scholarly journals CHADS2, CHA2DS2ASc, and New ABCD Scores Predict the Risk of Peripheral Arterial Disease in Patients with Sleep Apnea

2019 ◽  
Vol 8 (2) ◽  
pp. 188 ◽  
Author(s):  
Kuan-Li Wu ◽  
Chia-Yu Kuo ◽  
Yu-Chen Tsai ◽  
Jen-Yu Hung ◽  
Chau-Chyun Sheu ◽  
...  
Keyword(s):  
Sleep Apnea ◽  
Cox Regression ◽  
Arterial Disease ◽  
Population Based ◽  
Sensitivity Analyses ◽  
Clinical Tool ◽  
Chads2 Score ◽  
Artery Disease ◽  
Peripheral Arterial ◽  
Abcd Score

The association between sleep apnea (SA) and peripheral artery disease (PAD) remains debatable, and there is no clinical tool to predict incident PAD in SA patients. The CHADS2 score has been found useful in predicting PAD risk. This study was designed to investigate the association between these diseases and the usefulness of CHADS2 and CHA2DS2ASc scores in predicting subsequent PAD in SA patients. From a population-based database of one-million representative subjects, adult patients with SA diagnosis were enrolled as the suspected SA group, and those having SA diagnosis after polysomnography were further extracted as the probable SA group. Twenty sex- and age-matched control subjects were randomly selected for each SA patients. The occurrence of PAD after SA was taken as the primary endpoint. Totally, 10,702 and 4242 patients were enrolled in the suspected and probable SA groups, respectively. The cumulative incidence of PAD was similar between SA patients and the corresponding control groups. Multivariable Cox regression analyses showed that SA was not an independent risk factor for subsequent PAD. Sensitivity analyses using propensity score-matched cohorts showed consistent results. Furthermore, in stratifying the SA patients by CHADS2, CHA2DS2ASc, or a newly-proposed ABCD (composed of Age, high Blood pressure, Cerebral vascular disease, and Diabetes mellitus) score, patients with higher scores predicted higher risks of subsequent PAD, while the ABCD score appeared to be the most robust. Aggressive risk modification is suggested to reduce the subsequent PAD risk in SA patients with a higher CHADS2, CHA2DS2ASc, or ABCD score.

193Qualifying event proximity, cardiovascular risk, and benefit of empagliflozin in patients with type 2 diabetes and stable atherosclerosis in the EMPA-REG OUTCOME trial

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Udell ◽  
B Zinman ◽  
C Wanner ◽  
M Von Eynatten ◽  
J T George ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Type 2 Diabetes ◽  
Cox Regression ◽  
Arterial Disease ◽  
Outcome Trial ◽  
Artery Disease ◽  
Peripheral Arterial ◽  
Risk And Benefit ◽  
Similar Risk

Abstract Background In type 2 diabetes, the temporal proximity of an atherosclerotic cardiovascular (CV) event can impact prognosis, but whether timing influences sodium glucose co-transporter 2 inhibitor effects is unknown. We explored the association of time from last qualifying CV event before randomisation (myocardial infarction [MI], stroke, coronary artery disease or peripheral arterial disease) with CV outcomes and benefit of empagliflozin (EMPA) in EMPA-REG OUTCOME. Methods Patients (pts) were randomised to EMPA 10 mg, 25 mg or placebo and followed for 3.1 years (median). Risk of major adverse CV events (3P MACE: CV death, MI, stroke), CV death or hospitalisation for heart failure (HHF) were evaluated using Cox regression in subgroups of ≤1/>1 year since last qualifying CV event. Qualifying event stratification was possible in 6796 (97%) pts. Results In the overall population, N=6796 (4547 EMPA and 2249 placebo pts), median (Q1, Q3) time from last CV event was 3.8 (1.5–7.6) years. Overall, 1214 (EMPA 841; placebo 373) and 5582 (EMPA 3706; placebo 1876) pts had a last qualifying CV event ≤1 and >1 year, respectively. Pts with more recent events had similar risk for CV outcomes compared with pts >1 year from qualifying event (Figure). Moreover, the benefit of EMPA on CV outcomes was consistent between pts enrolled ≤1 or >1 year from the qualifying CV event (all p-interaction >0.05; Figure). Conclusion Although most pts had a qualifying CV event >1 year before randomisation in EMPA-REG OUTCOME, the benefits of EMPA appear to extend to pts with more recent CV events. Acknowledgement/Funding Boehringer Ingelheim & Eli Lilly and Company Diabetes Alliance

