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1.
Medicine (Baltimore) ; 99(39): e22219, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32991415

RESUMO

Short stature is reportedly associated with cardiovascular disease (CVD). However, the mechanism underlying this intriguing epidemiological finding is unclear. Pulse wave velocity (PWV), a marker of vascular stiffness, is a predictor of future CVD. Therefore, PWV may be affected by height even before overt CVD occurs. Here, we investigated the association between adult height and PWV in subjects without overt CVD.A total of 1019 subjects (48 ±â€Š12 years old; 509 men, 21 with diabetes mellitus, 209 with hypertension) without overt CVD were enrolled, all of whom underwent brachial-ankle PWV (baPWV) measurements. The subjects were divided into 3 groups by height. A multiple regression model was used to estimate baPWV values among heights after the adjustment for confounders.Mean baPWV value was highest in the group with the shortest height for both sexes (both P < .001). Bivariate correlation analysis between height and baPWV showed significant correlations in men (r = -0.131, P = .003) and women (r = -0.180, P < .001). In the multiple regression analysis with adjustment for identified confounders, group height was a predictor of baPWV (P for trend = .003) in younger men (<50 years old) but not in older men, while group height was correlated with baPWV in older women (≥50 years old, P for trend = .014) but not in younger women.Height is inversely correlated with baPWV in subjects without overt CVD, especially in younger men and older women. This may explain the historical epidemiological observation of an inverse relationship between height and CVD.


Assuntos
Estatura/fisiologia , Doenças Cardiovasculares/fisiopatologia , Rigidez Vascular/fisiologia , Adulto , Fatores Etários , Índice Tornozelo-Braço , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Onda de Pulso/estatística & dados numéricos , Fatores Sexuais
2.
Medicine (Baltimore) ; 99(36): e22073, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32899076

RESUMO

To examine the relationship between self-reported sleep duration and arterial stiffness in a large Chinese population from Kailuan.From July 2010 to December 2015, a total of 17,018 participants aged 18 to 98 years were enrolled after excluding those with a history of cerebrovascular events and coronary artery disease. Participants were divided into 5 categories according to self-reported night sleep duration: ≤5.0, 6.0, 7 (ref), 8, and ≥9.0 hours. A brachial-ankle pulse wave velocity ≥1400 cm/s was considered to represent arterial stiffness. Multivariate logistic regression models were used to calculate the odds ratio (OR) and confidence interval (CI) for arterial stiffness according to the sleep duration.Using 7 hours of sleep as the reference group, the multivariable adjusted ORs (95% CI) for arterial stiffness were 1.00 (0.87-1.16), 1.00 (0.90-1.11), 1.0 (ref), 1.03 (0.93-1.14), and 1.48 (1.05-2.08) from the lowest to highest category of sleep duration, respectively. Secondary analysis showed no evidence of interactions between sleep duration and age/sex on the risk of arterial stiffness (P-interaction = .390/.198).A long night sleep duration was associated with increased arterial stiffness.


Assuntos
Sono/fisiologia , Rigidez Vascular/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Índice Tornozelo-Braço , China , Estudos Transversais , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos , Análise de Onda de Pulso , Fatores de Risco , Fatores de Tempo , Adulto Jovem
3.
Orv Hetil ; 161(33): 1382-1390, 2020 08.
Artigo em Húngaro | MEDLINE | ID: mdl-32749233

RESUMO

INTRODUCTION: The screening tool for diagnosing lower extremity arterial disease (LEAD) is the assessment of the ankle-brachial index (ABI). In patients at risk for LEAD, the purpose of screening is to avoid major adverse limb events, such as amputation. However, resting ABI can easily produce a false negative result. AIM: In light of this, our goal was to test the usefulness of an easily performed, fast and cost-effective screening method and to determine the proportion of subjects without definitive diagnoses among patients screened in general practice (with special attention to groups having negative ABI with symptoms and patients with non-compressible arteries). METHOD: 680 patients were screened from the region of Northern Hungary. We used the Edinburgh Questionnaire, recorded medical histories, major risk factors, current complaints, and medication. Physical examinations were performed, including ABI testing. RESULTS: 34% complained about lower extremity claudication; 23% had abnormal ABI values; 14% of the patients within the normal ABI range had complaints of dysbasia; 12% were in the non-compressible artery group. The ABI-negative symptomatic group's risk factor profile showed a close similarity to the clear LEAD-positive and non-compressible artery groups. CONCLUSION: The percentage of LEAD could be higher than the number of patients diagnosed by ABI screening. Nearly a quarter of the population fell into the non-compressible artery and ABI-negative symptomatic groups. When screening purposely for LEAD, these patients deserve special attention due to the insufficient selectivity and sensitivity of measurements. If there is a high clinical suspicion of LEAD in spite of normal ABI values, further assessment may be considered. Orv Hetil. 2020; 161(33): 1381-1389.


