Markers predicting progression of disease in PAD

B.-M. Taute

doi:10.1055/s-0037-1617063

Hämostaseologie, Table of Contents

Hamostaseologie 2006; 26(03): 201-207
DOI: 10.1055/s-0037-1617063

Original Article

Schattauer GmbH

Prädiktive Marker der Krankheitsprogression bei pAVK

Welche sind praxisrelevant und ökonomisch vertretbar?Markers predicting progression of disease in PADWhich of them are both relevant to clinical practice and economically justifiable?

B.-M. Taute

¹Schwerpunkt Angiologie (Leitung: Prof. Dr. med. H. Podhaisky) der Universitätsklinik und Poliklinik für Innere Medizin III (Direktor: Prof. Dr. med. K. Werdan) an der Martin-Luther-Universität Halle- Wittenberg

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Abstract

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Zusammenfassung

Die hohe kardiovaskuläre Morbidität und Mortalität ist bei peripherer arterieller Verschlusskrankheit (pAVK) auf die ausgeprägte Generalisationstendenz des atherosklerotischen Prozesses, die systemische Atheroskleroseprogression, zurückzuführen. Das entscheidende Ziel im Management einer pAVK besteht in der Prävention der systemischen Progression. Eine Verbesserung der Prognose wird durch Früherkennung und frühzeitige individuelle Risikoprädiktion mit nachfolgender risikoadaptierter Prävention und einer kausal orientierten Therapie möglich. Früherkennung und Risikoprädiktion sind Maßnahmen, die bereits in der hausärztlichen Praxis angesiedelt sind. Für die individuelle Risikostratifizierung bedarf es deshalb praktikabler und ökonomisch vertretbarer Parameter, die dennoch hohen prädiktiven Wert besitzen. Geeignet sind die vaskulären Indikatoren Knöchel-Arm-Druckindex (ABI) und Lokalisationstyp der pAVK sowie die klassischen vaskulären Risikofaktoren unter Einschluss des Homozysteins. Die gewichtete Zusammenführung dieser Parameter in einen multivariablen Risiko-Score ermöglicht die Identifikation des Höchstrisikokollektivs für eine frühzeitige Generalisation der Atherosklerose bei pAVK.

Summary

The high cardiovascular morbidity and mortality on peripheral arterial disease (PAD) are attributable to the pronounced tendency to generalization of the atherosclerotic process, the systemic progression of atherosclerosis. The crucial objective in management of a PAD consists in preventing systemic progression. The prognosis can be improved by early diagnosis and early prediction of individual risk with subsequent risk-adapted prevention and causal therapy. Early diagnosis and risk prediction are measures that are already part of the repertory of the general practitioner. Practicable and economically justifiable parameters that nevertheless have a high predictive value are therefore required to stratify individual risk. The vascular indicators ankle-arm index and the localization of the PAD as well as the classical cardiovascular risk factors including homocysteine are suitable. Weighting of these parameters in a multivariable risk score enable the population with the highest risk of early generalization of atherosclerosis to be identified in PAD.

Schlüsselwörter

Periphere arterielle Verschlusskrankheit - systemische Atheroskleroseprogression - Risikoprädiktion

Keywords

Peripheral arterial disease - systemic progression of atherosclerosis - risk prediction

