Humans ; Peripheral Arterial Disease/epidemiology*

INTRODUCTION: Identifying peripheral arterial disease (PAD) during diabetic foot screening (DFS) is crucial in reducing the risk of diabetic foot ulcerations and lower limb amputations. Screening assessments commonly used include absolute systolic toe pressure (ASTP) and toe-brachial index (TBI). There is a lack of research defining the threshold values of both assessment methods. We aimed to compare the accuracy of ASTP and TBI and establish optimal threshold values of ASTP and TBI with reference to the internationally accepted ankle-brachial pressure index (ABPI) screening test, for a multiethnic diabetic population in Singapore. METHODS: A retrospective, observational study of DFS results from January 2017 to December 2017 was conducted. Receiver operating characteristic analysis was conducted for ASTP and TBI using the internationally accepted ABPI cut-off value of ≤0.9 to indicate PAD. RESULTS: A total of 1,454 patients with mean (standard deviation) age of 63.1 (12.4) years old were included. There were 50.8% men and 49.2% women, comprising 69.7% Chinese, 13.5% Indian, 10.1% Malay and 6.7% other ethnicities. Areas under the curve for ASTP and TBI were 0.89 (95% confidence interval [Cl] 0.85-0.94) and 0.94 (95% Cl 0.90-0.98), respectively, and the difference was statistically significant (P<0.001). Derived optimal threshold values to indicate ABPI≤0.9 for ASTP and TBI were <95.5mmHg (specificity 0.86, sensitivity 0.84) and <0.7 (specificity 0.89, sensitivity 0.95), respectively. CONCLUSION ASTP or TBI may be used to detect ABPI-determined PAD in DFS. The optimal threshold values derived from a multiethnic Asian diabetic population were <95.5mmHg for ASTP and <0.7 for TBI.
Ankle Brachial Index/methods* ; Diabetes Mellitus/epidemiology* ; Diabetic Foot/diagnosis* ; Female ; Humans ; Male ; Middle Aged ; Peripheral Arterial Disease/diagnosis* ; Retrospective Studies ; Toes

Objective: Liver fibrosis is an important predictor of mortality in nonalcoholic fatty liver disease (NAFLD). Peripheral artery disease (PAD) and liver fibrosis share many common metabolic dysfunctions. We aimed to explore the association between PAD and risk of fibrosis deterioration in NAFLD patients. Methods: The study recruited 1,610 NAFLD patients aged ≥ 40 years from a well-defined community at baseline in 2010 and followed up between August 2014 and May 2015. Fibrosis deterioration was defined as the NAFLD fibrosis score (NFS) status increased to a higher category at the follow-up visit. PAD was defined as an ankle-brachial index of < 0.90 or > 1.40. Results: During an average of 4.3 years' follow-up, 618 patients progressed to a higher NFS category. PAD was associated with 92% increased risk of fibrosis deterioration [multivariable-adjusted odds ratio ( ): 1.92, 95% confidence interval ( ): 1.24, 2.98]. When stratified by baseline NFS status, the for progression from low to intermediate or high NFS was 1.74 (95% : 1.02, 3.00), and progression from intermediate to high NFS was 2.24 (95% : 1.05, 4.80). There was a significant interaction between PAD and insulin resistance (IR) on fibrosis deterioration ( for interaction = 0.03). As compared with non-PAD and non-IR, the coexistence of PAD and IR was associated with a 3.85-fold (95% : 2.06, 7.18) increased risk of fibrosis deterioration. Conclusion PAD is associated with an increased risk of fibrosis deterioration in NAFLD patients, especially in those with IR. The coexistence of PAD and IR may impose an interactive effect on the risk of fibrosis deterioration.
Adult ; Aged ; Aged, 80 and over ; Ankle Brachial Index ; China ; epidemiology ; Female ; Humans ; Liver Cirrhosis ; epidemiology ; etiology ; Male ; Middle Aged ; Non-alcoholic Fatty Liver Disease ; epidemiology ; etiology ; Peripheral Arterial Disease ; complications ; Prevalence ; Prospective Studies ; Risk Factors

