Preview

Rational Pharmacotherapy in Cardiology

Advanced search

Predictors of atherosclerotic lesions of limb arteries according to cardioangiological screening of the adult population

https://doi.org/10.20996/1819-6446-2015-11-5-470-476

Full Text:

Abstract

Aim. To study the predictors of atherosclerotic lesions of arteries identified through a multi-channel volume sphygmography (MCVS).
Material and methods. Simultaneous survey of 441 rural residents over 40 years old was performed. Synchronous registration of blood pressure (BP) on four limbs using MCVS was fulfilled, and differences in systolic BP between arms (ΔSBParm) and legs (ΔSBPleg) were calculated. Ankle-brachial index (ABI) was also evaluated. ΔSBParm≥15 mm Hg or ΔSBPleg≥15 mm Hg or ABI≤0.9 were considered as the markers of atherosclerotic arterial disease.
Results. A significant asymmetry of SBP (≥15 mmHg) was found in 7.7% [95% confidence interval (CI) 5.5-10.6%] of patients in the upper limbs and in 6.8% (95 % CI 4.89.6%) of patients in the lower extremities. The relative risk of asymmetry of SBP (≥15 mm Hg) in the upper limbs increased in hypertension and obesity, and in the lower limbs in men and diabetes. Various quantitative risk factors of the onset and progression of atherosclerosis (age, body mass index, waist circumference, blood glucose, BP level) had a positive correlation with the level of asymmetry of SBP on the limbs. Using MCVS and the appropriate combinations of features (SBP asymmetry or ABI≤0.9) allowed us at the stage of screening to find out blood flow disturbances in the arteries of the extremities in 14.7% (95% CI 11.7-18.4%) of patients. This detection frequency was significantly higher than that when using only ABI.
Conclusion. Identification of significant SBP asymmetry (≥15 mm Hg) in the limbs may improve the diagnosis of atherosclerotic arterial disease at the stage of screening.

About the Authors

R. A. Khokhlov
Regional Clinical Hospital No1. Moskovskii prospekt, 151, Voronezh, 394066 Russia
Russian Federation


A. E. Gaydashev
Russian Peoples' Friendship University. Mikluho-Maclaya Street, 6, Moscow, 117198 Russia
Russian Federation


N. M. Akhmedzhanov
State Research Centre for Preventive Medicine. Petroverigsky per. 10, Moscow, 101990 Russia
Russian Federation


References

1. Order of the Health Ministry on December 3 2012 No 1006n "Procedure for medical examination of certain groups of adults". In Russian (Приказ МЗ РФ от 3 декабря 2012 г. No 1006н «Порядок проведения диспансеризации определённых групп взрослого населения»).

2. Boytsov SA, Chuchalin AG, eds. Dispensary observation of patients with chronic non-communicable diseases and patients with a high risk of their development. Guidelines. Moscow: ROPNZ; 2014. In Russian (Бойцов С.А., Чучалин А.Г., редакторы. Диспансерное наблюдение больных хроническими неинфекционными заболеваниями и пациентов с высоким риском их развития. Методические рекомендации. Москва: РОПНЗ; 2014).

3. ESC/EAS Guidelines for the management of dyslipidaemias: the Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). European Heart Journal 2011;32:1769-818.

4. Хохлов Р.А., Остроушко Н.И., Гайдашев А.Э. и др. Использование многоканальной объемной сфигмографии для кардиоангиологического скрининга взрослого населения. Рациональная фармакотерапия в кардиологии 2015;11(4):371-9. In Russian (Khokhlov R.A., Ostroushko N.I., Gaydashev A.E., et al. Multi-channel volume sphygmography in cardioangiological screening of the adult population. Ration Pharmacother Cardiol 2015;11(4):371-9).

5. Aboyans V., Kamineni A., Allison M. A., et al. The epidemiology of subclavian stenosis and its association with markers of subclinical atherosclerosis: the Multi-Ethnic Study of Atherosclerosis (MESA). Atherosclerosis 2010: 211: 266 -70.