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References

Literatur
1 American Diabetes Association.. Peripheral arterial disease in people with diabetes. Diabetes Care 2003; 26: 3333-41.
2 Bhatt DL, Steg PG, Ohman EM. et al. REACH Registry Investigators. International prevalence, recognition, and treatment of cardiovascular risk factors in outpatients with atherothrombosis. JAMA 2006; 295: 180-9.
3 Bloor K. Natural history of arteriosclerosis of the lower limbs. Ann R Coll surg Engl 1961; 28: 36-51.
4 Brevetti G, Silvestro A, Schiano V. et al. Endothelial dysfunction and cardiovascular risk prediction in peripheral arterial disease: additive value of flow-mediated dilation to ankle-brachial pressure index. Circulation 2003; 108: 2093-8.
5 Conroy RM, Pyorala K, Fitzgerald AP. et al. SCORE project group. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 2003; 11: 987-1003.
6 Criqui MH, Langer RD, Fronek A. et al. Coronary disease and stroke in patients with large-vessel peripheral arterial disease. Drugs 1991; 42: 16-21.
7 Criqui MH, Langer RD, Fronek A. et al. Mortality over a period of 10 years in patients with peripheral arterial disease. N Engl J Med 1992; 326: 381-6.
8 De Backer G, Ambrosioni E, Borch-Johnsen K. et al. Third Joint Task Force of European and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. European guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J 2003; 24: 1601-10.
9 Diehm C, Schuster A, Allenberg JR. et al. High prevalence of peripheral arterial disease and comorbidity in 6880 primary care patients: crosssectional study. Atherosclerosis 2004; 172: 95-105.
10 Fechner L, Große L, Podhaisky H. et al. Untersuchungen zur klinischen Manifestation der peripheren arteriellen Verschlusskrankheit bei Diabetes mellitus. Herz/Kreisl 1998; 30: 176-9.
11 Gerstein HC, Mann JF, Yi Q. et al. HOPE Study Investigators. Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. JAMA 2001; 286: 421-6.
12 Goessens BM, Visseren FL, Algra A. et al. SMART Study Group. Screening for asymptomatic cardiovascular disease with noninvasive imaging in patients at high-risk and low-risk according to the European Guidelines on Cardiovascular Disease Prevention: the SMART study. J Vasc Surg 2006; 43: 525-32.
13 Haennel RG, Lemire F. Physical activity to prevent cardiovascular disease. How much is enough? Can Fam Physician 2002; 48: 65-71.
14 Hayden MR, Tyagi SC. Homocysteine and reactive oxygen species in metabolic syndrome, type 2 diabetes mellitus, and atheroscleropathy: The pleiotropic effects of folate supplementation. Nutr J 2004; 3: 4.
15 Hertzer NR, Beven EG, Young JR. et al. Coronary artery disease in peripheral vascular patients. A classification of 1000 coronary angiograms and results of surgical management. Ann Surg. 1984; 199: 223-33.
16 Hirsch AT, Criqui MH, Treat-Jacobson D. et al. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA 2001; 286: 1317-24.
17 Hoogeveen EK, Kostense PJ, Jakobs C. et al. Hyperhomocysteinaemia is not associated with isolated crural arterial occlusive disease: The Hoorn Study. J Intern Med 2000; 247: 442-8.
18 Kannel WB, Skinner Jr JJ, Schwartz MJ. et al. Intermittent claudication. Incidence in the Framingham Study. Circulation 1970; 41: 875-83.
19 Kelle S, Hänsgen K, Taute BM. et al. Koronare Risikoindikatoren bei Patienten mit peripherer arterieller Verschlusskrankheit. Perfusion 2001; 13: 4-8.
20 Leng GC, Fowkes FG, Lee AJ. et al. Use of ankle brachial pressure index to predict cardiovascular events and death: a cohort study. Br Med J 1996; 313: 1440-4.
21 Matetzky S, Freimark D, Ben-Ami S. et al. Association of elevated homocysteine levels with a higher risk of recurrent coronary events and mortality in patients with acute myocardial infarction. Arch Intern Med 2003; 163: 1933-7.
