4.7 Review

Focus on Prevention: Peripheral Arterial Disease and the Central Role of the Cardiologist

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Review Peripheral Vascular Disease

Effects of SGLT2 inhibitors and GLP1-receptor agonists on cardiovascular and limb events in peripheral artery disease: A review

Nedaa Skeik et al.

Summary: Peripheral artery disease (PAD) and diabetes mellitus are two major health problems associated with cardiovascular events and increased mortality. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide 1-receptor agonists (GLP1-RA) have shown significant reduction in major adverse cardiovascular events (MACE) in patients with type 2 diabetes and cardiovascular risk.

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Long-term efficacy and safety of inclisiran in patients with high cardiovascular risk and elevated LDL cholesterol (ORION-3): results from the 4-year open-label extension of the ORION-1 trial

Kausik K. Ray et al.

Summary: This study aimed to assess the long-term effect of inclisiran on patients with high cardiovascular risk and elevated LDL cholesterol. The results showed that twice-yearly treatment with inclisiran resulted in sustained reductions in LDL cholesterol and was well tolerated over 4 years.

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Pleiotropic effects of GLP-1 receptor agonists on peripheral artery disease: Is there any hope?

Paola Caruso et al.

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Patients With High Cardiovascular Risk as Candidates to Bempedoic Acid, After Treatment With Statins, Ezetimibe and PCSK9 Inhibitors: An Estimation and Cost-Effectiveness Analysis

Jose Seijas-Amigo et al.

Summary: This study aimed to select potential patients for bempedoic acid treatment and evaluate its cost-effectiveness. The results showed the potential efficacy of PCSK9 inhibitors and different treatment responses in various patient groups. Further research is needed to assess the cost-effectiveness of bempedoic acid in different scenarios.

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Article Cardiac & Cardiovascular Systems

Guideline-Directed Medical Therapy and Long-Term Mortality and Amputation Outcomes in Patients Undergoing Peripheral Vascular Interventions

Kim G. Smolderen et al.

Summary: The lack of guideline-directed medical therapy (GDMT) in patients undergoing peripheral vascular interventions (PVIs) may increase mortality and amputation risk. This study examined the association between GDMT and mortality/amputation, as well as GDMT variability among providers and health systems.

JACC-CARDIOVASCULAR INTERVENTIONS (2023)

Article Cardiac & Cardiovascular Systems

Associations of lower-limb atherosclerosis and arteriosclerosis with cardiovascular risk factors and disease in older adults: The Atherosclerosis Risk in Communities (ARIC) study

Keeron Stone et al.

Summary: ABI and faPWV are independently associated with CVD risk factors and prevalent CVD. Assessment of faPWV may provide additional risk information beyond ABI.

ATHEROSCLEROSIS (2022)

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European Society of Cardiology: cardiovascular disease statistics 2021

Adam Timmis et al.

Summary: This report updates and expands upon the 2019 report, providing cardiovascular disease statistics for the 57 ESC member countries. The report highlights the determinants of CVD and the disparities among different countries.

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Supervised Exercise Therapy is Effective for Patients With Intermittent Claudication Regardless of Psychological Constructs

Sandra C. P. Jansen et al.

Summary: This study aimed to explore the associations between psychological constructs and the effectiveness of intermittent claudication treatment, as well as the potential improvement of self efficacy after treatment. The results showed that anxiety and neuroticism were associated with lower overall quality of life scores, while optimism and self efficacy were associated with higher six minute walk test scores. The beneficial effects of supervised exercise therapy (SET) were not influenced by psychological constructs, supporting the current guidelines recommending SET as the initial treatment strategy for each patient with intermittent claudication.

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Effect of SGLT2 inhibitors versus DPP4 inhibitors or GLP-1 agonists on diabetic foot-related extremity amputation in patients with T2DM: A meta-analysis

Yaping Du et al.

