Peripheral arterial disease and ankle-brachial pressure index as predictors of mortality in residents of Metlika County, Slovenia

Aim

To test how the presence of peripheral arterial disease predicted mortality of middle-aged and elderly residents of Metlika county, a rural area in southeastern Slovenia.

Methods

In 1987, we interviewed and examined a representative cohort of 646 subjects aged 45-80 years at inclusion without overt coronary or cerebrovascular disease, for cardiovascular risk factors and measured the ankle-brachial pressure index (ABPI). Peripheral arterial disease was defined as ABPI<0.90. The subjects were followed up 15 years or until death. All-cause mortality and cardiovascular mortality were assessed and compared between subjects with and without peripheral arterial disease in a multivariate model.

Results

There were 580 subjects with normal ABPI and 66 subjects with peripheral arterial disease, among which 49 were asymptomatic and 17 had intermittent claudication. Because subjects with peripheral arterial disease were on average 10 years older than those without peripheral arterial disease, the mere presence of peripheral arterial disease was not an independent predictor of mortality. However, there was a significant interaction of peripheral arterial disease with age, with a more pronounced adverse prognostic effect of peripheral arterial disease in younger than in older age groups. For a 55-year-old subject with peripheral arterial disease, the hazard ratio of dying from any cause in the follow-up period was 2.44 (95% confidence interval [CI], 1.15-4.96) in comparison to an age-matched subject without peripheral arterial disease, but at 75 years of age, the hazard ratio decreased to only 0.71 (95% CI, 0.46-1.09). For cardiovascular mortality, the hazard ratio in the presence of peripheral arterial disease was 6.05 (95% CI, 1.87-16.27) at 55 years and 0.92 (95% CI, 0.54-1.52) at 75 years. Among patients with peripheral arterial disease, each decrement of ABPI at inclusion by 0.10 significantly increased the cardiovascular mortality after 15 years by 30% (P = 0.038).

Conclusion

Peripheral arterial disease, even asymptomatic, is an important predictor of adverse cardiovascular prognosis in relatively young patients. Reduced ABPI is a strong, independent predictor of cardiovascular mortality in all patients with peripheral arterial disease.Clinical manifestation of peripheral arterial disease confirmed by reduced ankle-brachial pressure index (ABPI) ranges from the common asymptomatic disease, to the less prevalent intermittent claudication, to the relatively rare critical limb ischemia with rest pain, ulceration or gangrene (1). Even if peripheral arterial disease does not cause typical claudication, it reduces walking speed and walking endurance (2). Regardless of the clinical symptoms, reduced ABPI is a sign of hemodynamic disturbance in the arterial supply of the lower limbs, which is strongly associated with atherosclerosis in the coronary and carotid territories (3). Thus, peripheral arterial disease is associated with increased mortality due to myocardial infarction and ischemic stroke. Several studies described 2-3-fold greater mortality in patients with peripheral arterial disease in comparison with age-matched controls with normal ABPI; patients with peripheral arterial disease had a 5-year mortality of about 30% (4-9). Increasing severity of peripheral arterial disease, expressed as diminishing ABPI, progressively reduces survival (6-9).Most previously studied cohorts were either patients referred for non-invasive vascular testing (6) or patients with known risk factors such as hypertension (8) or hyperlipidemia (4). There is still little data on the prognostic value of largely asymptomatic early-stage peripheral arterial disease in patients free of overt coronary or cerebrovascular disease in a community setting. We have focused on a representative sample of residents of Metlika county, a rural area in southeastern Slovenia to test how the presence of peripheral arterial disease, defined as ABPI<0.90, and the severity of peripheral arterial disease at inclusion, expressed as diminishing ABPI, affected all-cause mortality and cardiovascular mortality in a community setting.     

The health-related quality of life of people with peripheral arterial disease in the community: the Edinburgh Artery Study.