22 McDermott MM, Feinglass J, Slavensky R. et al. The ankle-brachial index as a predictor of survival in patients with peripheral vascular disease. J Gen Intern Med 1994; 9: 445-9.
23 Moyna NM, Thompson PD. The effect of physical activity on endothelial function in man. Acta Physiol Scand 2004; 180: 113-23.
24 Murabito JM, Evans JC, Larson MG. et al. Framingham Study. The ankle-brachial index in the elderly and risk of stroke, coronary disease, and death: the Framingham Study. Arch Intern Med 2003; 163: 1939-42.
25 Newman AB, Shemanski L, Manolio TA. et al. Ankle-arm index as a predictor of cardiovascular disease and mortality in the Cardiovascular Health Study. The Cardiovascular Health Study Group. Arterioscler Thromb Vasc Biol 1999; 19: 538-45.
26 Nikolsky E, Mehran R, Dangas GD. et al. Prognostic significance of cerebrovascular and peripheral arterial disease in patients having percutaneous coronary interventions. Am J Cardiol 2004; 93: 1536-9.
27 Norman PE, Davis WA, Bruce DG. et al. Peripheral arterial disease and risk of cardiac death in type 2 diabetes: the Fremantle Diabetes Study. Diabetes Care 2006; 29: 575-80.
28 O’Hare AM, Glidden DV, Fox CS. et al. High prevalence of peripheral arterial disease in persons with renal insufficiency: results from the National Health and Nutrition Examination Survey 1999–2000. Circulation 2004; 109: 320-3.
29 O’Riordain DS, O’Donnell JA. Realistic expectations for the patient with intermittent claudication. Br J Surg 1991; 78: 861-3.
30 Podhaisky H. Die arterielle Verschlusskrankheit als Markererkrankung kardiovaskulärer Ereignisse – Konsequenzen für die Praxis. Spektrum der Diabetologie 2003; 2: 11-17.
31 Podhaisky H, Hänsgen K, Taute BM. et al. Duplexsonographie im distalen Extremitätenbereich zur Schweregradbeurteilung der PAVK. Perfusion 2005; 18: 95-100.
32 Smith GD, Shipley MJ, Rose G. Intermittent claudication, heart disease risk factors, and mortality. The Whitehall Study. Circulation 1990; 82: 1925-31.
33 TASC Working Group: Management of peripheral arterial disease.. TransAtlantic Inter-Society Consensus. Int Angiol 2000; 19 (Suppl. 01) 5-34.
34 Taute BM. Multivariabler Risikoscore zur Beurteilung des systemischen Progressionsrisikos bei symptomatischer peripherer arterieller Verschlusskrankheit. In: Taute BM. (Hrsg). Interdisziplinäre Angiologie. Berlin: Dr. Köster; 2005: 73-90.
35 Taute BM, Feller S, Hänsgen K. et al. Carotid atherosclerosis in patients with peripheral arterial disease. Perfusion 2002; 15: 183-8.
36 Taute BM, Hänsgen K, Fechner L. et al. Untersuchungen zum Progressionsrisiko der peripheren arteriellen Verschlusskrankheit. Vasomed 1997; 9: 8-15.
37 Taute BM, Taute R, Heins S. et al. Hyperhomocysteinemia – marker of systemic atherosclerosis in peripheral arterial disease. Int Angiol 2004; 23: 35-40.
38 Taute BM, Taute R, Podhaisky H. Cardiovascular risk assessment in arteriosclerotic peripheral arterial disease. J Pharmakol Ther 2003; 12: 171-7.
39 Taute BM, Taute R, Podhaisky H. Risikokonstellation postmenopausaler Frauen mit PAVK. VASA 2005; 34: 73.
40 Taylor Jr LM, Moneta GL, Sexton GJ. et al. Prospective blinded study of the relationship between plasma homocysteine and progression of symptomatic peripheral arterial disease. J Vasc Surg 1999; 29: 8-21.
41 Violi F, Criqui M, Longoni A. et al. Relation between risk factors and cardiovascular complications in patients with peripheral vascular disease. Results from the A. D. E. P. study. Atherosclerosis 1996; 120: 25-35.
42 Woo KS, Chook P, Lolin YI. et al. Folic acid improves arterial endothelial function in adults with hyperhomocystinemia. J Am Coll Cardiol 1999; 34: 2002-6.
43 Yu S, Yarnell JW, Sweetnam PM. et al. Caerphilly study. What level of physical activity protects against premature cardiovascular death? The Caerphilly study. Heart 2003; 89: 502-6.