Summary: The study compared the contribution of SGLT2 inhibitors to lower extremity amputation rates with that of DPP4 or GLP-1 inhibitors, finding that SGLT2 inhibitors were not significantly superior to other anti-hyperglycemic agents in terms of diabetic foot-related limb amputations.

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Editorial Material Cardiac & Cardiovascular Systems

Smoking Cessation Improves Outcomes in Patients With Peripheral Artery Disease

Mark A. Creager et al.

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Cardiovascular and Renal Effectiveness of GLP-1 Receptor Agonists vs. Other Glucose-Lowering Drugs in Type 2 Diabetes: A Systematic Review and Meta-Analysis of Real-World Studies

Irene Caruso et al.

Summary: Real-world studies have shown that GLP-1RA treatment has significant cardiovascular benefits compared to other glucose-lowering drugs, but it is less effective in preventing heart failure.

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Review Biochemistry & Molecular Biology

Atherosclerosis: Recent developments

Johan L. M. Bjoerkegren et al.

Summary: This article reviews the current understanding of the molecular, cellular, genetic, and environmental contributions to atherosclerosis and highlights recent developments and unexpected biological findings, such as the heterogeneity of inflammatory and smooth muscle cells in lesions, the roles of senescence and clonal hematopoiesis, and the links to the gut microbiome.
Article Endocrinology & Metabolism

Lower limb amputations: protection with GLP-1 receptor agonists rather than increased risk with SGLT2 inhibitors?

Andre J. Scheen

Summary: The relationship between sodium-glucose cotransporter type 2 inhibitors (SGLT2is) and the risk of lower limb amputations (LLA) remains controversial. Some studies have found that SGLT2i users have more than twofold increased risk of LLA compared to patients treated with glucagon-like peptide-1 receptor agonists (GLP-IRAs), while others have found no such increased risk. Overall, the use of SGLT2is may not increase the risk of LLA, and GLP-IRAs may help reduce such risk.

DIABETES & METABOLISM (2022)

Article Peripheral Vascular Disease

Hypertension-Mediated Organ Damage: Prevalence, Correlates, and Prognosis in the Community

Ramachandran S. Vasan et al.

Summary: This study examined the prevalence, correlates, and prognosis of hypertension-mediated organ damage (HMOD) in a community-based study. The findings showed that the prevalence of HMOD varied across different blood pressure guidelines and that the presence of HMOD increased the risk of cardiovascular disease.

HYPERTENSION (2022)

Article Cardiac & Cardiovascular Systems

Impact of extracardiac vascular disease on outcomes of 1.4 million patients undergoing percutaneous coronary intervention

Hussein Bashar et al.

Summary: Extracardiac vascular disease (ECVD) is associated with worse outcomes in patients undergoing percutaneous coronary intervention (PCI), including significantly higher rates of death and stroke.

CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS (2022)

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Role of Lipid-Lowering Therapy in Peripheral Artery Disease

Agastya D. Belur et al.

Summary: Atherosclerosis is a disease that causes plaque formation and significantly impacts the global rates of cardiovascular diseases. Peripheral artery disease is a common condition that leads to loss of mobility and amputation. This paper reviews the role of lipid-lowering therapies in lower extremity atherosclerotic peripheral artery disease.

JOURNAL OF CLINICAL MEDICINE (2022)

Editorial Material Cardiac & Cardiovascular Systems

2019 ESC/EAS Guidelines for management of dyslipidaemia: strengths and limitations

Michel Zeitouni et al.

Summary: In 2019, the European Society of Cardiology and European Atherosclerosis Society released a new guideline with substantial changes in cardiovascular risk assessment and treatments. The update in high-risk criteria improved primary prevention, but efforts are needed to better include risk modifiers specific to women. The guidelines also discuss the implementation of PCSK9 inhibitors for very high-risk individuals and lowering LDL cholesterol goals to 55 and 40 mg/dL.