BACKGROUND: Previous studies investigating the health-related quality of life of those with peripheral arterial disease have focused on patients recruited from hospital clinics. The health-related quality of life of people with peripheral arterial disease in the general population is unknown. AIMS: We aimed to determine the health-related quality of life of people with intermittent claudication and asymptomatic peripheral arterial disease in the general population and to compare it with those with angina and those with no peripheral arterial disease or angina.Design of study: Analysis of cross-sectional data from the 12-year follow-up of a population-based cohort. SETTING: Edinburgh, Scotland. METHOD: Data from the Edinburgh Artery Study cohort's 12-year follow-up was analysed. Participants' peripheral arterial disease status was measured using the World Health Organisation intermittent claudication questionnaire and the ankle brachial pressure index. Self-assessed health-related quality of life data was collected using the SF-36 generic questionnaire. Health-related quality of life scores were calculated and their associations with peripheral arterial disease status groups were tested. RESULTS: Subjects with intermittent claudication had significantly worse median health-related quality of life scores than patients without claudication in all domains except social functioning and mental health. Patients with claudication had a significantly lower physical component summary score than those without claudication (P 相似文献   

A rational connection of inflammation with peripheral arterial disease

Peripheral arterial disease (PAD) includes a wide range of manifestations in the lower limb, from asymptomatic to symptomatic disease ranging from intermittent claudication to critical limb ischemia, with ulcers, rest pain, or gangrene. It is manifestation of generalized atherosclerosis and this is clearly shown by the high prevalence of coexistence coronary and cerebral arterial disease in these patients. The cumulative findings on molecular and cellular biology have dramatically changed our concept of atherosclerotic disease. Recently, it has become clear that inflammation is fundamental to the process of atherosclerosis. Although the relation between inflammation and PAD is not well characterized, the emerging data demonstrated that PAD is a common manifestation of atherosclerosis that is associated with a systemic inflammation. The most important risk factors for PAD are similar to those of atherosclerotic disease elsewhere: age, male sex, diabetes mellitus, smoking, hypertension, hyperlipidemia, and hereditary factors. Serum levels of inflammatory markers, especially after exercise, have been found to be higher in patients with PAD than in controls, and associated with prognosis as well as restenosis in patients with PAD after revascularization. In the general United States adult population, inflammation is independently associated with PAD in a cross-sectional, nationally large representative sample. All of those evidences indicate that PAD is one aspect of atherosclerosis, a disease rationally connects with inflammation, which may further change our preventive and therapeutic strategies.     

Pulse wave velocity

Pulse wave velocity (PWV) reflects arterial stiffness. PWV correlates with other markers reflecting the severity of atherosclerosis such as the findings of ultrasound examination of carotid artery. In addition, several studies demonstrated that increased PWV is a predictor of future cardiovascular events in patients with either hypertension or diabetes mellitus. Thus, PWV is thought to be applicable as a marker relating with the severity of atherosclerosis and/or predicting future atherosclerotic cardiovascular events. Age and blood pressure is a major determinant of PWV, and the influence of these factors should be taken into account to use PWV as a marker of cardiovascular risk. On the other hand, while anti-hypertensive medication or statins improve PWV, it has not been fully evaluated whether these improvement reflect the improvement of prognosis. Therefore, the significance of PWV as a surrogate marker for the treatment of atherosclerotic cardiovascular risk has not been fully established. Carotid-femoral PWV is used as a conventional method. Recently, more simple method: brachial-ankle PWV is available in clinical settings. This method is simple fully enough to apply in a large population. However, brachial-ankle PWV includes peripheral component of artery in its assessment of arterial stiffness, and it has not been fully concluded that brachial-ankle PWV has a similar potential as a marker using the management of atherosclerotic cardiovascular disease as carotid-femoral PWV. Further study is proposal to evaluate the clinical significance of brachial-ankle PWC as a tool using the management of cardiovascular disease.     

The prognosis of non-critical limb ischaemia: a systematic review of population-based evidence.

