumatic vascular injury is caused by explosions and projectiles (bullets and shrapnel); it may affect the arteries and veins of the limbs, and is common in wartime, triggering bleeding, and ischemia. The increasing use of high-energy weapons in modern warfare is associated with severe vascular injuries. METHODS: To summarize the current evidence of diagnosis and treatment for traumatic vascular injury of limbs, for saving limbs and lives, and put forward some new insights, we comprehensively consulted literatures and analyzed progress in injury diagnosis and wound treatment, summarized the advanced treatments now available, especially in wartime, and explored the principal factors in play in an effort to optimize clinical outcomes. RESULTS: Extremity vascular trauma poses several difficult dilemmas in diagnosis and treatment. The increasing use of high-energy weapons in modern warfare is associated with severe vascular injuries. Any delay in treatment may lead to loss of limbs or death. The development of diagnose and treat vascular injury of extremities are the clinical significance to the tip of military medicine, such as the use of fast, cheap, low invasive diagnostic methods, repairing severe vascular injury as soon as possible, using related technologies actively (fasciotomy, etc). CONCLUSION: We point out the frontier of the diagnosis and treatment of traumatic vascular injury, also with a new model of wartime injury treatment in American (forward surgical teams and combat support hospitals), French military surgeons regarding management of war-related vascular wounds and Chinese military ("3 districts and 7 grades" model). Many issues remain to be resolved by further experience and investigation.


Assuntos
Medicina de Emergência/métodos , Extremidades , Medicina Militar/métodos , Lesões do Sistema Vascular/diagnóstico , Lesões do Sistema Vascular/terapia , Amputação/métodos , Índice Tornozelo-Braço , Traumatismos por Explosões/diagnóstico , Traumatismos por Explosões/terapia , Prótese Vascular , Descompressão Cirúrgica/métodos , Fasciotomia/métodos , Fraturas Ósseas/terapia , Humanos , Militares , Estudos Retrospectivos , Transplante de Pele/métodos , Fatores de Tempo , Índices de Gravidade do Trauma , Estados Unidos , Procedimentos Cirúrgicos Vasculares/métodos , Lesões do Sistema Vascular/diagnóstico por imagem
9.
Medicine (Baltimore) ; 98(19): e15556, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31083218

RESUMO

Increased interarm systolic blood pressure difference (IASBPD) is associated with cardiovascular prognosis in the general population. This study aimed to evaluate whether IASBPD or ankle brachial index (ABI) is strongly associated with cardiovascular outcomes in patients with type 2 diabetes.Total 446 type 2 diabetes followed up for a mean 5.8 years divided by ABI (<0.9 vs ≥0.9) or IASBPD (<10 vs ≥10 mm Hg). The primary outcome was a composite of all-cause mortality, hospitalization for coronary artery disease, nonfatal stroke, carotid, or peripheral revascularization, amputations, and diabetic foot syndrome. The secondary endpoint was all-cause mortality.Sixty-four composite events and 17 deaths were identified. The primary and secondary outcomes were higher than those in the group with ABI < 0.9 vs ABI ≥ 0.9 (32.8% vs 11.6%, P < .005 for primary outcome; 14.0% vs 2.3%, P < .005 for all-cause mortality) but IASBPD cannot exhibit a prognostic value. ABI < 0.9 was also the dominant risk factor of both endpoints demonstrated by multivariate Cox proportional analysis (composite events: adjusted hazard ratio [HR], 2.39; 95% confidence interval [CI], 1.26-4.53; P = .007; all-cause mortality: adjusted HR, 3.27: 95% CI, 1.91-5.60; P < .001).The ABI was more associated with cardiovascular outcomes in patients with diabetes than IASBPD.