EUROPEAN HEART JOURNAL-CARDIOVASCULAR PHARMACOTHERAPY (2021)

Review Cardiac & Cardiovascular Systems

Smoking and the Pathophysiology of Peripheral Artery Disease

Weiming Wang et al.

Summary: Smoking plays a key role in causing peripheral artery disease (PAD) through inducing endothelial cell dysfunction, smooth muscle cell remodeling, and macrophage phenotypic transformation. These pathological changes serve as the molecular basis for the occurrence and development of peripheral vascular diseases.

FRONTIERS IN CARDIOVASCULAR MEDICINE (2021)

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Impact of pre-existent vascular and poly-vascular disease on acute myocardial infarction management and outcomes: An analysis of 2 million patients from the National Inpatient Sample

Ofer Kobo et al.

Summary: Patients with pre-existing vascular disease have worse outcomes after acute myocardial infarction (AMI), with an incremental increase in adverse outcomes as the number of diseased vascular beds increases, and differences in outcomes and utilization of invasive procedures based on sub-types of sites involved.

INTERNATIONAL JOURNAL OF CARDIOLOGY (2021)

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Prevalence of asymptomatic carotid artery stenosis in Chinese patients with lower extremity peripheral arterial disease: a cross-sectional study on 653 patients

Zhui Li et al.

Summary: This study revealed a prevalence of approximately 19.6% for significant ACAS in Southern Chinese patients with PAD. Older age (>70 years), ABI <= 0.5, ABI <= 0.4, and Fontaine stage IV were identified as predictive factors for significant ACAS. Selective carotid screening may be more beneficial for high-risk patients with PAD.

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Major adverse cardiovascular and limb events in patients with diabetes treated with GLP-1 receptor agonists vs DPP-4 inhibitors

Donna Shu-Han Lin et al.

Summary: The study revealed that in patients with type 2 diabetes, the use of GLP1RAs was associated with significantly lower risks of major adverse limb events compared to DPP4is. The reduction in risk was primarily due to decreased rates of amputations.

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Article Cardiac & Cardiovascular Systems

Antithrombotic therapies in aortic and peripheral arterial diseases in 2021: a consensus document from the ESC working group on aorta and peripheral vascular diseases, the ESC working group on thrombosis, and the ESC working group on cardiovascular pharmacotherapy

Victor Aboyans et al.

Summary: The collaborative document aims to update clinicians on optimal antithrombotic strategies for patients with aortic and/or peripheral arterial diseases. It highlights the importance of a regular reassessment of antithrombotic therapy based on individual patient's ischaemic and bleeding risks, as well as therapeutic paths.

EUROPEAN HEART JOURNAL (2021)

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Epidemiology and the Magnitude of Coronary Artery Disease and Acute Coronary Syndrome: A Narrative Review

Udaya Ralapanawa et al.

Summary: Coronary Artery Disease (CAD) is a leading cause of mortality globally, with the burden disproportionately affecting low and middle income countries. There are significant variations in CAD prevalence and mortality rates among different regions and countries, with developed countries experiencing a decline in CAD incidence over the years. On the other hand, developing countries are facing an increasing incidence of CAD due to globalization of the Western diet and sedentary lifestyles.

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Morbidity and mortality associated with atherosclerotic peripheral artery disease: A systematic review

Giancarlo Agnelli et al.

ATHEROSCLEROSIS (2020)

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2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD

Francesco Cosentino et al.

EUROPEAN HEART JOURNAL (2020)

Article Peripheral Vascular Disease

Arterial stiffness and 5-year mortality in patients with peripheral arterial disease

Giovanni Scandale et al.

JOURNAL OF HUMAN HYPERTENSION (2020)

Editorial Material Cardiac & Cardiovascular Systems

Evaluating Multisite Atherosclerosis and its Progression Ready for Prime Time?

Nathan D. Wong

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY (2020)

Article Medicine, General & Internal

Rivaroxaban in Peripheral Artery Disease after Revascularization

Marc P. Bonaca et al.