BACKGROUND: Peripheral arterial occlusive disease (PAOD) is the most common peripheral vascular disorder in the elderly. A clear picture of the disease's course, especially in patients with non-critical limb ischaemia (Fontaine stages I and II), is essential for the general practitioner, who plays a key role in the diagnosis and management of PAOD. AIM: To evaluate the population-based evidence on the course and prognosis of PAOD. METHODS: An exhaustive literature search yielded 16 population-based studies on the prognosis of PAOD. The methodological qualities of the studies were assessed according to eight criteria. RESULTS: Thirteen studies of high methodological quality show that data on the course, cardiovascular morbidity, and mortality of asymptomatic PAOD are scarce. Only a small group of asymptomatic patients seem to develop intermittent claudication symptoms. However, asymptomatic patients appear to have the same increased risk for cardiovascular morbidity and mortality when compared with claudicants. No data were available on prognostic factors for intermittent claudication and cardiovascular morbidity in asymptomatic patients. The course, cardiovascular morbidity, and mortality of symptomatic PAOD are better documented. A small group of claudicants experience symptom progression. Smoking, hypertension, increasing age, and diabetes are the most relevant risk factors for intermittent claudication. Claudicants are at a higher risk for developing other cardiovascular diseases, resulting in a significantly increased mortality mainly owing to coronary heart disease. Intermittent claudication and a low ankle-brachial pressure index are significant predictors of mortality. Men had intermittent claudication and symptom progression more often than women. Cardiovascular (co-)morbidity was common in both male and female PAOD patients, but male PAOD patients had a higher mortality compared with female PAOD patients. CONCLUSION: Given the current knowledge on the prognosis of PAOD in the general population, an important task for (secondary) prevention is reserved for the general practitioner. Further research is required to document the course and prognosis of asymptomatic PAOD patients.     

Personality and social predictors of atherosclerotic progression: Edinburgh Artery Study

OBJECTIVE: The aim of this study was to determine whether personality traits and social factors predict the progression of peripheral atherosclerosis. Progression was assessed using the objective, noninvasive ankle brachial pressure index (ABPI). METHODS: In the Edinburgh Artery Study, 1592 men and women were randomly sampled from the general population, and their ABPI was measured at baseline and at the end of a 5-year follow-up period. A low ABPI suggests the presence of peripheral arterial disease. The revised Bedford-Foulds Personality Deviance Scale was administered at baseline to assess submissiveness and hostility. Data on other baseline risk factors, including physiological and social factors, were also collected. RESULTS: Change in ABPI over 5 years was negatively correlated with age in both men and women (men, r = -0.10; women, r = -0.25). In multiple linear regression models, smoking, alcohol consumption, and submissiveness together accounted for 2% of the variance in ABPI change in men; in women, only age was related to change, accounting for 6% of the variance. Well-fitting structural equation models in both sexes showed that age influenced baseline ABPI and change in ABPI; that smoking and social deprivation directly affected baseline ABPI; and that the effect of hostility, and some of the effect of social deprivation, was mediated by smoking. CONCLUSIONS: Social and personality factors were associated directly with baseline ABPI levels and indirectly with progression of atherosclerosis. Structural equation models revealed that associations among personality, social factors, and atherosclerotic progression were complex, involving mediation through other variables.     

Symptomatic peripheral arterial disease: the value of a validated questionnaire and a clinical decision rule

BACKGROUND: If a validated questionnaire, when applied to patients reporting with symptoms of intermittent claudication, could adequately discriminate between those with and without peripheral arterial disease, GPs could avoid the diagnostic measurement of the ankle brachial index. AIM: To investigate the Edinburgh Claudication Questionnaire (ECQ) in general practice and to develop a clinical decision rule based on risk factors to enable GPs to easily assess the likelihood of peripheral arterial disease. DESIGN OF STUDY: An observational study. SETTING: General practice in The Netherlands. METHOD: This observational study included patients of > or =55 years visiting their GP for symptoms suggestive of intermittent claudication or with one risk factor. The ECQ and the ankle brachial index were performed. The prevalence of peripheral arterial disease, defined as an ankle brachial index <0.9, was related to risk factors using logistic regression analyses, on which a clinical decision rule was developed and related to the presence of peripheral arterial disease. RESULTS: Of the 4790 included patients visiting their GP with symptoms suggestive of intermittent claudication, 4527 were eligible for analyses. The prevalence of peripheral arterial disease in this group was 48.3%. The sensitivity of the ECQ was only 56.2%. The prevalence of peripheral arterial disease in a clinical decision rule that included age, male sex, smoking, hypertension, hypercholesterolemia, and a positive ECQ, increased from 14% in the lowest to 76% in the highest category. CONCLUSION: This study indicates that the ECQ alone has an inadequate diagnostic value in detecting patients with peripheral arterial disease. The ankle brachial index should be performed to diagnose peripheral arterial disease in patients with complaints suggestive of intermittent claudication, although our clinical decision rule could help to differentiate between extremely high and lower prevalence of peripheral arterial disease.     