Epidemiologic studies have revealed diabetes mellitus is an important determining factor not only for the presence of peripheral arterial disease (PAD) but also for the severity of PAD. As PAD is closely related to mortality and morbidity in individuals with diabetes as well as the general population, the primary prevention for PAD is very important. Age, disease duration, the level of hyperglycemia, blood pressure, and smoking status are independent risk factors for development of PAD in diabetic patients, and management of those risk factors might be an effective tool for reducing PAD burden.
Blood Pressure ; Diabetes Mellitus ; Epidemiologic Studies ; Epidemiology ; Humans ; Hyperglycemia ; Mortality ; Peripheral Arterial Disease ; Primary Prevention ; Risk Factors ; Smoke ; Smoking

BACKGROUND: The ankle-brachial index (ABI) is a simple, noninvasive clinical test that is useful in the diagnosis of peripheral artery disease (PAD). The borderline ABI value is 0.91–0.99 and has also been reported in endothelial dysfunction and preclinical PAD. We investigated the relationship between resting heart rate as a surrogate marker of autonomic balance and borderline ABI in apparently healthy individuals.METHODS: We evaluated the association between resting heart rate and borderline ABI in 618 participants (348 male and 270 female) in a health examination program. The odds ratios for borderline ABI were calculated using a multivariable logistic regression analysis after adjusting for confounding variables across heart rate quartiles (Q1≤56, Q2=57–62, Q3=63–68, and Q4≥69 beats/min).RESULTS: The overall prevalence of borderline ABI was 13.9%. The age- and sex-adjusted resting heart rate was significantly higher in the borderline ABI group than in the control group (66.9±0.9 vs. 63.0±0.4 beats/min, P < 0.001). The odds ratios (95% confidence intervals) for the borderline ABI in each heart rate quartile were 1.00, 1.04 (0.43–2.52), 1.69 (0.73–3.93), and 3.52 (1.55–7.97) after adjusting for age, sex, smoking status, alcohol intake, regular exercise, body mass index, systolic blood pressure, fasting plasma glucose level, triglyceride level, high-density lipoprotein-cholesterol level, white blood cell count, C-reactive protein level, uric acid level, γ-glutamyltransferase level, hypertension medication, diabetes medication, and dyslipidemia medication.CONCLUSION: These findings indicate that a higher resting heart rate is independently associated with borderline ABI.
Ankle Brachial Index ; Biomarkers ; Blood Glucose ; Blood Pressure ; Body Mass Index ; C-Reactive Protein ; Confounding Factors (Epidemiology) ; Diagnosis ; Dyslipidemias ; Fasting ; Heart Rate ; Heart ; Humans ; Hypertension ; Leukocyte Count ; Logistic Models ; Male ; Odds Ratio ; Peripheral Arterial Disease ; Prevalence ; Smoke ; Smoking ; Triglycerides ; Uric Acid

BACKGROUND: Peripheral arterial disease (PAD) is known as the greatest risk factor affecting the amputation of diabetic foot. Thus, it is crucial to understand the epidemiology of PAD associated with diabetic foot and the relationship between PTA and amputation in predicting prognosis. However, no such multi-year data are available in Korea. Thus, the purpose of this study was to investigate trends of amputation involving diabetic foot based on vascular interventions for PAD in Korea. METHODS: This study was conducted using six-year data obtained from Health Insurance Review and Assessment Service from January 1, 2011 to December 31, 2016. Our study included data pertaining to diabetic foot, PAD, and vascular intervention codes (percutaneous transluminal angioplasty [PTA, M6597], percutaneous intravascular installation of stent-graft [PIISG, M6605], and percutaneous intravascular atherectomy [PIA, M6620]). We analyzed the number of vascular interventions and minor and major amputations each year. The relationship between annual amputation and vascular intervention was analyzed using χ² test. RESULTS: The overall number of vascular interventions increased from 253 (PTA, 111; PIISG, 140; and PIA, 2) in 2011 to 1,230 (PTA, 745; PIISG, 470; and PIA, 15) in 2016. During the same period, the number of minor amputations increased from 2,534 to 3,319 while major amputations decreased from 980 to 956. The proportion of minor amputations among patients who underwent vascular intervention was significantly increased from 19.34% in 2011 to 21.45% in 2016 while the proportion of major amputations among these patients was significantly reduced from 9.88% to 4.27%. In addition, the association between vascular intervention and amputation increased from 0.56 (spearman correlation coefficient) in 2011 to 0.62 in 2016. CONCLUSION: In diabetic foot patients, increase in vascular intervention resulted in a change in amputation pattern, showing statistically significant correlation.
Amputation ; Angioplasty ; Atherectomy ; Diabetic Foot ; Epidemiology ; Humans ; Insurance, Health ; Korea ; Lower Extremity ; Peripheral Arterial Disease ; Prognosis ; Risk Factors