Assuntos
Artéria Braquial/fisiopatologia , Extremidade Inferior/irrigação sanguínea , Programas de Rastreamento/métodos , Doença Arterial Periférica/diagnóstico , Doenças Vasculares Periféricas/fisiopatologia , Tornozelo/irrigação sanguínea , Tornozelo/diagnóstico por imagem , Índice Tornozelo-Braço , Humanos , Hungria , Extremidade Inferior/diagnóstico por imagem
4.
PLoS One ; 15(8): e0236834, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32780748

RESUMO

PURPOSE: Pulse wave velocity (PWV), an indicator of vascular stiffness, increases with age and is increasingly recognized as an independent risk factor for cardiovascular disease (CVD). Although many mechanical and chemical factors underlie the stiffness of the elastic artery, genetic risk factors related to age-dependent increases in PWV in apparently healthy people are largely unknown. The transcription factor nuclear factor E2 (NF-E2)-related factor 2 (Nrf2), which is activated by unidirectional vascular pulsatile shear stress or oxidative stress, regulates vascular redox homeostasis. Previous reports have shown that a SNP in the NRF2 gene regulatory region (-617C>A; hereafter called SNP-617) affects NRF2 gene expression such that the minor A allele confers lower gene expression compared to the C allele, and it is associated with various diseases, including CVD. We aimed to investigate whether SNP-617 affects vascular stiffness with aging in apparently healthy people. METHODS: Analyzing wide-ranging data obtained from a public health survey performed in Japan, we evaluated whether SNP-617 affected brachial-ankle PWV (baPWV) in never-smoking healthy subjects (n = 642). We also evaluated the effects of SNP-617 on other cardiovascular and blood test measurements. RESULTS: We have shown that not only AA carriers (n = 55) but also CA carriers (n = 247) show arterial stiffness compared to CC carriers (n = 340). Furthermore, SNP-617 also affected blood pressure indexes such as systolic blood pressure and mean arterial pressure but not the ankle brachial pressure index, an indicator of atherosclerosis. Multivariate analysis showed that SNP-617 accelerates the incremental ratio of baPWV with age. CONCLUSIONS: This study is the first to show that SNP-617 affects the age-dependent increase in vascular stiffness. Our results indicate that low NRF2 activity induces premature vascular aging and could be targeted for the prevention of cardiovascular diseases associated with aging.


Assuntos
Envelhecimento , Fator 2 Relacionado a NF-E2/genética , Rigidez Vascular/fisiologia , Adulto , Alelos , Índice Tornozelo-Braço , Aterosclerose/genética , Aterosclerose/patologia , Pressão Sanguínea , Frequência do Gene , Genótipo , Inquéritos Epidemiológicos , Humanos , Pessoa de Meia-Idade , Análise Multivariada , Polimorfismo de Nucleotídeo Único , Regiões Promotoras Genéticas , Análise de Onda de Pulso , Fumar
5.
Eur J Vasc Endovasc Surg ; 60(3): 462-468, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32763120

RESUMO

OBJECTIVE: Ankle brachial index (ABI) is widely used for the diagnosis of lower extremity artery disease (LEAD). The purpose of this prospective study was to validate the diagnostic ability and reproducibility of a four cuff automated oscillometric device vs. the Doppler method. METHODS: Patients with suspected LEAD or asymptomatic individuals at risk because of the presence two or more cardiovascular risk factors were enrolled. For each patient, Doppler and oscillometric ABI measurements were repeated by two observers to address intra- and interobserver reproducibility. RESULTS: In total, 118 patients were evaluated. The prevalence of Doppler ABI (Dop-ABI) ≤ 0.90 was 45.8%. Taking the Dop-ABI as the reference, the sensitivity, specificity, accuracy, positive and negative predictive values of oscillometric ABI (Osc-ABI) during the first measurement by the first observer were 89.1%, 94.4%, 94.1%, 91.8%, and 92.4%, respectively. The concordance for diagnosing ABI ≤0.90 between methods was excellent (kappa coefficients ranging from 0.80 to 0.88 with different observers). Intra-observer reproducibility assessed by intraclass correlation coefficient (ICC) between methods were 0.94 for observer 1 and 0.96 for observer 2. The intra-observer reproducibility using the same method was also excellent (ICC 0.94, 95% confidence interval [CI] 0.91-0.95) for Dop-ABI and 0.95 (95% CI 0.93-0.97) for Osc-ABI). The ICC for interobserver reproducibility using the same method was 0.95 (95% CI 0.92-0.96) for Dop-ABI and 0.96 (95% CI 0.94-0.97) for Osc-ABI. CONCLUSION: This study validates the excellent diagnostic performances of a four cuff oscillometric device specifically designed for screening for LEAD. The simple measurement method could therefore be advocated in primary care where fast, easy, and reliable methods are suitable.