Assuntos
Índice Tornozelo-Braço , Pressão Sanguínea , Doenças Cardiovasculares/diagnóstico , Doenças Cardiovasculares/mortalidade , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/mortalidade , Idoso , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/fisiopatologia , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/fisiopatologia , Feminino , Seguimentos , Humanos , Masculino , Prognóstico , Estudos Retrospectivos , Fatores de Risco
10.
Clin Exp Rheumatol ; 37 Suppl 117(2): 65-71, 2019 Mar-Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31074717

RESUMO

OBJECTIVES: This study aims to investigate the association between arterial stiffness measured by brachial-ankle pulse wave velocity (baPWV) and cardiovascular events (CVEs) in patients with Takayasu's arteritis (TAK). METHODS: A total of 240 TAK patients, who underwent baPWV measurement, were included in the study. The primary outcome was CVEs, which was defined as presently or previously diagnosed with myocardial infarction, unstable angina, congestive heart failure, aortic aneurysm/dissection, cerebral infarction/transient ischaemic attack (TIA), or cerebral haemorrhage. RESULTS: A total of 74 (30.8%) patients with CVEs were included in the present cohort. Compared with the patients without CVEs, those with CVEs had a higher prevalence of hyperlipidaemia (HL), smoking history, active stage, angiographic type V, renal dysfunction (RDF), higher baPWV and high sensitive C-reactive protein (hs-CRP) level (all, p<0.05). The multivariate logistic regression analysis showed that HL (OR: 2.465, 95%CI: 1.308-4.648, p=0.005), smoking history (OR: 4.764, 95%CI: 1.623-13.985, p=0.004), baPWV (OR: 1.132, 95%CI: 1.063-1.204, p<0.001), and hs-CRP (OR: 1.111, 95%CI: 1.040-1.188, p=0.002) were independently associated with the presence of CVEs. The multiple linear regression analysis revealed that age (ß=0.100, p=0.002), mean blood pressure (ß=0.071, p<0.001), angiographic type V (ß=3.681, p<0.001) and RDF (ß=1.800, p=0.048) were independently correlated with baPWV. CONCLUSIONS: Increased baPWV was independently associated with CVEs in patients with TAK. Age, angiographic type V, mean blood pressure and RDF were the strongest determinants for baPWV in TAK. BaPWV may be a potential maker to predict CVEs in patients with TAK.


Assuntos
Doenças Cardiovasculares/etiologia , Arterite de Takayasu/complicações , Rigidez Vascular , Adulto , Índice Tornozelo-Braço , Pressão Sanguínea , Doenças Cardiovasculares/epidemiologia , Feminino , Humanos , Masculino , Análise de Onda de Pulso , Fatores de Risco , Arterite de Takayasu/epidemiologia , Adulto Jovem
11.
Clin Interv Aging ; 14: 735-742, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31114178

RESUMO

Purpose: Frailty and atherosclerotic diseases are prevalent among the older people and usually present the same pathogenesis and risk factors. Therefore, the aim of this study was to determine the association between frailty and atherosclerosis. Patients and methods: The enrolled participants were 171 patients aged 60-96 years in Beijing Tongren Hospital. Data that were collected included sex, age, height, weight, calculated body mass index (BMI), past medical history, comorbidities (including hypertension, coronary heart disease [CHD], and diabetes), ability to perform activities of daily living (ADL) as measured using the Barthel index, handgrip strength, 15-feet (4.57 m) walking speed, body composition features determined by bioelectrical impedance analysis, the ankle-brachial index (ABI), and atherosclerosis determined by the cardio-ankle vascular index (CAVI). Patients were divided into frail, pre-frail, and non-frail groups using Fried's frailty index. ANOVA was used to assess the differences among these groups. Linear correlation analysis was used to examine the relationship between the CAVI and frailty phenotype. Ordinal multivariate logistic regression analysis was used to examine the factors affecting frailty and the relationship between frailty and atherosclerosis. Results: The population was categorized as 21.3% frail, 38.4% pre-frail, and 40.3% non-frail. Patients in the frail group were older, had lower handgrip strength, slower walking speed, and a lower ABI and a higher proportion of carotid intima-media thickening with values of at least 1 mm compared with those in the pre-frail and non-frail groups. The CAVI score was higher in the frail group than that in the other two groups. There were significant inverse linear correlations between grip strength, walking speed, and the CAVI. CAVI showed an independent risk factor for frailty (OR: 2.013, 95% CI 1.498-2.703, p<0.001). Conclusion: Our study shows that arterial stiffness is associated with frailty in older patients, even when adjusting for multiple factors.


