Leg Symptoms in Peripheral Arterial Disease

McDermott, Mary M.; Greenland, Philip; Liu, Kiang; Guralnik, Jack M.; Criqui, Michael H.; Dolan, Nancy C.; Chan, Cheeling; Celic, Lillian; Pearce, William H.; Schneider, Joseph R.; Sharma, Leena; Clark, Elizabeth T.; Gibson, Daniel; Martin, Gary J.

doi:10.1001/jama.286.13.1599

Cited by 733 publications

(297 citation statements)

References 34 publications

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“…However, patients, particularly diabetic patients, commonly have other processes at the same time that can alter the traditional symptoms of PAD, making them much less specific [33] . Accordingly, the measurement of the ratio of the systolic blood pressures in the ankle and the arm, the ABI, has been recommended as the screening method for asymptomatic PAD and as a form of confirmation in symptomatic PAD [2,34,35] .…”

Section: Diagnosis Of Pad In Diabetesmentioning

confidence: 99%

Peripheral arterial disease, type 2 diabetes and postprandial lipidaemia: Is there a link?

Valdivielso

Ramírez-Bollero

Pérez-López

2014

WJD

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Section: Diagnosis Of Pad In Diabetesmentioning

confidence: 99%

Peripheral arterial disease, type 2 diabetes and postprandial lipidaemia: Is there a link?

Valdivielso

Ramírez-Bollero

Pérez-López

2014

WJD

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“…6 which is greater than or similar to the costs associated with cardiac dysrhythmias, congestive heart failure and cerebrovascular disease. Patients with PAD have ambulatory dysfunction and leg pain, 7 impaired physical function, 8, 9 lower physical activity levels. 10, 11 and even worse health-related quality of life scores than in individuals with coronary artery disease and congestive heart failure.…”

Section: Introductionmentioning

confidence: 99%

Gender and racial differences in endothelial oxidative stress and inflammation in patients with symptomatic peripheral artery disease

Gardner

Parker

Montgomery

et al. 2015

Journal of Vascular Surgery

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Background We compared (a) cellular reactive oxygen species (ROS) production, inflammation, and apoptosis of cultured endothelial cells treated with sera, and (b) circulating inflammatory, antioxidant capacity, vascular biomarkers, and calf muscle hemoglobin oxygen saturation (StO2) in men and women with PAD. A secondary aim was to compare exercise performance and daily ambulatory activity between men and women. We hypothesized that women would have more impaired endothelial cellular ROS, inflammation, and apoptosis than men, as well as worse systemic inflammation, antioxidant capacity, vascular biomarkers, calf muscle StO2, exercise performance, and daily ambulatory activity. Methods One hundred forty-eight symptomatic men and women with PAD were characterized on the endothelial effects of circulating factors present in the sera using a cell culture-based bioassay on primary human arterial endothelial cells. Patients were further evaluated on circulating inflammatory and vascular biomarkers, physical examination and medical history, exercise performance, calf muscle StO2 during exercise, and ambulatory activity monitored during one week. Results Cellular ROS production was higher in African-American women than in men (p = 0.021), but there was no gender difference in Caucasians (p = 537). Men and women were not significantly different on endothelial cell apoptois (p = 833) and NF-κB activity (p = 0.465). For circulating factors, additional gender differences were found when comparisons were made within each race. In African-Americans, women had higher intercellular cell adhesion molecule-1 (p = 0.022) and leptin (p < 0.001), whereas in Caucasians, women had higher matrix metallopeptidase 9 (p = 0.047), higher vascular cell adhesion molecule-1 (p = 0.047), and lower hepatocyte growth factor (p = 0.046). Overall, women had higher apolipoprotein CIII (p = 0.035), lower pain-free distance (p = 0.048) and total distance (p < 0.001) during the 6-minute walk test, shorter time for calf muscle StO2 to reach the minimum value during exercise (p = 0.027), and slower average cadence (p = 0.004) during daily ambulation. Conclusions African-American women with symptomatic PAD have a heightened oxidative status likely resulting in increased endothelial oxidative stress than men. Furthermore, women exhibit a more pronounced pro-inflammatory profile of circulating biomarkers than men, as well as more limited peripheral microcirculation, exercise performance, and ambulatory activity than men. The clinical significance is that women with symptomatic PAD are in greater need of clinical intervention to improve oxidative stress, inflammation, and microcirculation than men, which may, in turn, favorably impact their lower exercise performance and daily activity.

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“…Alternately, physical inactivity or comorbid diseases limiting ambulation may prevent even patients with severe PAD from reaching an ischemic threshold. 8 It is important to better understand the pain symptomatology in PAD to improve diagnosis and initiation of measures to mitigate symptoms, progression, and its associated risk for ischemic events.…”

mentioning

confidence: 99%

Exertional Leg Pain in Patients With and Without Peripheral Arterial Disease

et al. 2005

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Background-Although exertional leg pain is a hallmark of peripheral arterial disease (PAD) and can occur in persons without PAD, symptom variation has received inadequate attention. Methods and Results-Three cohort studies were combined for cross-sectional analysis. The San Diego ClaudicationQuestionnaire assessed exertional leg pain. PAD was defined as ankle brachial index (ABI) Յ0.90 or history of lower-extremity revascularization. Of 3658 subjects, 3629 were analyzed after exclusions. Of these, 24.1% had PAD in 1 or both legs. There was a stepwise decrease in average ABI, from no pain to pain on exertion and rest, noncalf pain, atypical calf pain, and classic claudication (Pϭ0.002). When stratified by PAD, this trend was no longer significant.

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Leg Symptoms in Peripheral Arterial Disease

Abstract: There is a wide range of leg symptoms in persons with PAD beyond that of classic IC. Comorbid disease may contribute to these symptoms in PAD. Functional impairments are found in every PAD symptom group, and the degree of functional limitation varies depending on the type of leg symptom.

Cited by 733 publications

References 34 publications

Peripheral arterial disease, type 2 diabetes and postprandial lipidaemia: Is there a link?

Peripheral arterial disease, type 2 diabetes and postprandial lipidaemia: Is there a link?

Gender and racial differences in endothelial oxidative stress and inflammation in patients with symptomatic peripheral artery disease

Exertional Leg Pain in Patients With and Without Peripheral Arterial Disease

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