Assuntos
Índice Tornozelo-Braço/instrumentação , Extremidade Inferior/irrigação sanguínea , Oscilometria/instrumentação , Doença Arterial Periférica/diagnóstico , Ultrassonografia Doppler , Idoso , Idoso de 80 Anos ou mais , Desenho de Equipamento , Feminino , França , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Doença Arterial Periférica/diagnóstico por imagem , Doença Arterial Periférica/fisiopatologia , Valor Preditivo dos Testes , Estudos Prospectivos , Reprodutibilidade dos Testes
6.
Diab Vasc Dis Res ; 17(7): 1479164120945910, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32746630

RESUMO

BACKGROUND: The effect of interarm blood pressure difference on the development of diabetic retinopathy, proteinuria and chronic kidney disease remains unknown. We investigated to determine the impact of interarm blood pressure difference on the prevalence of diabetic retinopathy, proteinuria and chronic kidney disease in patients with type 2 diabetes. METHODS: The study included 563 patients with diabetes, who were evaluated with a simultaneous bilateral blood pressure measurement. The cutoff values for interarm blood pressure difference were 5, 10 and 15 mmHg. Logistic regression analysis was used to explore the relation between interarm blood pressure difference and diabetic retinopathy, proteinuria and chronic kidney disease. RESULTS: Diabetic patients with systolic interarm blood pressure difference ⩾5, ⩾10 and ⩾15 mmHg showed an increased risk of diabetic retinopathy [adjusted odds ratio = 1.48 (95% confidence interval = 1.01-2.18), odds ratio = 1.80 (95% confidence interval = 0.99-3.22), odds ratio = 2.29 (95% confidence interval = 1.00-5.23)] after adjustment. There were significant associations between interarm blood pressure difference ⩾5 and ⩾10 mmHg and proteinuria [odds ratio = 1.68 (95% confidence interval = 1.15-2.44), 1.89 (95% confidence interval = 1.05-3.37)]. CONCLUSION: The association between interarm blood pressure difference and the presence of diabetic retinopathy emerged even for systolic interarm blood pressure difference ⩾5 mmHg without interaction of systolic blood pressure. Systolic interarm blood pressure difference should be considered a surrogate marker for vascular complication in patients with type 2 diabetes.


Assuntos
Pressão Sanguínea , Diabetes Mellitus Tipo 2/fisiopatologia , Retinopatia Diabética/fisiopatologia , Extremidade Superior/irrigação sanguínea , Idoso , Índice Tornozelo-Braço , Estudos Transversais , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiologia , Nefropatias Diabéticas/diagnóstico , Nefropatias Diabéticas/epidemiologia , Nefropatias Diabéticas/fisiopatologia , Retinopatia Diabética/diagnóstico , Retinopatia Diabética/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Prevalência , Proteinúria/diagnóstico , Proteinúria/epidemiologia , Proteinúria/fisiopatologia , Insuficiência Renal Crônica/diagnóstico , Insuficiência Renal Crônica/epidemiologia , Insuficiência Renal Crônica/fisiopatologia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Seul/epidemiologia
7.
Int Heart J ; 61(4): 727-733, 2020 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-32684599

RESUMO

Despite witnessing an upsurge in heart valve diseases (HVDs), the correlation between HVDs and atherosclerotic peripheral arterial obstructive disease (PAOD) remains unclear. This study aims to investigate the prevalence and predictors of PAOD in HVDs.In this study, a total of 245 consecutive patients were examined: 153 with severe aortic valve stenosis (AS), 66 with severe primary mitral valve regurgitation (MR), and 26 with severe pure native aortic valve regurgitation (AR). All patients underwent ultrasound scan of the carotid artery to ascertain the presence of internal carotid artery stenosis (ICAS). ICAS was defined as a peak systolic velocity ≥ 125 cm/second and/or ≥ 50% reduction in diameter. In addition, we measured the ankle-brachial index in each leg using a volume plethysmograph. A result of ≤ 0.9 was considered lower extremity artery disease (LEAD).The presence of ICAS was statistically more frequent in patients with severe AS than in patients with severe MR and AR (11.1% versus 1.5% versus 3.8%; P = 0.038). LEAD was present in patients with severe AS (17.6%) and MR (10.6%) but not in patients with severe AR (P = 0.037). The multivariate analysis revealed that the presence of severe AS (OR, 5.6 [1.3-24.9]; P = 0.023) was an independent predictor for ICAS, while history of coronary artery disease (OR, 4.8 [2.2-10.5]; P < 0.001) was an independent predictor for LEAD.The prevalence of PAOD varies depending on each valvular disease. Individual screening should be considered on the basis of atherosclerotic risk factors, especially for patients with severe AS.