Assuntos
Índice Tornozelo-Braço , Aterosclerose/complicações , Fragilidade/complicações , Atividades Cotidianas , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Tornozelo/irrigação sanguínea , Índice de Massa Corporal , Pesos e Medidas Corporais , Comorbidade , Feminino , Força da Mão , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prevalência , Fatores de Risco , Fatores Sexuais , Rigidez Vascular , Velocidade de Caminhada
12.
Int Angiol ; 38(2): 150-156, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30938496

RESUMO

BACKGROUND: Arterial stiffness has emerged as an independent risk factor for adverse cardiovascular disease events and is the consequence of multiple risk factors. The aim of the present study is to explore the main determinants of arterial stiffness in a Chinese population and to study how the arterial stiffness levels affected by different number of risk factors. METHODS: This study included 358 subjects in Hefei area of China. Anthropometric indexes, biochemical indexes, cardiovascular function indexes and lifestyle were achieved. Brachial-ankle pulse wave velocity (baPWV) was used to assess arterial stiffness. Multivariate linear regression model was performed to identify the main determinants of arterial stiffness levels. RESULTS: baPWV was correlated with age, sex, hypertension, various blood pressure components (systolic blood pressure [SPB], diastolic blood pressure, pulse pressure, and central arterial pressure), serum lipids, fasting blood-glucose and body mass index, subendocardial viability ratio (SEVR) and ejection duration (ED) in bivariate correlation analysis. Moreover, baPWV was only positively correlated with age, hypertension and SBP and inversely correlated with SEVR and ED in multivariable regression model. These five variables explained about 74.8% variances of baPWV and age was the strongest determinant of arterial stiffness. In addition, the levels of arterial stiffness increased with the augmented number of risk factors when the total number of factors was no more than 4. CONCLUSIONS: The main determinants of arterial stiffness were age, hypertension, SBP, SEVR and ED. Furthermore, the number of risk factors had an independent influence on arterial stiffness, it is of great importance to consider the number of risk factors when it comes to cardiovascular risk assessment.


Assuntos
Doenças Cardiovasculares/epidemiologia , Rigidez Vascular , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Índice Tornozelo-Braço , Pressão Sanguínea , Índice de Massa Corporal , China/epidemiologia , Estudos Transversais , Feminino , Humanos , Hipertensão , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Análise de Onda de Pulso , Fatores de Risco , Adulto Jovem
13.
Vasc Med ; 24(4): 306-312, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31023166

RESUMO

Common carotid artery (CCA) intima-media thickness (IMT) is associated with coronary heart disease and can be measured on ultrasound images either by hand or with an automated edge detector. The association of CCA IMT with incident peripheral artery disease (PAD) is poorly studied. We studied 5467 participants of the Multi-Ethnic Study of Atherosclerosis composed of non-Hispanic white, Chinese, Hispanic, and African American participants with a mean age of 61.9 years (47.8% men). Framingham Risk Factors, manual-traced IMT (mt-IMT), and edge-detected IMT (ed-IMT) were entered into multivariable Cox proportional hazards models with incident PAD as the outcome. There were 87 events during a median follow-up of 12.2 years. In fully adjusted models and expressing the hazard ratios (HR) as an increment in SD values, both mt-IMT and ed-IMT were significantly associated with incident PAD: HR 1.36 (95% CI: 1.15, 1.61) and 1.29 (95% CI: 1.04, 1.60), respectively. We conclude that ed- and mt-CCA IMT measurements are associated with incident PAD. ClinicalTrials.gov Identifier: NCT00063440.


