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Query: UMLS:C0011849 (diabetes)
 277,896 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Peripheral arterial disease (PAD) is part of a global vascular problem of diffuse atherosclerosis. PAD patients die mostly of cardiac and cerebrovascular-related events and much less frequently due to obstructive disease of the lower extremities. Aggressive risk factors modification is needed to reduce cardiac mortality in PAD patients. These include smoking cessation, reduction of blood pressure to current guidelines, aggressive low density lipoprotein lowering, losing weight, controlling diabetes and the use of oral antiplatelet drugs such as aspirin or clopidogrel. In addition to quitting smoking and exercise, cilostazol and statins have been shown to reduce claudication in patients with PAD. Patients with critical rest limb ischemia or severe progressive claudication need to be treated with revascularization to minimize the chance of limb loss, reduce symptoms, and improve quality of life.
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PMID:Epidemiology, classification, and modifiable risk factors of peripheral arterial disease. 1758 Jul 33

Peripheral arterial disease (PAD), which threatens limb viability and patient survival, is increasing in frequency in the dialysis population, but associated risk factors remain poorly defined. We conducted a cross-sectional analysis of the association of novel and traditional cardiovascular risk factors with PAD in incident-dialysis patients enrolled in the CHOICE study by application of multivariate logistic-regression models with adjustment for confounders. Risk factors were determined by interview, record review, and laboratory analysis of frozen specimens. Among 922 patients, 25% had a diagnosis of PAD. After adjustment, higher prevalence of PAD was associated with increasing age (odds ratio [OR], 95% CI = 1.28 [range: 1.12 to 1.48] per 10-year increase in age); presence of diabetes mellitus (OR, 95% CI = 2.76 [range: 1.72 to 4.42]); higher Index of Co-Existent Disease (ICED), ICED 2 and ICED 3 versus ICED 0-1, (OR, 95% CI = 2.04; [range: 1.24 to 3.35] and OR, 95% CI = 2.81 [range: 1.83 to 4.30], respectively). After adjustment, we found no statistically significant association between CRP and prevalence of PAD. The prevalence of PAD diagnosis was 34% higher per quartile increase in Lp(a) (OR, 95% CI = 1.34 [range: 1.13 to 1.59]). Similarly, the prevalence of PAD diagnosis was 19% higher per quartile increase in total homocysteine (OR, 95% CI = 1.19 [range: 1.05 to 1.35]). The prevalence of PAD is high in incident-dialysis patients and is associated with several novel and traditional cardiovascular risk factors. This study identifies several novel risk factors (eg, Lp(a) and total homocysteine) and underscores the need for further research to reduce the burden of PAD in this high-risk group of patients.
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PMID:Novel and traditional cardiovascular risk factors for peripheral arterial disease in incident-dialysis patients. 1760 86

Peripheral arterial disease is more aggressive in concomitant diabetes posing an increased risk for critical limb ischemia and subsequent limb loss. The majority of therapies available are not effective to prevent amputation in patients with severe disease. The current observational study reports the effect of the heparin-induced extracorporal LDL-precipitation (H.E.L.P.) as a novel therapeutic approach in patients with severe diabetic foot syndrome. Seventeen diabetic patients with septic foot lesions recruited from the diabetic outpatient clinic underwent H.E.L.P. apheresis regularly until fibrinogen levels were stabilized at 3 g/l or infection was controllable as evidenced by alleviation of necrosis. Patients were subsequently followed up for 2 to 73 months. Fibrinogen levels were reduced by 68% after H.E.L.P. treatment. No severe complications were noted. Necrosis could be confined in sixteen patients. Minor amputations were indicated in twelve patients. Three patients underwent major amputations of the lower limb and two patients received surgical reconstruction. In conclusion, H.E.L.P. apheresis may offer an alternative therapeutic option to diabetic patients with critically ischemic feet and appears to have a beneficial major/minor amputation ratio.
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PMID:Heparin-induced Extracorporal LDL precipitation (H.E.L.P) in diabetic foot syndrome - preventive and regenerative potential? 1862 89