Assuntos
Estenose das Carótidas/complicações , Doenças das Valvas Cardíacas/complicações , Doença Arterial Periférica/complicações , Idoso , Idoso de 80 Anos ou mais , Índice Tornozelo-Braço , Estenose das Carótidas/diagnóstico por imagem , Feminino , Humanos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/epidemiologia , Prevalência , Estudos Retrospectivos , Ultrassonografia
8.
Surg Clin North Am ; 100(4): 807-822, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32681878

RESUMO

Peripheral arterial disease (PAD) affects many individuals worldwide and is associated with increased morbidity and mortality. Controversy exists on whether or not to screen asymptomatic patients. Further complicating this is that many patients with a chronic lower extremity wound are often asymptomatic. PAD and traditional noninvasive vascular studies may be inaccurate in providing a correct diagnosis. A review of current and novel vascular assessment modalities along with their benefits and limitations are presented here. A combination of these vascular assessments may help improve accuracy in diagnosis, providing timely care to those patients in need.


Assuntos
Perna (Membro)/irrigação sanguínea , Doença Arterial Periférica/fisiopatologia , Índice Tornozelo-Braço , Monitorização Transcutânea dos Gases Sanguíneos/métodos , Pressão Sanguínea/fisiologia , Determinação da Pressão Arterial/métodos , Humanos , Pele/irrigação sanguínea , Dermatopatias Vasculares/fisiopatologia , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Sístole/fisiologia , Cicatrização/fisiologia
9.
Rev Med Chil ; 148(4): 496-499, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32730458

RESUMO

Background The ambulatory arterial stiffness index (AASI), derived from 24 h ambulatory blood pressure monitoring (ABPM) can be a good indicator of arterial stiffness. Aim To assess the correlation between AASI and brachial-ankle pulse wave velocity (baPWV), ankle-brachial index (ABI) and cardio-ankle vascular index (CAVI) in patients with type 2 diabetes mellitus without hypertension. Material and Methods Cross sectional study in 28 diabetic patients aged 49 ± 7 years (40% women). AASI was calculated as 1 minus the regression slope of diastolic on systolic blood pressure, using ABPM data. ABPM was measured in the arm using an oscillometric device. ABI was calculated as the ratio between ankle and brachial systolic blood pressure. CAVI was derived from pulse wave velocity using the Vasera VS-1000 device. Correlations were calculated using a bivariate Spearman correlation. Results The mean values for AASI, ABI, baPWV and CAVI were 0.39 ± 0.14, 1.14 ± 0.09, 15.15 ± 2.71 m/s and 7.60 ± 1.90, respectively. There was a significant negative correlation between AASI and ABI (r = -0.491, p < 0.01). Conclusions In these diabetic patients, there was an association between AASI, an arterial stiffness marker and ABI, an indicator for the presence of atherosclerosis.


Assuntos
Tornozelo/irrigação sanguínea , Artérias/fisiopatologia , Pressão Sanguínea/fisiologia , Artéria Braquial/fisiopatologia , Diabetes Mellitus Tipo 2/complicações , Rigidez Vascular/fisiologia , Adulto , Idoso , Índice Tornozelo-Braço , Monitorização Ambulatorial da Pressão Arterial , Artérias Carótidas/diagnóstico por imagem , Estudos Transversais , Diabetes Mellitus Tipo 2/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Análise de Onda de Pulso
10.
J Assoc Physicians India ; 68(4): 53-55, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32610847

RESUMO

Background: Lower extremity arterial disease is common disorder affecting large number of peoples and is frequently asymptomatic. Currently ABI is used as screening test for LEAD, which is time consuming and requires special instrument for measurement. We compare the role of pulse oximetry, ABI and its combination in diagnosis of LEAD. Methods: Total 224 patients (448 limbs) were enrolled in the study. Complete history, examination was done. Pulse oximetry of all limbs and ABI of both lower limbs were measured. CT angiography and pulse Doppler was done to diagnose LEAD. Results: Pulse oximetry was found to have sensitivity of 60.5%, specificity of 95.9% positive likelihood ratio 14.93 and negative likelihood ratio 0.41. ABI was found to have sensitivity of 69.7%, specificity of 97.3%, positive likelihood ratio 25.8 and negative likelihood ratio 0.32. But when both are combined, sensitivity increases to 84.2%, specificity decreases to 91.9%, positive likelihood ratio decreases to 10.39 and negative likelihood ratio decreases to 0.17. Conclusion: Our study suggests that pulse oximetry is simple and non-invasive test that provides quick result which is at least as accurate as ABI and thus is an easy alternative/ additional method for the screening of LEAD. However when used in combination with ABI the sensitivity for the detection of LEAD increases.