Peripheral artery disease (PAD) is an important marker for the risk stratification of patients with coronary artery disease (CAD). We investigated the prevalence of PAD in patients undergoing percutaneous coronary intervention (PCI) with CAD and the relationship between ankle-brachial pressure index (ABPI) and CAD severity. A total of 711 patients undergoing PCI for CAD from August 2009 to August 2011 were enrolled. PAD diagnosis was made using the ABPI. The prevalence of PAD was 12.8%. In PAD patients, mean values of right and left ABPI were 0.71 +/- 0.15 and 0.73 +/- 0.15. Patients with PAD had a higher prevalence of left main coronary disease (14.3% vs 5.8%, P = 0.003), more frequently had multivessel lesions (74.9% vs 52.1%, P < 0.001) and had higher SYNTAX score (18.2 +/- 12.3 vs 13.1 +/- 8.26, P = 0.002). Using multivariate analysis, we determined that left main CAD (OR, 2.954; 95% CI, 1.418-6.152, P = 0.004) and multivessel CAD (OR, 2.321; 95% CI, 1.363-3.953, P = 0.002) were both independently associated with PAD. We recommend that ABPI-based PAD screening should be implemented in all patients undergoing PCI with CAD, especially in severe cases.
Aged ; Ankle Brachial Index ; Asian Continental Ancestry Group ; Coronary Artery Disease/*diagnosis/epidemiology/etiology ; Female ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Odds Ratio ; Percutaneous Coronary Intervention ; Peripheral Arterial Disease/complications/*diagnosis/epidemiology ; Prevalence ; Republic of Korea/epidemiology ; Risk Factors ; Severity of Illness Index

Major and profound changes have taken place in China over the past 30 years. Rapid socioeconomic progress has exerted a great impact on lifestyle, ranging from food, clothing, working and living conditions, and means of transportation to leisure activities and entertainment. At the same time, new health problems have emerged, and health services are facing new challenges. Presently, cardiovascular diseases (CVD) are among the top health problems of the Chinese people, and pose a serious challenge to all engaged in the prevention and control of these diseases. An epidemic of CVD in China is emerging as a result of lifestyle changes, urbanization and longevity. Both national policy decision-making and medical practice urgently need an authoritative report which comprehensively reflects the trends in the epidemic of CVD and current preventive measures. Since 2005, guided by the Bureau of Disease Prevention of the Ministry of Health of the People's Republic of China and the National Center for Cardiovascular Diseases of China, nationwide experts in the fields of epidemiology, clinical medicine and health economics in the realms of CVD, cerebrovascular disease, diabetes and chronic kidney disease, completed the Report on Cardiovascular Diseases in China every year. The report aims to provide a timely review of the trend of the epidemic and to assess the progress of prevention and control of CVD. In addition, as the report is authoritative, representative and readable, it will become an information platform in the CVD field and an important reference book for government, academic institutes, medical organizations and clinical physicians. This publication is expected to play a positive role in the prevention and control of CVD in China. We present an abstract from the Report on Cardiovascular Diseases in China (2010), including trends in CVD, morbidity and mortality of major CVDs, up-to-date assessment of risk factors, as well as health resources for CVD, and a profile of medical expenditure, with the aim of providing evidence for decision-making in CVD prevention and control programs in China, and of delivering the most authoritative information on CVD prevention and control for all citizens.
Arrhythmias, Cardiac ; epidemiology ; prevention & control ; China ; epidemiology ; Coronary Disease ; epidemiology ; mortality ; prevention & control ; Diabetes Complications ; epidemiology ; Diet ; Dyslipidemias ; complications ; epidemiology ; Epidemics ; Heart Failure ; epidemiology ; mortality ; prevention & control ; Humans ; Hypertension ; complications ; epidemiology ; Kidney Failure, Chronic ; epidemiology ; mortality ; prevention & control ; Metabolic Syndrome ; Motor Activity ; Nutritional Physiological Phenomena ; Overweight ; complications ; epidemiology ; Peripheral Arterial Disease ; epidemiology ; prevention & control ; Risk Factors ; Smoking ; adverse effects ; Stroke ; epidemiology ; mortality ; prevention & control