Assuntos
Artéria Carótida Primitiva/diagnóstico por imagem , Espessura Intima-Media Carotídea , Doença da Artéria Coronariana/diagnóstico por imagem , Doença da Artéria Coronariana/etnologia , Interpretação de Imagem Assistida por Computador , Doença Arterial Periférica/etnologia , Idoso , Idoso de 80 Anos ou mais , Índice Tornozelo-Braço , Feminino , Humanos , Incidência , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico , Valor Preditivo dos Testes , Prognóstico , Medição de Risco , Fatores de Risco , Fatores de Tempo , Estados Unidos/epidemiologia
14.
Blood Purif ; 47 Suppl 2: 25-30, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30943475

RESUMO

BACKGROUND: Peripheral arterial disease (PAD) has increased in association with the increase in the numbers of patients with kidney disease or diabetes. The aim of this study was to assess the prevalence of PAD in hemodialysis patients with diabetes. METHODS: To examine the usefulness of the cardio-ankle vascular index (CAVI) to screen for the presence of PAD, cross-sectional studies of 100 patients undergoing chronic hemodialysis were performed. The CAVI and other inflammatory markers were evaluated. RESULTS: The CAVI was markedly elevated in patients with a history of PAD or cardiovascular disease. When dialysis patients were classified on the basis of CAVI quartiles, increased CAVI was associated with other risk factors for PAD. CONCLUSION: The prevalence of PAD is high in elderly diabetic patients on hemodialysis. The present findings suggest that the CAVI can be a useful index that predicts the occurrence of macrovascular complications in dialysis patients with diabetes.


Assuntos
Complicações do Diabetes/etiologia , Nefropatias/complicações , Doença Arterial Periférica/etiologia , Diálise Renal , Idoso , Índice Tornozelo-Braço , Estudos Transversais , Complicações do Diabetes/diagnóstico , Feminino , Humanos , Nefropatias/terapia , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/diagnóstico , Prevalência , Fatores de Risco , Rigidez Vascular
15.
Khirurgiia (Mosk) ; (3): 98-104, 2019.
Artigo em Russo | MEDLINE | ID: mdl-30938364

RESUMO

Peripheral artery disease is still one of the most important surgical problems. General surgeons treat the majority of patients with chronic lower limb ischemia due to the lack of specialized surgical care. Current methods for risk factors adjustment, exercise therapy and the most common drugs for intermittent claudication management are reviewed in the article. The effect of these medicines on subjective (pain-free walking distance, maximal walking distance, etc.) and objective (ankle-brachial index) parameters and the incidence of complications are analyzed.


Assuntos
Tratamento Conservador/métodos , Isquemia/terapia , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/terapia , Assistência Ambulatorial/métodos , Índice Tornozelo-Braço , Doença Crônica , Terapia por Exercício , Humanos , Claudicação Intermitente/tratamento farmacológico , Claudicação Intermitente/etiologia , Claudicação Intermitente/terapia , Isquemia/etiologia , Doença Arterial Periférica/complicações , Medição de Risco , Fatores de Risco , Federação Russa , Caminhada
16.
FP Essent ; 479: 11-15, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30994999

RESUMO

Lower extremity peripheral artery disease (PAD) refers to atherosclerotic disease that involves the iliac, femoral, or more distal arteries of the lower extremities. This condition affects 8 to 12 million Americans. Risk factors include advanced age, hypertension, dyslipidemia, diabetes, and cigarette smoking. Approximately 10% to 30% of patients with PAD present with the classic symptom of intermittent claudication. Some patients experience symptoms such as pallor, hair loss, or nonhealing wounds, and up to half of patients are asymptomatic. There are differing recommendations from various organizations for screening of asymptomatic patients. If PAD is suspected, the ankle-brachial index is the preferred first test. Further tests, including duplex ultrasonography or angiography, may be warranted depending on the clinical situation. Therapy for patients with PAD consists of lifestyle modifications, which include diet modification, exercise programs, and smoking cessation. Medical therapy consists of antiplatelet and statin therapies for secondary prevention of vascular complications, and consideration of drugs such as cilostazol for symptom control. Patients with acute limb ischemia should be referred emergently for evaluation and possible revascularization. Patients with lifestyle-limiting claudication despite lifestyle modification and medical therapy and patients with chronic limb ischemia (eg, nonhealing wounds) should be considered for revascularization.