Assuntos
Doença da Artéria Coronariana , Doença Arterial Periférica , Índice Tornozelo-Braço , Artérias , Artéria Braquial , Humanos , Extremidade Inferior , Oximetria
11.
Health Qual Life Outcomes ; 18(1): 235, 2020 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-32680523

RESUMO

BACKGROUND: VascuQoL-6 (VQ-6) is a disease-specific quality of life (QoL) instrument validated for use in clinical practice and vascular registries before and after treatment for peripheral arterial disease (PAD). To improve future interpretation of self-reported outcome, an unselected cohort was followed through one year to provide observational data after both conservative and invasive treatment. METHODS: Consecutive patients with intermittent claudication (IC) or critical limb ischemia (CLI) were included. All patients completed VQ-6 and Short Form-36 (SF-36), and were evaluated with ankle-brachial index (ABI) measurement pre- and post-exercise, a constant load treadmill test and clinical consultation at baseline and after one year. Change statistics and correlation analysis were used to describe self-reported outcome after conservative and invasive treatment for PAD. RESULTS: One hundred seventy-one patients with peripheral arterial disease (PAD) were included, 70 (41%) female. 147 (86%) of the patients suffered from IC. 136 (80%) patients had one-year follow up, death, amputation and withdrawal were the major causes of loss to follow-up. Forty-eight patients (35%) evaluated their health to be unchanged compared to one year ago. There was a strong correlation between self-reported general health status based on SF-36 item 2 and VQ-6 summary score (Spearmans rho = - 0.536). Patients admitted to invasive intervention (endovascular or surgery) improved in all domains of SF-36, and in the physical component summary score (SF-36 PCS). Patients admitted to best medical treatment, smoking cessation and walking exercise (conservative group) improved only in the physical domains. There was significant improvement in VQ-6 summary score for both groups, mean 2.20 (95%CI 1.14-3.27) in the conservative group, 4.68 (95%CI 3.67-5.70) in the invasive group. VQ-6 sum score improved more than four points for 56% in the invasive group, 36% in the conservative group. CONCLUSIONS: Treatment for symptomatic PAD, both invasive and conservative, improves self-reported health status and disease specific QoL after one year. Interpretation of patient-reported outcome measured with VQ-6 after surgery or endovascular treatment must be seen in light of the improvement from conservative treatment alone. TRIAL REGISTRATION: ISRCTN14846962 (retrospectively registered).


Assuntos
Nível de Saúde , Medidas de Resultados Relatados pelo Paciente , Doença Arterial Periférica/terapia , Qualidade de Vida , Idoso , Idoso de 80 Anos ou mais , Índice Tornozelo-Braço , Tratamento Conservador , Terapia por Exercício , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/psicologia
12.
Vasc Endovascular Surg ; 54(7): 605-611, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32691691

RESUMO

We evaluated the outcome of multimodal supervised exercise training (SET) on walking performances and different hemodynamic parameters (ankle/toe-brachial index [ABI/TBI], and transcutaneous oxygen pressure [TcPO2]) in patients with symptomatic lower extremity peripheral artery disease (PAD). Whether hemodynamic parameters predict walking performances at baseline and following SET was also investigated. Fontaine stage II PAD's patients following a 3-month SET were retrospectively included. Hemodynamic parameters and walking performances (pain-free [PFWD], maximal [MWD], and 6-minute [6MWD] walking distance) were measured in each patient. Eighty-five symptomatic PAD patients were included. Following SET, PFWD, MWD, and 6MWD significantly increased (+142%, +94%, +14%; respectively; P ≤ .001). Toe-brachial index significantly increased (MD: 0.04 ± 0.01; P = .02), whereas ABI and TcPO2 did not change significantly. At baseline, patients with higher TBI and TcPO2 performed significantly better (PFWD: ß = 0.25, P = .01 for TBI; PFWD: ß = 0.30, P = .005, and MWD: ß = 0.22, P = .04, for TcPO2). No significant relationship was observed at baseline between ABI and walking performances. Baseline values of hemodynamic parameters did not significantly correlate with changes in walking performances. Multimodal SET significantly improves walking performances. Following SET, no significant changes in ABI and TcPO2 were observed. Toe-brachial index values significantly improved after SET. However, this increase was very modest and its clinical relevance remains questionable. Although baseline TBI and supine TcPO2 values predict baseline walking performances, no association was found between baseline hemodynamic parameters and changes in walking performances following SET.


Assuntos
Terapia por Exercício/métodos , Tolerância ao Exercício , Hemodinâmica , Claudicação Intermitente/terapia , Extremidade Inferior/irrigação sanguínea , Doença Arterial Periférica/terapia , Caminhada , Idoso , Índice Tornozelo-Braço , Monitorização Transcutânea dos Gases Sanguíneos , Feminino , Humanos , Claudicação Intermitente/diagnóstico , Claudicação Intermitente/fisiopatologia , Masculino , Pessoa de Meia-Idade , Força Muscular , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/fisiopatologia , Recuperação de Função Fisiológica , Treinamento de Resistência , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Teste de Caminhada
13.
Medicine (Baltimore) ; 99(27): e21140, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629750