NEW ENGLAND JOURNAL OF MEDICINE (2020)

Article Hematology

Epidemiology and Risk of Amputation in Patients With Diabetes Mellitus and Peripheral Artery Disease

J. Aaron Barnes et al.

ARTERIOSCLEROSIS THROMBOSIS AND VASCULAR BIOLOGY (2020)

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Alirocumab in Patients With Polyvascular Disease and Recent Acute Coronary Syndrome ODYSSEY OUTCOMES Trial

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William E. Kraus et al.

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Successful Smoking Cessation Associated with Walking Behavior in Patients with Claudication

Sherene E. Sharath et al.

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Risk of peripheral artery disease according to a healthy lifestyle score: The PREDIMED study

Nieves Lopez-Laguna et al.

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Ten Year Mortality in Different Peripheral Arterial Disease Stages: A Population Based Observational Study on Outcome

Fredrik Sartipy et al.

EUROPEAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY (2018)

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2018 ESC/ESH Guidelines for the management of arterial hypertension

Bryan Williams et al.

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Polyvascular disease, type 2 diabetes, and long-term vascular risk: a secondary analysis of the IMPROVE-IT trial

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Fiona Bragg et al.

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Rivaroxaban with or without Aspirin in Stable Cardiovascular Disease

J. W. Eikelboom et al.

NEW ENGLAND JOURNAL OF MEDICINE (2017)

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Ticagrelor versus Clopidogrel in Symptomatic Peripheral Artery Disease

William R. Hiatt et al.

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Fabian Sanchis-Gomar et al.

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Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes

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NEW ENGLAND JOURNAL OF MEDICINE (2015)

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Usual blood pressure, peripheral arterial disease, and vascular risk: cohort study of 4.2 million adults

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BMJ-BRITISH MEDICAL JOURNAL (2015)

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Usual blood pressure, peripheral arterial disease, and vascular risk: cohort study of 4.2 million adults

Connor A. Emdin et al.

BMJ-BRITISH MEDICAL JOURNAL (2015)

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Usefulness of the Ankle-Brachial Index to Predict High Coronary SYNTAX Scores, Myocardium at Risk, and Incomplete Coronary Revascularization

Meghan Sebastianski et al.

AMERICAN JOURNAL OF CARDIOLOGY (2014)

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Multisite artery disease: a common and challenging clinical condition calling for specific management

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High Prevalence of Peripheral Arterial Disease in Patients with Acute Ischaemic Stroke

Raffi Topakian et al.

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Aspirin for Prevention of Cardiovascular Events in a General Population Screened for a Low Ankle Brachial Index A Randomized Controlled Trial

F. Gerald R. Fowkes et al.

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION (2010)

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Sex differences in the prevalence of peripheral artery disease in patients undergoing coronary catheterization

Amir H. Sadrzadeh Rafie et al.

VASCULAR MEDICINE (2010)

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Ankle Brachial Index Combined With Framingham Risk Score to Predict Cardiovascular Events and Mortality

JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION (2008)

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Telmisartan, ramipril, or both in patients at high risk for vascular events

Salim Yusuf et al.

NEW ENGLAND JOURNAL OF MEDICINE (2008)

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Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes

Anushka Patel et al.

NEW ENGLAND JOURNAL OF MEDICINE (2008)

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Hertzel C. Gerstein et al.

NEW ENGLAND JOURNAL OF MEDICINE (2008)

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10-year follow-up of intensive glucose control in type 2 diabetes

Rury R. Holman et al.

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Clopidogrel and aspirin versus aspirin alone for the prevention of atherothrombotic events

DL Bhatt et al.

NEW ENGLAND JOURNAL OF MEDICINE (2006)

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Impact of ramipril in patients with evidence of clinical or subclinical peripheral arterial disease

J Ostergren et al.

EUROPEAN HEART JOURNAL (2004)

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Premature cardiovascular disease is common in relatives of patients with premature peripheral atherosclerosis

RJ Valentine et al.

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