Abstract 16346: Soluble P-Selectin Predicts Lower Extremity Peripheral Artery Disease Incidence and Change in the Ankle Brachial Index: The Multi-Ethnic Study of Atherosclerosis (MESA)

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Christina L Wassel ◽  
Cecilia Berardi ◽  
James S Pankow ◽  
Nicholas B Larson ◽  
Paul A Decker ◽  
...  
Keyword(s):  
Disease Incidence ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Population Based ◽  
Ethnic Study ◽  
Growth Curve Models ◽  
C Statistic ◽  
Artery Disease ◽  
Peripheral Arterial ◽  
D Dimer

Background: Given the global burden of peripheral arterial disease (PAD) and the associated morbidity, continuing investigation of potential biomarkers as therapeutic targets for preventing PAD is warranted. The association of P-selectin, an endothelial cell adhesion molecule, with the ankle brachial index (ABI) and PAD is not well established. Thus, we examined the association of circulating P-selectin with prevalent and incident PAD, the ABI, and change in the ABI. Methods: The Multi-Ethnic Study of Atherosclerosis (MESA) is a prospective population-based cohort including 6814 non-Hispanic white, African American, Hispanic and Chinese men and women aged 45-84 at baseline (2000-02). For this analysis, 5700 participants with both P-selectin at Exam 2 (2002-04) and the ABI at Exam 3 (2004-05) were available, with change in ABI from Exam 3 to Exam 5 (2010-12) available on 4276 participants. P-selectin was modeled per standard deviation (SD), while prevalent and incident PAD were defined as ABI ≤ 0.90 after excluding those with ABI>1.4. Linear regression was used for ABI, growth curve models for change in ABI, and logistic regression for prevalent and incident PAD. Results: In models adjusted for demographics, lifestyle factors, comorbidities, blood pressure, lipids, fasting glucose, c-reactive protein (CRP), interleukin-6 (IL-6), D-dimer, and fibrinogen, each SD (13 ng/mL) higher P-selectin was significantly associated with 0.007 lower ABI (95% CI ((-0.011, -0.004)), p<0.001), and an average change in the ABI of -0.006 ((-0.010, -0.003, p<0.001). P-selectin was also significantly associated with a 1.14-fold greater odds of prevalent PAD ((1.00, 1.28), p=0.04), and a 1.30-fold greater odds of incident PAD ((1.10, 1.55), p<0.001). There were no significant interactions of p-selectin by race/ethnicity or gender. Addition of P-selectin to models containing traditional PAD risk factors as well as CRP, IL-6, D-dimer and fibrinogen did not improve the c-statistic or net reclassification for incident PAD. Conclusions: P-selectin appears to be strongly associated with the development of PAD. However, further research is needed in population-based studies to confirm prospective associations of p-selectin with incident PAD and change in the ABI.

scholarly journals COPD is associated with an increased risk of peripheral artery disease and mortality

2018 ◽  
Vol 4 (4) ◽  
pp. 00086-2018 ◽  
Author(s):  
Natalie Terzikhan ◽  
Lies Lahousse ◽  
Katia M.C. Verhamme ◽  
Oscar H. Franco ◽  
M. Arfan Ikram ◽  
...  
Keyword(s):  
Cox Regression ◽  
Ankle Brachial Index ◽  
Arterial Disease ◽  
Mortality Rates ◽  
Population Based ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Interaction Terms ◽  
Increased Risk ◽  
Peripheral Arterial

Patients with chronic obstructive pulmonary disease (COPD) commonly present with multimorbidity. We aimed to investigate the association between COPD and the development of peripheral arterial disease (PAD) in the general population, and how this might affect mortality among individuals with COPD.We included 3123 participants of the population-based Rotterdam Study without PAD at baseline (mean age 65 years; 57.4% female). The association between COPD at baseline and PAD during follow-up was studied using logistic regression (PAD being indicated by an ankle–brachial index (ABI) of 0.9 or less). Cox regression was used for mortality analysis and interaction terms were used to investigate mortality risk modification by PAD.The presence of COPD was associated with incident PAD (adjusted odds ratio 1.9, 95% CI 1.1–3.2). Mortality rates per 100 000 person-years were as follows: 10.0 in individuals without COPD or PAD, 18.4 in those with COPD only, 16.1 in those with PAD only and 30.1 in individuals with both COPD and PAD. No statistical interaction was found between PAD and COPD on risk of dying.Individuals with COPD have an almost doubled risk of developing PAD. Although PAD does not modify the association between COPD and mortality, people suffering from both diseases have substantially higher mortality rates.