RESUMO

INTRODUCTION: Treating blood stasis is effective in treating obesity and metabolic diseases in traditional Korean medicine. The aim of this prospective observational study is to determine the effectiveness of the diagnosis index for metabolic diseases with blood stasis by analyzing clinical data and blood samples. METHODS AND ANALYSIS: We will perform a prospective observational study. Participants who meet the inclusion criteria will be recruited from the Dongguk university Ilsan Oriental hospital. The outcomes are resistin, serum amyloid P component, C-reactive protein, D-dimer, and blood stasis scores. In addition, the blood pressure, ankle-brachial pressure index, brachial-ankle pulse wave velocity, body mass index, waist circumference, and levels of blood lipid will be assessed. DISCUSSION: Through this study, we could collect specific data for diagnosing metabolic diseases with blood stasis. Therefore, the findings of this study will provide a summary of the current state of evidence regarding the effectiveness of the diagnosis index in managing metabolic disease with blood stasis. ETHICS AND DISSEMINATION: The study was approved by the Institutional Review Board of the Dongguk University Ilsan Oriental Hospital (DUIOH-2018-09-001-007). The results will be published in a peer-reviewed journal and will be disseminated electronically and in print. TRIAL REGISTRATION NUMBER: Clinical Research Information Service: KCT0003548.


Assuntos
Medicina Tradicional Coreana/métodos , Doenças Metabólicas/diagnóstico , Doenças Metabólicas/terapia , Língua/irrigação sanguínea , Adulto , Idoso , Índice Tornozelo-Braço/métodos , Pressão Sanguínea/fisiologia , Índice de Massa Corporal , Feminino , Humanos , Lipídeos/sangue , Masculino , Doenças Metabólicas/complicações , Doenças Metabólicas/metabolismo , Pessoa de Meia-Idade , Estudos Prospectivos , Análise de Onda de Pulso/métodos , República da Coreia/epidemiologia , Língua/patologia , Circunferência da Cintura/fisiologia
14.
Clín. investig. arterioscler. (Ed. impr.) ; 32(3): 94-100, mayo-jun. 2020. tab, graf, ilus
Artigo em Inglês | IBECS | ID: ibc-193353

RESUMO

OBJECTIVES: To estimate the prevalence of an inter-arm blood pressure difference greater than 10mmHg in patients with type 2 diabetes, and the association of this measurement with the presence of a low ankle-brachial index and mortality at 5-year follow-up. METHOD: A validated blood pressure measurement protocol was used. The blood pressure was calculated for each arm to obtain mean systolic differences. Peripheral arterial disease was confirmed by an ankle-arm index less than 0.9. The medical history of the patient was reviewed in the computerized clinical notes after 5 years of follow-up. RESULTS: The study included 139 patients with a mean age of 70.1 years (49% male), and a mean duration of diabetes mellitus of 10.8 years. A total of 50 (36%) patients had an inter-arm systolic blood pressure difference greater than 10mmHg. Patients with an inter-arm systolic blood pressure greater than 10 mmHg had lower ankle-arm index (0.91 ± 0.30 vs. 1.04 ± 0.28, P = 0.005), and higher mortality rates from all causes (48.0% vs. 28.9%; hazard ratio 1.64; 95% confidence interval: 1.06-2.53; P = 0.03), compared with those with lower inter-arm systolic blood pressure difference. CONCLUSION: A high proportion of patients with type 2 diabetes have an elevated systolic blood pressure difference between arms. A significant relationship was found between elevated inter-arm systolic blood pressure difference, lower ankle-brachial index and greater all-cause mortality


OBJETIVOS: Estimar la prevalencia de una diferencia de presión arterial entre brazos superior a 10mmHg en pacientes con diabetes tipo 2, y su asociación con el índice tobillo-brazo y la mortalidad a los 5 años de seguimiento. MÉTODO: Se utilizó un protocolo validado de medición de presión arterial. La presión sanguínea se calculó para cada brazo para obtener diferencias sistólicas medias. La enfermedad arterial periférica fue confirmada por un índice tobillo-brazo inferior a 0,9. El estado vital del paciente se revisó en la historia clínica electrónica a los 5 años de seguimiento. RESULTADOS: Estudiamos a 139 pacientes con una edad media de 70,1 años (49% hombres) y una duración media de diabetes mellitus de 10,8 años. Un total de 50 (36%) pacientes tenía una diferencia de presión arterial sistólica entre brazos mayor de 10 mmHg. Los pacientes con diferencia elevada de presión arterial sistólica entre los brazos mostraron un menor índice tobillo-brazo (0,91 ± 0,30 vs. 1,04 ± 0,28; P = 0,005), y una mayor tasa de mortalidad por todas las causas (48,0% vs. 28,9%; cociente de riesgo 1,64; intervalo de confianza al 95%: 1,06-2,53; P = 0,03), respecto a los pacientes con menores diferencias de presión sistólica entre brazos. CONCLUSIÓN: Encontramos una alta proporción de pacientes con diabetes tipo 2 que tenían una diferencia elevada de presión arterial sistólica entre los brazos. Existe una asociación significativa entre la diferencia elevada de la presión arterial sistólica entre brazos, el índice tobillo-brazo y mortalidad


