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van Mil, ACCM, Pouwels, S, Wilbrink, J, Warlé, MC and Thijssen, DHJ (2017) Carotid Artery Reactivity Predicts Events in Peripheral Arterial Disease Patients. Annals of Surgery. ISSN 0003-4932
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van Mil - CAR-PAD prognosis -redlined-2- Annals of surgery_final.pdf - Accepted Version Download (644kB) | Preview |
Abstract
OBJECTIVE: Patients with peripheral arterial disease (PAD) have increased risk on future cerebro- and cardiovascular events. Our aim was to examine whether carotid artery reactivity (CAR; a novel, simple procedure to examine endothelial function) predicts cardiovascular events in PAD patients. BACKGROUND: Increased risk for future cardiovascular events in PAD patients is likely related to endothelial dysfunction, highlighting the necessity for simple assessment of endothelial function. METHODS: A total of 172 PAD patients (68 ± 10 years, 67% male) underwent the CAR, which involves ultrasound measurement of carotid artery diameter during sympathetic stimulation produced by 90-second hand immersion in 4°C ice-water (ie, cold pressor test). CAR-responses were dichotomized into carotid constriction or dilation. We recorded cardiac and cerebrovascular events, mortality, and clinical progression to percutaneous transluminal angioplasty or loss of patency during 12-month follow-up. RESULTS: Eighty-two PAD patients demonstrated carotid constriction and 90 patients demonstrated dilation. PAD patients with carotid constriction showed more cardiovascular events compared to patients with dilation (Kaplan-Meier Log rank; P < 0.05). Cox proportional hazard models showed that patients with carotid constriction continued to show higher risk for cardiovascular events [hazard ratio: 4.1; 95% confidence interval (CI), 1.3-12.5] and clinical progression (hazard ratio: 2.0; 95% CI, 1.2-3.3), even after adjustment for other risk factors. Ankle brachial pressure index and carotid intima-medial thickness alone did not predict (cardiovascular) event or improve risk assessment beyond that provided by CAR. CONCLUSION: Carotid vasoconstriction identifies PAD patients with a 4-fold increased risk for future cardiovascular events and 2-fold increased risk for clinical deterioration. CAR provides a simple, novel strategy to predict cardiovascular events and progression in PAD patients. CLINICAL TRIAL REGISTRATION: www.trialregister.nl/trialreg/index.asp, NTR-4117.
| Item Type: | Article |
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| Additional Information: | This is the accepted version of the following article: van Mil, Anke C. C. M. MSc; Pouwels, Sjaak PhD; Wilbrink, Jelmer MSc; Warlé, Michiel C. MD; Thijssen, Dick H. J. PhD Carotid Artery Reactivity Predicts Events in Peripheral Arterial Disease Patients. Annals of Surgery. 23/10/2017 http://dx.doi.org/10.1097/SLA.0000000000002558 |
| Uncontrolled Keywords: | 11 Medical And Health Sciences |
| Subjects: | R Medicine > RC Internal medicine > RC1200 Sports Medicine |
| Divisions: | Sport & Exercise Sciences |
| Publisher: | Lippincott, Williams & Wilkins |
| Related URLs: | |
| Date Deposited: | 30 Oct 2017 11:43 |
| Last Modified: | 04 Sep 2021 03:41 |
| DOI or ID number: | 10.1097/SLA.0000000000002558 |
| URI: | https://researchonline.ljmu.ac.uk/id/eprint/7438 |
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