This prospective study surveyed the prevalence of peripheral arterial disease (PAD) in Korean patients with coronary arterial disease (CAD) or cerebrovascular disorder (CVD). From March 2010, 576 hospitalized patients in cardiovascular or stroke center were enrolled as the study group. Ankle-brachial index (ABI) was measured and the cut-off point for diagnosing PAD was < or = 0.9 at rest. A total of 424 hospitalized patients in the Department of Surgery and aged > or = 50 yr was enrolled as the control group. The prevalence of PAD was significantly higher in the study group than the control group (7.6% vs 1.7%; P < 0.001). To analyze the relationship of other vascular diseases and PAD, the patients were regrouped; group A (no CAD or CVD), group B (CAD only), group C (CVD only), and group D (CAD and CVD). Compared with group A, those with other vascular diseases (group B, C, D) had significantly higher prevalence of PAD, diabetes, dyslipidemia, renal insufficiency and claudication. The trend that patients with CAD or CVD are at risk of PAD is observed in this cross-sectional study in Koreans. Routine ABI measurement is recommended in these high-risk groups for early detection and proper management of PAD.
Aged ; Ankle Brachial Index ; Cerebrovascular Disorders/complications/*epidemiology ; Coronary Artery Disease/complications/*epidemiology ; Cross-Sectional Studies ; Female ; Humans ; Male ; Middle Aged ; Odds Ratio ; Peripheral Arterial Disease/*epidemiology/etiology ; Prevalence ; Prospective Studies ; Republic of Korea/epidemiology ; Risk Factors

BACKGROUNDThe investigations of prevalence and risk factors of peripheral arterial disease (PAD) in type 2 diabetic patients have been carried out in many countries and regions, except for Central China. In this study, we determined the prevalence of PAD in type 2 diabetic patients and the related factors that gave rise to increasing of the risk of PAD development in Wuhan, China.

METHODSThe study enrolled 2010 patients aged 60 years and older who were regularly visiting the Central Hospital of Wuhan that is a public hospital from 2005 to 2010, where all residents of the city were offered the medical services. PAD was defined as an ankle-brachial index < 0.90 in either leg. To evaluate the role of various risk factors in PAD development, uniformed interviews, clinical examinations and laboratory investigation of all of participants were performed in this study. The correlation between potential risk factors and PAD was analyzed.

RESULTSIn Wuhan, the prevalence rate of PAD was 24.1% in elderly diabetic patients. Totally, 291 patients with PAD had at least one weak but not absent dorsalis pedis pulse in both feet, while 541 patients without PAD showed this way. At least one absent dorsalis pedis pulse was found in 192 patients with PAD as well as 10 patients without PAD. The results of multivariate regression analysis suggested that the age, smoking history, hypertension, diabetic neuropathy and macroangiopathy gave rise to significant increase of PAD development in type 2 diabetic diseases.

CONCLUSIONSThe prevalence of PAD in elderly patients with type 2 diabetes in Wuhan was close to the prevalence that was reported in other regions of China and other Asian countries. Control of the related risk factors and early diagnosis of PAD may play a role in PAD prevention and improving prognosis.

Aged ; China ; epidemiology ; Diabetes Mellitus, Type 2 ; complications ; epidemiology ; Female ; Humans ; Male ; Middle Aged ; Peripheral Arterial Disease ; epidemiology ; etiology ; Prevalence ; Risk Factors