Assuntos
Humanos , Masculino , Idoso , Idoso de 80 Anos ou mais , Pressão Sanguínea/fisiologia , Braço/irrigação sanguínea , Índice Tornozelo-Braço/métodos , Diabetes Mellitus/mortalidade , Protocolos Clínicos , Pressão Arterial/fisiologia , Intervalos de Confiança , Análise de Variância
15.
Rev Assoc Med Bras (1992) ; 66(4): 407-413, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32578771

RESUMO

OBJECTIVE: Analyzing the association between ABI and the main risk factors for coronary artery disease in coronary patients. METHODS: Were selected 156 adult patients from a hospital in Maceió, Alagoas. Were evaluated with risk factors age, obesity, hypertension, diabetes mellitus, smoking, and dyslipidemia. PAOD screening was performed by the ankle-brachial index (ABI). The Mann-Whitney, chi-square, and Fisher's exact tests were used. Confidence Interval of 95% and a significance of 5%. RESULTS: 67.3% (n=105) males, 52.6% (n=82) elderly, 23.1% (n = 34) obese, 72.4% 6% (n=113) hypertensive, 34.6% (n=54) diabetics, 53.2% (n=83) smokers, 34.6% (n=54) dyslipidemic and 70.5% (n=110) with a family history of CAD. 16.7% (n=26) of the individuals presented PAOD. Three factors were associated with PAOD: age group ≥ 60 years (OR:3.656; p=0.005), diabetes mellitus (OR:2.625; p=0.024) and hypertension (OR:5.528; p=0.008). No significant difference was observed in the variables smoking, dyslipidemia, family history of CAD, and obesity. CONCLUSION: The independent risk factors for PAOD were age, diabetes mellitus, and systemic arterial hypertension.


Assuntos
Índice Tornozelo-Braço , Doença da Artéria Coronariana , Adulto , Idoso , Diabetes Mellitus , Humanos , Hipertensão , Masculino , Fatores de Risco
16.
Beijing Da Xue Xue Bao Yi Xue Ban ; 52(3): 514-520, 2020 Jun 18.
Artigo em Chinês | MEDLINE | ID: mdl-32541986

RESUMO

OBJECTIVE: To explore the predictive value of carotid femoral artery pulse wave velocity (CF-PWV), carotid radial artery pulse wave velocity (CR-PWV), cardio-ankle vascular index (CAVI), and ankle brachial index (ABI) on coronary heart disease (CHD) and cerebral infarction (CI), and the preliminary validation of Beijing vascular health stratification (BVHS). METHODS: Subjects with at least 2 in-patient records were included into the study between 2010 and 2017 from Vascular Medicine Center of Peking University Shougang Hospital. Subjects with CHD or CI, and without data of vascular function at baseline were excluded. Eventually, 467 subjects free of CHD [cohort 1, mean age: (63.4±12.3) years, female 42.2%] and 658 subjects free of CI [cohort 2, mean age: (64.3±12.2) years, female 48.7%] at baseline were included. The first in-patient records were as the baseline data, the second in-patient records were as a following-up data. Cox proportional hazard regression was used to establish the predictive models of CHD or CI derived from BVHS by multivariable-adjusted analysis. RESULTS: The median follow-up time of cohort 1 and cohort 2 was 1.9 years and 2.1 years, respectively. During the follow-up, 164 first CHD events occurred in cohort 1 and 117 first CI events occurred in cohort 2. Four indicators were assessed as continuous variables simultaneously by multivariable-adjusted analysis. In cohort 1, CF-PWV, CR-PWV, ABI, and CAVI reached statistical significance in the multivariable-adjusted models (P<0.05). In cohort 2, only CAVI (P<0.05) was of statistical significance. In addition, the higher CF-PWV became a protector of CHD or CI (P<0.05). The prediction value of BVHS reached the statistical significance for CHD and CI in the unadjusted models (all P<0.05), however, BVHS could only predict the incidence of CHD (P<0.05), but not the incidence of CI (P>0.05) in the multivariable-adjusted models. CF-PWV, CR-PWV, ABI, and CAVI were associated factors of CHD independent of each other (P<0.05), only CAVI (P<0.05) was the risk factor of CI independent of the other three. CONCLUSION: The different vascular indicators might have different effect on CHD or CI. CAVI might be a stable predictor of both CHD and CI. Higher baseline CF-PWV was not necessarily a risk factor of CHD or CI because of proper vascular health management. BVHS was a potential factor for the prediction of CHD, and further research is needed to explore the prediction value for CI.