Peripheral arterial disease and its relationship to cardiovascular risk factors and coronary heart disease in newly diagnosed non-insulin-dependent diabetics

The prevalence of peripheral arterial disease and its relationship to cardiovascular risk factors was investigated in 133 patients aged 45-64 years with newly diagnosed non-insulin-dependent diabetes and in 144 randomly selected non-diabetic subjects of the same age. History of intermittent claudication, absent foot pulses, decreased ankle-arm blood pressure ratio (less than 0.9) and radiologically detectable arterial calcifications of the lower limbs were used as indicators of the presence of peripheral arterial disease. Peripheral arterial disease tended to be somewhat more common in men with newly diagnosed non-insulin-dependent diabetes than in non-diabetic men, whereas no difference was found in prevalence of peripheral arterial disease between diabetic and non-diabetic women. The association of various indicators of peripheral arterial disease with cardiovascular risk factors and coronary heart disease was low or absent.     

Association between ear creases and peripheral arterial disease

INTRODUCTION:

Peripheral arterial disease is a severe manifestation of atherosclerosis that can lead to critical ischemia of the lower limbs and is also associated with high cardiovascular risk. Diagonal lobular and anterior tragal ear creases have been associated with coronary artery disease, but they have not yet been investigated in patients with peripheral arterial disease.

OBJECTIVES:

To evaluate the prevalence of ear creases among patients with peripheral arterial disease of the lower limbs, compared with patients without documented atherosclerotic disease.

METHODS:

Cross‐sectional study including 60 male patients with peripheral arterial disease of the lower limbs and 60 dermatologic outpatients matched for age and gender. The associations were adjusted for other risk factors by conditional logistic regression.

RESULTS:

The prevalence of diagonal and anterior tragal ear creases was higher among cases (73% vs. 25% and 80% vs. 43%, respectively) than controls; these associations remained significant even when adjusting for other known risk factors of atherosclerosis (odds ratio  =  8.1 and 4.1, respectively).

CONCLUSIONS:

Ear creases are independently associated with peripheral arterial disease and may be an external marker for risk identification.     

Peripheral arterial disease in women

Peripheral arterial disease (PAD) is chronic arterial occlusive disease of the lower extremities caused by atherosclerosis whose prevalence increases with age. Only one-half of women with PAD are symptomatic. Symptomatic and asymptomatic women with PAD are at increased risk for all-cause mortality, cardiovascular mortality, and mortality from coronary artery disease. Modifiable risk factors that predispose women to PAD include active cigarette smoking, passive smoking, diabetes mellitus, hypertension, dyslipidemia, increased plasma homocysteine levels and hypothyroidism. With regard to management, women who smoke should be encouraged to quit and referred to a smoking cessation program. Hypertension, diabetes mellitus, dyslipidemia, and hypothyroidism require treatment. Statins reduce the incidence of intermittent claudication and improve exercise duration until the onset of intermittent claudication in women with PAD and hypercholesterolemia. Anti-platelet drugs such as aspirin or especially clopidogrel, angiotensin-converting enzyme inhibitors and statins should be given to all women with PAD. Beta blockers are recommended if coronary artery disease is present. Exercise rehabilitation programs and cilostazol increase exercise time until intermittent claudication develops. Chelation therapy should be avoided as it is ineffective. Indications for lower extremity percutaneous transluminal angioplasty or bypass surgery in women are (1) incapacitating claudication interfering with work or lifestyle; and (2) limb salvage in women with limb-threatening ischemia as manifested by rest pain, non-healing ulcers, and/or infection or gangrene. Future research includes investigation of mechanisms underlying why women have a higher risk of graft failure and major amputation.     