6. Clark C.E., Campbell J.L., Powell R.J. The interarm blood pressure difference as predictor of cardiovascular events in patients with hypertension in primary care: cohort study. Journal of Human Hypertension. 2007: 21, 633-638.

7. Clark CE, Taylor RS, Shore AC, et al. Association of a difference in systolic blood pressure between arms with vascular disease and mortality: a systematic review and meta-analysis. Lancet 2012:380 (9838):218.

8. Sheng CS, Liu M, Zeng WF, et al. Four-Limb Blood Pressure as Predictors of Mortality in Elderly Chinese. Hypertension 2013: 61: 1155-60.

9. White J., Mortensen L.H., Kivimaki M., et al. Interarm differences in systolic blood pressure and mortality among US army veterans: aetiological associations and risk prediction in the Vietnam experience study. Eur J Prev Cardiol 2014;21(11):1394-400.

10. Weinberg I., et al. The Systolic Blood Pressure Difference Between Arms and Cardiovascular Disease in the Framingham Heart Study. The American Journal of Medicine 2014:127, 209-15.

11. Diehma N., Dick F., Czuprina C., et al. Oscillometric measurement of ankle-brachial index in patients with suspected peripheralvascular disease: comparison with Doppler method. Swiss medical weekly 2009; 139 (25-26): 357-63.

12. Clark C.E., Campbell J.L., Evans P.H., Millward A. Prevalence and clinical implications of the inter-arm blood pressure difference: a systematic review. Journal of Human Hypertension 2006; 20: 923-931.

13. Zhang Z., Ma J., Tao X., et al. The Prevalence and Influence Factors of Inter-Ankle Systolic Blood Pressure Difference in Community Population. PLoS ONE 2013; 8(8): e70777.

14. 2013 ESH/ESC Guidelines for the management of arterial hypertension. Journal of Hypertension 2013; 31:1281-357.

15. European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). Eur Heart J 2012;33:1635-701.

16. Criqui MH, McClelland RL, McDermott MM, et al. The Ankle-Brachial Index and Incident Cardiovascular Events in the MESA (Multi-Ethnic Study of Atherosclerosis) J Am Coll Cardiol 2010;56:

17. -12.

18. ESC Guidelines on the diagnosis and treatment of peripheral artery diseases: Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteries: the Task Force on the Diagnosis and Treatment of Peripheral Artery Diseases of the European Society of Cardiology (ESC). European Heart Journal 2011;32,2851-2906.

19. Clark C.E., Steele A.M.,Taylor R.S., et al. Interarm Blood Pressure Difference in People With Diabetes: Measurement and Vascular and Mortality Implications A Cohort Study. Diabetes Care 2014;37: 1613-20.

20. Quiroga B, Galán I, García de Vinuesa S, et al. Interarm systolic blood pressure as a predictor of cardiovascular events in patients with chronic kidney disease. Nephrol Dial Transplant 2015;30:801-6.

21. Su H-M., Lin T-H., Hsu P-C., et al. Association of Interarm Systolic Blood Pressure Difference with Atherosclerosis and LeftVentricular Hypertrophy. PLoS ONE 2012; 7(8): e41173.

22. Su H-M., Lin T-H., Hsu P-C., et al. Association of Bilateral Brachial-Ankle Pulse Wave Velocity Difference with Peripheral VascularDisease and Left Ventricular Mass Index. PLoS ONE 2014;9(2):e88331.


For citation:


Khokhlov R.A., Gaydashev A.E., Akhmedzhanov N.M. Predictors of atherosclerotic lesions of limb arteries according to cardioangiological screening of the adult population. Rational Pharmacotherapy in Cardiology. 2015;11(5):470-476. (In Russ.) https://doi.org/10.20996/1819-6446-2015-11-5-470-476

Views: 353


Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.


ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)