Peripheral arterial disease (PAD) is common, but often not diagnosed. A biomarker index would be useful to raise suspicion of PAD, so as to trigger appropriate vascular testing and management. The study comprised 540 individuals: 197 individuals with both coronary artery disease and peripheral arterial disease (CAD + PAD); 81 with CAD only; and 262 with no hemodynamically significant disease (NHSD) of the coronary or peripheral arteries. Multiple linear regression was performed to generate a biomarker panel score that could predict ankle-brachial index (ABI). Logistic regression was used to investigate the relationship between disease status and the panel score as well as other risk factors (e.g. age, diabetes status, smoking status). ROC analysis was performed to test the prediction power of the biomarker panel score. Among the plasma markers tested, beta 2 microglobulin (beta2M) and cystatin C had the highest correlation with ABI, and higher than any of the conventional risk factors of age, smoking status, and diabetes status. A biomarker panel score derived from beta2M, cystatin C, hsCRP, and glucose had an increased association with PAD status (OR = 12.4, 95% confidence interval (CI) 6.6-23.5 for highest vs lowest quartile), which was still significant after adjusting for known risk factors (OR = 7.3, 95% CI 3.6-14.9 for highest vs lowest quartile). In conclusion, after taking into account the traditional risk factors for PAD, a biomarker panel comprising beta2M, cystatin C, hsCRP, and glucose adds useful information to assess the risk of disease.
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PMID:A biomarker panel for peripheral arterial disease. 1868 58

Peripheral arterial disease (PAD) is stenosis or occlusion of peripheral arterial vessels by atherosclerotic plaque. It may present as intermittent claudication, rest pain and impotence. PAD of the lower limbs is the third most important site of atherosclerotic disease after coronary heart disease and cerebrovascular disease. Increasing age, family history, smoking, hypertension, dyslipidemia and more decisively diabetes are significant risk factors. PAD is a clinical condition that has often been neglected, underdiagnosed, undertreated and has a serious outcome. It may lead to nonhealing wounds, gangrene and amputation of the lower limbs. Hence, early identification of patients at risk of PAD and timely referral to the vascular surgeon in severe cases is crucial.
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PMID:Peripheral arterial disease in general and diabetic population. 1870 64

Diabetic foot ulcerations result from different physiopathological mechanisms; a clear understanding of them is crucial to reduce their incidence, provide early care, and finally delay the amputation risk. The three main diabetes complications involved in foot ulcerations are neuropathy, peripheral arterial disease, and infection. The most common pathway to ulceration is peripheral sensorimotor and autonomic neuropathy, leading to loss of sensitivity, foot deformities, high foot pressure, and dry skin. Peripheral arterial disease is more frequent and more serious in the diabetic population. It delays cicatrization and causes gangrene and finally amputation. Infection is also a major complication of ulceration because of its risk of spreading into deep tissue and bone, which increases the risk of amputation. Infection may also generalize and become life-threatening. These complications preferentially affect the foot because it is exposed to hyper pressure, neuropathy, and peripheral arterial disease, which cause distal lesions, and the foot is exposed to a closed atmosphere, a source of soaking and skin frailty. Diabetes itself may enhance the risk of complications stemming from the disease's long-term progression and poor glucose control, thereby affecting ocular and renal functions. Finally, some psychosocial situations such as depression syndrome or poor hygiene possibly enhance diabetic foot occurrence.
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PMID:[Physiopathology of the diabetic foot]. 1882 48