Accelerated atherosclerosis in systemic lupus erythematosus and other connective tissue diseases

Connective tissue diseases are associated with increased morbidity and mortality related to a higher rate of cardiovascular events and higher prevalence of subclinical atherosclerosis. Atherosclerosis is now considered a multifactorial process where autoimmunity and chronic inflammation play an important pathogenic role. In systemic autoimmune rheumatic diseases in general, and in systemic lupus erythematosus in particular, atherosclerosis cannot be explained by traditional cardiovascular risk factors alone. Cellular and humoral mechanisms, together with specific factors associated with the disease itself and/or its treatments, have been advocated to explain the acceleration of arterial wall organic damage in these patients. Endothelial dysfunction, carotid intima-media thickness and plaque evaluations provide accurate detection of atherosclerotic process at a preclinical stage, before appearance of clinical disease, allowing preventive measure introduction with the aim to modify the cardiovascular risk in subjects with systemic autoimmune rheumatic diseases.     

Cholesterol reduction in patients with lower limb atherosclerotic disease

Patients with peripheral arterial disease (PAD) have a 2-3 times increased risk of death and in the most severe stage, critical peripheral ischaemia, the mortality rate is around 50% within 4-5. This poor survival rate is due to concomitant coronary and cerebrovascular atherosclerotic disease. Among the major risk factors for atherosclerosis are dyslipidaemia, smoking, hypertension and diabetes. Large randomised trials have shown that dyslipidaemia is easily modifiable in both patients with and without established coronary artery disease, with significant reductions in cardiovascular morbidity and mortality. Although none of these trials directly measured peripheral vascular status, there is every indication that conclusions submitted for patients with ischaemic heart disease can be translated to patients with peripheral vascular disease. The object of this review was therefore to divulge current evidence available supporting active treatment of dyslipidaemia in patients with peripheral vascular disease.     

Peripheral arterial disease of the lower extremities

Persons with peripheral arterial disease (PAD) are at increased risk for all-cause mortality, cardiovascular mortality, and mortality from coronary artery disease. Smoking should be stopped and hypertension, dyslipidemia, diabetes mellitus, and hypothyroidism treated. Statins reduce the incidence of intermittent claudication and improve exercise duration until the onset of intermittent claudication in persons with PAD and hypercholesterolemia. The serum low-density lipoprotein cholesterol should be reduced to < 70 mg/dl. Antiplatelet drugs such as aspirin or clopidogrel, angiotensin-converting enzyme inhibitors, and statins should be given to persons with PAD. β-Blockers should be given if coronary artery disease is present. Cilostazol improves exercise time until intermittent claudication. Exercise rehabilitation programs should be used. Revascularization should be performed if indicated.     

Lipoprotein(a): risk factor for atherosclerotic vascular disease important to take into account in practice

Coronary artery disease is a leading cause of death in France. Some of its risk factors are well identified such as age, smoking, high blood pressure and dyslipidemia, but some others such as lipoprotein (a) (Lp(a)) are still under investigation. Lp(a) is an LDL-like particle to which is linked an apolipoprotein (a). The latter shows a high sequence homology with plasminogen that gives Lp(a) thrombogenic properties in addition to its atherogenic capacity. Many epidemiological studies have shown that a high plasma level of Lp(a) is a risk factor for coronary, cerebral and peripheral atherosclerosis. Out of thirteen prospective studies, ten have confirmed this result. The negative results from the three remaining studies were probably due to either the inadequate storage of the samples or the preventive drug treatment given to the patients during the studies and to the lack of standardization of Lp(a) assays. More over it has been shown that beside high plasma Lp(a) level, the presence of a low molecular weight Apo(a) isoform is also related to a higher incidence of coronary artery disease. This review of the literature clearly demonstrates the relationship between Lp(a) and atherosclerosis, and the need to measure Lp(a) in order to better evaluate the risk of atherosclerotic vascular disease especially in patients with a hyper LDLemia an early cardio- or cerebrovascular disease or a family history of atherosclerosis. Management of patients with high Lp(a) concentrations should be directed at minimizing all other risk factors for atherosclerotic disease.     