Assuntos
Doenças Cardiovasculares , Claudicação Intermitente , Doença Arterial Periférica , Índice Tornozelo-Braço , Doenças Cardiovasculares/complicações , Humanos , Claudicação Intermitente/complicações , Extremidade Inferior , Doença Arterial Periférica/complicações , Fatores de Risco
18.
Lipids Health Dis ; 18(1): 57, 2019 Mar 04.
Artigo em Inglês | MEDLINE | ID: mdl-30832679

RESUMO

BACKGROUND: Evidence regarding the relationship between estimated glomerular filtration rate (eGFR) and arterial stiffness is limited, and the data analysis is not sufficient to clarify the true relationship between the two. We aimed to investigate the relationship between eGFR and brachial-ankle pulse wave velocity (baPWV) in Japanese. METHODS: The present study was a cross-sectional study. Nine hundred twelve Japanese men and women, aging 24-84 years old, received a health medical check-up program including the results from baPWV inspection and various standardized questionnaires in a health examination center in Japan. The main outcome measures included eGFR, baPWV, fatty liver and postmenopausal status. Abdominal ultrasonography was used to diagnose fatty liver. Postmenopausal state was defined as beginning 1 year after the cessation of menses. RESULTS: The average age of the 912 selected participants was 51.5 ± 9.6 years old, and about 57.6% of them were male. The participants' eGFR distribution was median 69.29 (min 39, max 122.28). The results of multivariate linear regression showed eGFR was not independently associated with baPWV after adjusting potential confounders (ß = - 1.11, 95%CI -2.25 to 0.03), this is inconsistent with the result of eGFR (quartile) as a categorical variable (p for trend was 0.038). A non-linear relationship was detected between eGFR and baPWV, whose point was 77.05. The effect sizes and the confidence intervals of the left and right sides of inflection point were - 2.80 (- 4.41 to - 1.19) and 1.84 (- 0.50, 4.17), respectively. Subgroup analysis showed, the change in the elderly population is more pronounced (P for interaction = 0.018; - 2.83 with ≤60 year vs - 6.12 with > 60 year). The same trend was also seen in hypertensive people (P for interaction = 0.018; - 4.55 with hypertension vs - 0.82 with non-hypertension). CONCLUSION: The relationship between eGFR and baPWV is non-linear. eGFR was negatively related to baPWV when eGFR is less than 77.05.


Assuntos
Fígado Gorduroso/fisiopatologia , Taxa de Filtração Glomerular , Hipertensão/fisiopatologia , Rigidez Vascular , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice Tornozelo-Braço/métodos , Grupo com Ancestrais do Continente Asiático , Estudos Transversais , Fígado Gorduroso/diagnóstico por imagem , Fígado Gorduroso/etnologia , Feminino , Nível de Saúde , Humanos , Hipertensão/diagnóstico por imagem , Hipertensão/etnologia , Japão , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Pós-Menopausa/fisiologia , Análise de Onda de Pulso , Ultrassonografia
19.
Diabetes Res Clin Pract ; 150: 57-63, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30825562

RESUMO

OBJECTIVE: Meteorin-like (Metrnl) is a novel secreted protein that has a beneficial effect on glucose homeostasis with anti-inflammatory properties. Our goal is to determine whether low serum Metrnl levels are associated with worsening of glucose tolerance, impaired endothelial function, and atherosclerosis. METHODS: This study included 260 adults, 89 of whom had normal oral glucose tolerance (nOGT), 77 with glucose tolerance impairment (GTI) and 94 with type 2 diabetes (T2DM). Insulin resistance was assessed by evaluating the homeostasis model assessment of insulin resistance (HOMA-IR). Serum Metrnl level, proinflammatory, biochemical, endothelial and atherosclerosis parameters were measured. RESULTS: Serum Metrnl levels decreased significantly in patients with T2DM versus subjects with nOGT (P < 0.001). Metrnl levels were negatively correlated with fasting blood glucose, 2-h postload glucose (2 h-PLG), fasting insulin, HOMA-IR, HbA1c, high-sensitive C-reactive protein (hs-CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), Carotid intima media thickness (CIMT), brachial-ankle pulse wave velocity (baPWV), intercellular adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1) and E-selectin. High serum Metrnl level was significantly correlated with reduced risk of T2DM as revealed by multivariate logistic regression analysis after control of potential risk factors for diabetes. Furthermore, the association remains significant after further adjustment for IL-6, TNF-α, hs-CRP, CIMT, baPWV, ICAM-1, VCAM-1 and E-selectin. CONCLUSIONS: Low Serum Metrnl may be associated with worsening of glucose tolerance, impaired endothelial function and atherosclerosis. It may also be considered a possible surrogate marker of endothelial dysfunction, and atherosclerosis and an independent risk factor of T2DM.