Assuntos
Análise de Onda de Pulso , Rigidez Vascular , Idoso , Índice Tornozelo-Braço , Artérias Carótidas , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
17.
Rev Assoc Med Bras (1992) ; 66(3): 268-274, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32520144

RESUMO

OBJECTIVE: To investigate the association between low serum vitamin D levels and peripheral arterial disease (PAD). METHODS: A cross-sectional study with a consecutive sample of 133 individuals from Caxias do Sul, Brasil. We considered PAD patients those with an ankle-brachial index (ABI) ≤ 0.90 or with arterial revascularization. Vitamin D serum level was categorized as sufficient (≥30 ng/mL), insufficient (>20 to 29 ng/mL), and deficient (<20 ng/mL). Prevalence ratios (RP) were calculated through Poisson regression. RESULTS: The prevalence of PAD was 50.7% (95% CI 42-59). After adjustment for potential PAD risk factors, RP were 1.08 (95% CI 0.66-1.76) for insufficient serum level and 1.57 (95% CI 0.96-2.57) for deficient vitamin D serum level; (p for trend = 0.020). CONCLUSION: Vitamin D serum levels showed an inverse and significant dose-response relationship with PAD.


Assuntos
Doença Arterial Periférica/sangue , Doença Arterial Periférica/etiologia , Deficiência de Vitamina D/complicações , Vitamina D/sangue , Adulto , Índice Tornozelo-Braço , Brasil/epidemiologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doença Arterial Periférica/epidemiologia , Prevalência , Fatores de Risco , Vitamina D/uso terapêutico , Deficiência de Vitamina D/sangue
19.
Diab Vasc Dis Res ; 17(3): 1479164120928868, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32538155

RESUMO

PURPOSE OF STUDY: To investigate toe systolic blood pressure and/or toe-brachial pressure index in predicting healing post minor diabetic foot amputations. KEY METHODS: A systematic search of EMBASE and PubMed (including Medline and The Cochrane Library) was conducted from database inception to 9 March 2020. Two authors independently reviewed and selected relevant studies. Quality was assessed with a modified Critical Appraisal Skill Programme checklist. MAIN RESULTS: Ten studies met the inclusion criteria. Nine studies investigating toe systolic blood pressure reported healing occurred at mean toe systolic blood pressure values ⩾30 mmHg, ranging between 30 and 83.6 mmHg. The meta-analysis (four studies) found toe systolic blood pressure <30 mmHg had 2.09 times the relative risk of non-healing post amputation, compared to toe systolic blood pressure ⩾30 mmHg (relative risk = 2.09, 95% confidence interval: 1.37-3.20, p = 0.001). Two studies investigating toe-brachial pressure index report successful healing where toe-brachial pressure index >0.2, with one study reporting a higher value of 0.8. MAIN CONCLUSIONS: Successful post-amputation healing outcomes were reported at mean toe systolic blood pressure ⩾30 mmHg, and the results varied considerably between the studies. Further research should identify whether variables, including amputation level, method of wound closure and length of post-operative follow-up periods, affect the values of toe systolic blood pressure and toe-brachial pressure index observed in this review.


Assuntos
Amputação , Índice Tornozelo-Braço , Pressão Sanguínea , Pé Diabético/cirurgia , Dedos do Pé/irrigação sanguínea , Dedos do Pé/cirurgia , Cicatrização , Idoso , Idoso de 80 Anos ou mais , Amputação/efeitos adversos , Pé Diabético/diagnóstico , Pé Diabético/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Fluxo Sanguíneo Regional , Fatores de Risco , Resultado do Tratamento
20.
Vasc Med ; 25(2): 118-123, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32366205

RESUMO

Disturbed wound healing (DWH) following elective foot and ankle surgery is associated with a number of known risk factors. The purpose of this study was to determine if peripheral artery disease (PAD) is a potential risk factor that contributes to an increase in postoperative DWH. In a case-control study, we analyzed all patients undergoing elective foot and ankle surgery between January 1, 2014 and December 31, 2017 at two institutions and identified 51 patients with postoperative DWH. After matching with 51 control patients without DWH, all 102 patients were evaluated for PAD. The prevalence of PAD was significantly higher in the DWH group compared to the control group (41.2% vs 19.6%, p < 0.01). This difference was even more distinctive for patients with any abnormal ankle-brachial index (ABI) (51.0% vs 19.6%, p < 0.001). After adjustment for diabetes, hypertension, hypercholesterolemia, and smoking, any abnormal ABI or a history of PAD remained an independent risk factor for DWH (odds ratio 3.28; 95% CI 1.24-8.71). In this dual-center study, postoperative DWH was associated with significantly higher rates of PAD. These findings suggest that preoperative evaluation for PAD could be a helpful tool to identify patients at high risk for postoperative wound complications undergoing foot and ankle surgery. This trial is registered with drks.de, number DRKS00012580.


Assuntos
Índice Tornozelo-Braço , Tornozelo/cirurgia , Pé/cirurgia , Doenças Musculoesqueléticas/cirurgia , Procedimentos Ortopédicos/efeitos adversos , Doença Arterial Periférica/epidemiologia , Cicatrização , Idoso , Procedimentos Cirúrgicos Eletivos , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/diagnóstico , Doenças Musculoesqueléticas/epidemiologia , Doença Arterial Periférica/diagnóstico , Prevalência , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
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