scholarly journals Obstructive Sleep Apnea Patients Having Surgery Are Less Associated with Glaucoma

2014 ◽  
Vol 2014 ◽  
pp. 1-6 ◽  
Author(s):  
Hsin-Yi Chen ◽  
Yue-Cune Chang ◽  
Che-Chen Lin ◽  
Fung-Chang Sung ◽  
Wen-Chi Chen
Keyword(s):  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Cox Regression ◽  
Population Based ◽  
Multiple Modalities ◽  
Obstructive Sleep ◽  
Increased Risk ◽  
Artery Disease ◽  
Using Data ◽  
Estimate Hazard Ratio

Objective.To investigate if different treatment strategy of obstructive sleep apnea (OSA) was associated glaucoma risk in Taiwanese population.Methods.Population-based retrospective cohort study was conducted using data sourced from the Longitudinal Health Insurance Database 2000. We included 2528 OSA patients and randomly selected and matched 10112 subjects without OSA as the control cohort. The risk of glaucoma in OSA patients was investigated based on the managements of OSA (without treatment, with surgery, with continuous positive airway pressure (CPAP) treatment, and with multiple modalities). The multivariable Cox regression was used to estimate hazard ratio (HR) after adjusting for sex, age, hypertension, diabetes, hyperlipidemia, and coronary artery disease.Results.The adjusted HR of glaucoma for OSA patients was 1.88 (95% CI: 1.46–2.42), compared with controls. For patients without treatment, the adjusted HR was 2.15 (95% CI: 1.60–2.88). For patients with treatments, the adjusted HRs of glaucoma were not significantly different from controls, except for those with CPAP (adjusted HR = 1.65, 95% CI = 1.09–2.49).Conclusions.OSA is associated with an increased risk of glaucoma. However, surgery reduces slightly the glaucoma hazard for OSA patients.

scholarly journals Increased risk of developing peripheral artery disease in hemodialysis patients receiving statin treatments: a population-based cohort study in Taiwan

2019 ◽  
Vol 35 (10) ◽  
pp. 1753-1760 ◽  
Author(s):  
Yueh-Han Hsu ◽  
Fung-Chang Sung ◽  
Chih-Hsin Muo ◽  
Shao-Yuan Chuang ◽  
Chun-Ming Chen ◽  
...  
Keyword(s):  
Proportional Hazards ◽  
Arterial Disease ◽  
Statin Treatment ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Moderate Intensity ◽  
Increased Risk ◽  
Artery Disease ◽  
Peripheral Arterial

Abstract Background Few investigations have evaluated the influences on peripheral arterial disease (PAD) risk of statin treatment in hemodialysis (HD) subjects with hyperlipidemia (HL). Methods From the National Health Insurance Research Dataset, we identified 3658 HD patients with statin therapy for HL as the statin cohort, and then selected, by 1:1 propensity score matching, 3658 HD patients with HL but without statin use as the nonstatin cohort in 2000–07. The cohorts were followed through until the end of 2011. We used Cox proportional hazards regression analysis to assess the hazard ratio (HR) of PAD development. Results The average follow-up period was 4.18 years; the incident PAD risk was 1.35-fold greater in statin users than in nonusers (16.87 versus 12.46/1000 person-years), with an adjusted HR (aHR) of 1.34 for PAD [95% confidence interval (CI) 1.12–1.62]. The PAD risk increases were significant for patients receiving fluvastatin (aHR 1.88; 95% CI 1.12–3.14) and atorvastatin (aHR 1.60; 95% CI 1.24–2.08). The risk increased with higher annual average statin dosage (P for trend &lt;0.0001); the risk was higher for those receiving moderate-intensity statin treatment. The sensitivity test revealed similar findings. Conclusions HD patients with HL on statin medication were at increased PAD risk, which increased with cumulative statin dosage. Thorough considerations are needed before prescribing statins to HD patients.

scholarly journals Increased risk of peripheral arterial disease in polymyalgia rheumatica: a population-based cohort study

2009 ◽  
Vol 11 (2) ◽  
pp. R50 ◽  
Author(s):  
Kenneth J Warrington ◽  
Elena P Jarpa ◽  
Cynthia S Crowson ◽  
Leslie T Cooper ◽  
Gene G Hunder ◽  
...  
Keyword(s):  
Cohort Study ◽  
Peripheral Arterial Disease ◽  
Polymyalgia Rheumatica ◽  
Arterial Disease ◽  
Population Based ◽  
Increased Risk ◽  
Peripheral Arterial
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