Assuntos
Adipocinas/sangue , Aterosclerose/sangue , Biomarcadores/sangue , Diabetes Mellitus Tipo 2/sangue , Endotélio Vascular/metabolismo , Intolerância à Glucose/sangue , Resistência à Insulina , Adulto , Idoso , Índice Tornozelo-Braço , Aterosclerose/epidemiologia , Glicemia/análise , Proteína C-Reativa/metabolismo , Espessura Intima-Media Carotídea , Estudos Transversais , Diabetes Mellitus Tipo 2/epidemiologia , Selectina E/sangue , Egito/epidemiologia , Endotélio Vascular/patologia , Feminino , Intolerância à Glucose/epidemiologia , Humanos , Molécula 1 de Adesão Intercelular/sangue , Interleucina-6/sangue , Masculino , Pessoa de Meia-Idade , Análise de Onda de Pulso , Fatores de Risco , Fator de Necrose Tumoral alfa/metabolismo , Molécula 1 de Adesão de Célula Vascular/sangue , Adulto Jovem
20.
Zhonghua Xin Xue Guan Bing Za Zhi ; 47(3): 228-234, 2019 Mar 24.
Artigo em Chinês | MEDLINE | ID: mdl-30897883

RESUMO

Objective: To investigate the association between sleep duration and brachial-ankle pulse wave velocity (baPWV). Methods: A cross-sectional study method was used to observe 38 604 employees of Kailuan Group who participated in the physical examination and the baPWV test from January 2010 to July 2018. The age was (51.6±11.1) years old. There were 72.4% (27 955/38 604) male participants. According to the sleep duration, subjects were divided into 5 groups including ≤ 5 hours group (3 762 cases),>5 hours and ≤6 hours group (9 585 cases),>6 hours and ≤7 hours group (12 604 cases), >7 hours and ≤8 hours group (11 921 cases) and >8 hours group (732 cases). Multivariate logistic regression model was used to analyze the association between sleep duration and the baPWV. Results: The age was (51.6±11.1) years old. There were 72.4% (27 955/38 604) male participants. The prevalence of baPWV≥14 m/s in ≤ 5 hours group, >5 hours and ≤6 hours group, >6 hours and ≤7 hours group, >7 hours and ≤8 hours group, and >8 hours group was 63.5% (2 389/3 762), 58.9% (5 645/9 585), 55.0% (6 926/12 604), 53.3% (6 356/11 921) and 54.8% (401/732) respectively. After adjusting for confounding factors including age, gender, smoking, drinking, physical exercise, snoring, hypertension, diabetes mellitus, dyslipidemia, body mass index≥24 kg/m(2), mean arterial pressure, heart rate, and C-reactive protein, the multivariate logistic regression analysis showed that the OR were 1.48 (95%CI 1.29-1.70, P<0.01) and 1.18 (95%CI 1.07-1.30, P<0.01) respectively for baPWV≥14 m/s in ≤ 5 hours and >5 hours and ≤6 hours group when compared with >7 hours and ≤ 8 hours group. Conclusion: Short sleep duration is associated with elevated baPWV in mid-aged Chinese population.


Assuntos
Índice Tornozelo-Braço , Análise de Onda de Pulso , Sono , Rigidez Vascular , Adulto , Pressão Sanguínea , Estudos Transversais , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Sono/fisiologia
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