Peripheral arterial disease--natural outcome

Three hundred and twelve patients with peripheral arterial disease were followed up for 8 3/4 years or more (maximum 11 3/4 years) to assess the natural history of the disease and factors determining its outcome. Of the 312 patients, 188 (69%) died during the follow-up, 68% of the deaths having cardiovascular causes. The 10-year relative cumulative survival rate was 0.61 for males and 0.48 for females. The role of smoking as a risk factor could not be analysed without bias. In addition to known risk factors diabetes mellitus, cerebrovascular disease and coronary heart disease, the degree of peripheral arterial disease itself also proved to be a risk factor among men. The expected life lost for men with intermittent claudication was 20%, but 44.3% for men with advanced lower limb ischaemia (p less than 0.01). This difference could not be explained by the well-known association of advanced ischaemia and diabetes mellitus. The present results therefore suggest that the state of advanced ischaemia indicates larger involvement of the whole of the arterial tree and predicts fatal cardiovascular events among these patients.     

A histological investigation into the correlation of central retinal artery atherosclerosis with the systemic circulation

Current research suggests that retinal arterial changes such as arteriovenous nicking and arterial narrowing are pathologically distinct from atherosclerosis. Other studies have found a positive correlation between retinal changes and systemic atherosclerosis. However, limited recent histopathologic evidence assessing atherosclerosis in the central retinal artery exists. We investigated atherosclerosis in the central retinal artery and how it correlates to atherosclerosis in the carotid and coronary arteries. Twenty‐two cadavers (12 males, 10 females) were dissected, obtaining one orbit, one carotid artery, and one coronary artery from each. The specimens were sectioned and stained for histologic analysis by light microscopy using hematoxylin and eosin, Verhoeff's elastic, and Gomori's trichrome stains. The degree of atherosclerosis was graded from absent, or I (least severe) to VIII (most severe) based on the current American Heart Association guidelines. Atherosclerotic changes were present in the central retinal, coronary, and carotid arteries. A positive correlation was found between the central retinal artery and the carotid artery (r = 0.23, P = 0.15), the central retinal artery and the coronary artery (r = 0.31, P = 0.08), and the carotid artery and the coronary artery (r = 0.45, P = 0.02). The presence of low‐grade atherosclerosis in the central retinal artery is prevalent in a population of advanced vascular disease. However, central retinal artery atherosclerotic lesion severity is poorly correlated with disease severity in the carotid and coronary arteries. Anat Rec, 297:1430–1434, 2014. © 2014 Wiley Periodicals, Inc.     

Atherosclerosis in theHuman Common Carotid Artery. A Morphometric Study of 31 Specimens

The carotid artery bifurcation is of special interest to both the pathologist because of its frequent atherosclerotic depositions, and to the fluidmechanicist because of its complex flow properties. However, current knowledge is incomplete regarding the level and position of atherosclerotic plaques in the carotid bifurcation and their quantitative correlation with its geometry. The study presented here is intended to fill that knowledge gap and try to quantify the geometrical risk factors. During the post-mortem the arteries were excised and filled with a resin at the proper transmural pressure of 80mmHg. Thirty-one vessel casts of the carotid artery from twenty-three autopsied individuals were made. The vessel casts were used to measure several geometrical parameters. After fabrication of the vessel casts each artery was investigated according to pathomorphological procedure. An atherometric system (AS) indicating the level of atherosclerotic lesions was applied. The specimens were divided into three groups according to the level of atherosclerosis. The comparison was made between the level of wall alteration of the main branches of the carotid bifurcation (common, internal and external carotid branch), and between these three groups themselves. Further, we conducted a comparison of the averaged geometric parameters in different groups to define the correlations between atherosclerotic lesions and geometric parameters. The results show that the most advanced lesions (fibrous and severe plaques) with about 70% of all lesions were mainly found in the internal and the external carotid branches, compared with only 25% for the common carotid branch. The comparative analysis showed that a relatively high carotid sinus enlargement of >1.2 of the common carotid branch diameter is a most significant geometric risk factor among those investigated, whereas there was no correlation between branch angles and atherosclerosis. In conclusion, the quantification of atherosclerotic risk factors is very important in the investigation of atherosclerotic disease development.     

