Principal predictors of major adverse limb events in diabetic peripheral artery disease: A narrative review

Biscetti, Federico; Cecchini, Andrea Leonardo; Rando, Maria Margherita; Nardella, Elisabetta; Gasbarrini, Antonio; Massetti, Massimo; Flex, Andrea

doi:10.1016/j.athplu.2021.10.003

Cited by 5 publications

(1 citation statement)

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“…Despite significant improvements in the treatment of traditional cardiovascular risk factors, there is a substantial number of patients with PAD that experience significant progression of disease burden and poor outcomes [3][4][5]. This residual risk and disease progression suggest a plausible resistance to traditional therapies that have failed to address other pathophysiological disease pathways [6].…”

Section: Introductionmentioning

confidence: 99%

Current Medical Therapy and Revascularization in Peripheral Artery Disease of the Lower Limbs: Impacts on Subclinical Chronic Inflammation

Cecchini,

Biscetti,

Manzato

et al. 2023

IJMS

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Peripheral artery disease (PAD), coronary artery disease (CAD), and cerebrovascular disease (CeVD) are characterized by atherosclerosis and inflammation as their underlying mechanisms. This paper aims to conduct a literature review on pharmacotherapy for PAD, specifically focusing on how different drug classes target pro-inflammatory pathways. The goal is to enhance the choice of therapeutic plans by considering their impact on the chronic subclinical inflammation that is associated with PAD development and progression. We conducted a comprehensive review of currently published original articles, narratives, systematic reviews, and meta-analyses. The aim was to explore the relationship between PAD and inflammation and evaluate the influence of current pharmacological and nonpharmacological interventions on the underlying chronic subclinical inflammation. Our findings indicate that the existing treatments have added anti-inflammatory properties that can potentially delay or prevent PAD progression and improve outcomes, independent of their effects on traditional risk factors. Although inflammation-targeted therapy in PAD shows promising potential, its benefits have not been definitively proven yet. However, it is crucial not to overlook the pleiotropic properties of the currently available treatments, as they may provide valuable insights for therapeutic strategies. Further studies focusing on the anti-inflammatory and immunomodulatory effects of these treatments could enhance our understanding of the mechanisms contributing to the residual risk in PAD and pave the way for the development of novel therapies.

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Section: Introductionmentioning

confidence: 99%

Current Medical Therapy and Revascularization in Peripheral Artery Disease of the Lower Limbs: Impacts on Subclinical Chronic Inflammation

Cecchini,

Biscetti,

Manzato

et al. 2023

IJMS

Self Cite

View full text Add to dashboard Cite

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Association of Lipoprotein(a) Levels With Incidence of Major Adverse Limb Events

et al. 2022

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ImportanceHigh lipoprotein(a) (Lp[a]) levels are involved in the development of cardiovascular events, particularly in myocardial infarction, stroke, and peripheral artery disease. Studies assessing the Lp(a) levels associated with adverse lower-limb events are lacking.ObjectiveTo assess the association between Lp(a) levels and incidence of major adverse limb events in unselected hospitalized patients.Design, Setting, and ParticipantsThis large retrospective monocentric cohort study was conducted from January 1, 2000, to December 31, 2020. Data were derived from the clinical information system of the Hôpital Européen Georges-Pompidou, a Paris-based university hospital. Patients who underwent at least 1 Lp(a) measurement at the center during the study period were included. Patients who had no follow-up data or who had the first Lp(a) measurement after the study outcome had occurred were excluded. Data analyses were performed from May 2021 to January 2022.Main Outcomes and MeasuresThe primary outcome was the first inpatient major adverse limb event, defined as a major amputation, peripheral endovascular revascularization, or peripheral surgical revascularization, during follow-up. Secondary outcomes included individual components of the primary outcome. Lipoprotein(a) levels were categorized as follows: normal (&lt;50 mg/dL), high (50 to &lt;134 mg/dL), and very high (≥134 mg/dL); to convert Lp(a) values to milligrams per liter, multiply by 0.1.ResultsA total of 16 513 patients (median [IQR] age, 58.2 [49.0-66.7] years; 9774 men [59.2%]) were included in the cohort. The median (IQR) Lp(a) level was 24 (10.0-60.0) mg/dL. The 1-year incidence of major adverse limb event was 2.44% in the overall population and 4.54% among patients with very high Lp(a) levels. High (adjusted accelerated failure time [AFT] exponential estimate: 0.43; 95% CI, 0.24-0.78; Benjamini-Hochberg–corrected P = .01) and very high (adjusted AFT exponential estimate: 0.17; 95% CI, 0.07-0.40; Benjamini-Hochberg–corrected P &lt; .001) Lp(a) levels were independently associated with an increased risk of major adverse limb event.Conclusions and RelevanceResults of this study showed that higher Lp(a) levels were independently associated with an increased risk of a major adverse limb event in hospitalized patients. The Lp(a) measurement needs to be taken into account to improve lower-limb vascular risk assessment.

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Principles of Anaesthesia in Endovascular Procedures

Khan,

Banugo,

Bidd

2024

Mastering Endovascular Techniques

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Principal predictors of major adverse limb events in diabetic peripheral artery disease: A narrative review

Cited by 5 publications

References 250 publications

Current Medical Therapy and Revascularization in Peripheral Artery Disease of the Lower Limbs: Impacts on Subclinical Chronic Inflammation

Current Medical Therapy and Revascularization in Peripheral Artery Disease of the Lower Limbs: Impacts on Subclinical Chronic Inflammation

Association of Lipoprotein(a) Levels With Incidence of Major Adverse Limb Events

Principles of Anaesthesia in Endovascular Procedures

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