The risk for peripheral arterial disease (PAD) is increased in patients with chronic kidney disease. We investigated the effects of renal function on PAD in Chinese with type 2 diabetes mellitus. This study enrolled a total of 2983 (1342 men and 1641 women) Chinese adults with diabetes. The mean age was 63.2 +/- 11.9 years. Peripheral arterial disease was diagnosed by an ankle-brachial index less than 0.9. Renal function was evaluated by serum creatinine (SCr), estimated glomerular filtration rate, and urinary albumin-creatinine ratio (ACR). Risk factors for PAD were evaluated using multiple logistic regression analysis. Age, cholesterol, and high-density lipoprotein cholesterol (HDL-C) (inverse association) were significant risk factors in men, whereas age, body mass index (inverse association), low-density lipoprotein cholesterol, and HDL-C (inverse association) were significant risk factors for diabetic women. After adjustment for age, body mass index, blood pressure, glycosylated hemoglobin, cholesterol, HDL-C, low-density lipoprotein cholesterol, and triglyceride levels, we found that SCr levels greater than 1.5 mg/dL, estimated glomerular filtration rate less than 60 mL/min, and urinary ACR greater than 30 mg/g were independent risk factors for PAD in diabetic men and that SCr levels greater than 1.4 mg/dL and urinary ACR greater than 30 mg/g were independently associated with PAD in diabetic women. The risk factors for PAD are somewhat different between men and women with diabetes in Chinese population in Taiwan. Diabetic nephropathy is significantly associated with PAD in this patient population.
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PMID:Diabetic nephropathy and risk factors for peripheral artery disease in Chinese with type 2 diabetes mellitus. 1930 71

Peripheral arterial disease (PAD) is a common manifestation of atherosclerotic vascular disease. Its incidence increases with age and in the presence of known cardiovascular risk factors (eg, smoking and diabetes). PAD frequently coexists with coronary and/or cerebrovascular disease, probably because of common risk factors. Asymptomatic PAD of the lower limbs (defined as an ankle-brachial index of less than 0.9) is believed to be approximately three to four times more common than symptomatic PAD. Both symptomatic and asymptomatic diseases are associated with high risk of cardiovascular mortality and morbidity. Therefore, patients with PAD are candidates for preventive strategies for cardiovascular events. Platelet activation and aggregation is believed to significantly contribute to atherothrombotic events. Thus, patients with PAD can benefit from antiplatelet therapy. Both acetylsalicylic acid and clopidogrel decrease serious cardiovascular events in patients with PAD. However, acetylsalicylic acid is the preferred agent because of its low cost and wide availability. Cilostazol is recommended for use in patients with severe and disabling symptoms but not for asymptomatic or less disabling disease. Currently, there is insufficient evidence to recommend routine use of newer agents such as picotamide in patients with PAD.
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PMID:Medical management and cardiovascular risk reduction in peripheral arterial disease. 1934 25

Peripheral arterial disease (PAD) is associated with significant morbidity and mortality and is an important marker of systemic atherosclerosis. However, little is known about the associated risk factors for PAD in patients on maintenance hemodialysis (HD). We collected the basic data and possible risk factors associated with PAD for 277 patients on maintenance HD. Furthermore, we measured ankle-brachial blood pressure index (ABI) in these patients. PAD was defined as an ABI value less than 0.90. The prevalence of PAD in our HD center was 22.8% (61/268). Advanced age (P = 0.006), longer history of HD (P < 0.001), diabetes (P = 0.002) and presence of PAD symptoms (P < 0.001) were independent predictors of PAD. PAD patients with diabetes had shorter history of HD (P = 0.001). 2-vessel PAD had higher serum cholesterol in HD patients (>or= 200 vs < 200 mg/dL; Odds ratio, 12.12, 95% confidence interval, 2.199-67.79; P < 0.004).
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PMID:Peripheral arterial disease and clinical risks in Taiwanese hemodialysis patients. 1939 18

Peripheral arterial disease is characterized by a gradual reduction in blood to the extremities secondary to atherosclerosis. In diabetes, the pattern of atherosclerotic occlusion typically shows a propensity toward the infrapopliteal vessels. Additionally, impairment of the microcirculation manifests in diminished vasoreactivity and a functional ischemia that is not always correctable with surgery. However, when a nonhealing wound is complicated by peripheral arterial disease, revascularization is paramount to wound healing. Revascularization can be accomplished through traditional bypass surgery or newer endovascular interventions, such as angioplasty and stenting. These less invasive techniques of revascularization offer the advantages of quicker recovery and lower morbidity but durability may be compromised. Ultimately, the choice of revascularization procedure should be based on the clinical characteristics of the atherosclerotic lesion along with the individual patient history.
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PMID:Peripheral arterial disease and diabetes: a clinical update. 1944 96


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