Association of abdominal obesity with atherosclerosis in type 2 diabetes mellitus (T2DM) in Korea

The aim of this study was to investigate the relationship between obesity, insulin resistance and atherosclerosis in type 2 diabetes mellitus (T2DM) patients. Total 530 patients with T2DM were included. To evaluate the severity of atherosclerosis, we measured the coronary artery calcification (CAC) score, intima-media thickness (IMT) of the common carotid artery, and the ankle-brachial pressure index (ABPI). Subjects were classified according to body mass index (BMI), a marker of general obesity, and waist-to-hip ratio (WHR), a marker of regional obesity. The insulin sensitivity index (ISI) was measured by the short insulin tolerance test. All subjects were classified into four groups, according to BMI: the under-weight group, the normal-weight (NW) group, the over-weight (OW) group, and the obese (OB) group. WHR and systolic blood pressure, triglycerides (TG), HDL-cholesterol (HDLC), free fatty acids (FFA), fibrinogen, and fasting c-peptide levels were significantly different between BMI groups. TG, HDL-C, FFA, fibrinogen and ISI were significantly different between patients with and without abdominal obesity. In the OW group as well as in the NW group, carotid IMT, ABPI and CAC score were significantly different between patients with and without abdominal obesity. This study indicates that abdominal obesity was associated with atherosclerosis in T2DM patients.     

Dopplersonographie der extracraniellen hirnversorgenden und der peripheren Arterien bei Arterioskleroserisikofaktoren und bei KHE

Summary Doppler examination of the neck and limbs of 160 patients with a predisposition to arterial vascular disease in the presence of hypertension, hyperlipoproteinaemia, cigarette smoking and diabetes mellitus, 66% of whom had a combination of two or more of these risk factors, showed in 48 cases single or combined lesions in the arteries of the neck. One patient had unilateral stenosis of the common carotid artery; 20 patients showed unilateral and seven bilateral stenosis of the internal cartid artery; nine patients had unilateral and two patients bilateral stenosis of the external cartid artery; 28 patients showed unilateral flow reduction in the vertebral artery. There was a combined lesion of two or three vessels of the neck in 12 patients. Stenotic peripheral arteries at different levels of the leg with an ankle pressure index decrease of up to 22.5% were detected in 54 patients. These peripheral arterial diseases were associated with stenotic carotid arteries in 28%. Peripheral vascular lesions were present in 40% of patients with stenotic carotid arteries. Of the 160 patients studied 67 had proven coronary heart disease; 22% of these showed stenotic carotid arteries and 29% showed stenotic peripheral arteries. Combined lesions of the coronary, carotid and peripheral arteries were found in 13%.

     

Arteriographic changes in femoropopliteal arteriosclerosis obliterans. A five-year follow-up study.

Nineteen limbs in 15 patients with atherosclerosis obliterans of the femoral artery causing intermittent claudication were studied by serial arteriography. A total of 109 arteriograms were obtained. The shortest span between the first and last arteriogram in an individual patient was five, and the longest nine years. Progression of symptoms was noted in only 2 limbs. There were 2 deaths, 1 from pulmonary disease and 1 from a cerebrovascular or cardiovascular accident. There were no amputations. Progression of atherosclerotic lesions was seen arteriographically in 14 limbs and was absent in 5. Progression was noted in the upper segment (the one subjected to full arterial pressure) in all the 14 limbs that showed progression. Only 2 limbs showed progression in the lower segment also. It was observed that in the majority of cases, the gradual progression of the atherosclerotic process centripetally from the block in the lower extremity was not dangerous to the limb because of the continuing development of collateral circulation. The suggestion is made that the segment below the block is relatively protected from atherosclerotic progression because it is not accessible to mainstream flow and pressure. It is further theorized (though not proved by these data) that when centrifugal progression occurs, it is, by virtue of its greater opportunity to cut off collateral circulation, more likely than centripetal progression to endanger the limb.