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Ciccarone Articles

Ciccarone Center Research


PVD – Peripheral Vascular Disease

Usefulness of baseline obesity to predict development of a high ankle brachial index (from the Multi-Ethnic Study of Atherosclerosis).
By: Tison GH, Ndumele CE, Gerstenblith G, Allison MA, Polak JF, Szklo M.
An abnormally high ABI is associated with increased all-cause and cardiovascular mortality. The relation of obesity to incident high ABI has not been characterized. The aim of this study was to investigate the hypothesis that increased obesity — quantified by body weight, body mass index, waist circumference, and waist-to-hip-ratio — is positively associated with a high ABI (?1.3) and with mean ABI increases over a 4-year follow-up. Independent, positive, and graded associations of increasing obesity with prevalent and incident high ABI and with mean increases in ABI values over time were found. Weight and body mass index seemed to be at least as strongly, if not more strongly, associated with a high ABI than were measures of abdominal obesity.
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Approach to smoking cessation in the patient with vascular disease.
By: Ratchford EV, Black JH 3rd.
In the patient with vascular disease, cigarette smoking is particularly perilous; the benefits of smoking cessation greatly exceed any risks associated with pharmacologic treatment. Multiple clinical trials have demonstrated the efficacy of pharmacologic therapy for smoking cessation. In parallel with aggressive counseling and pharmacotherapy for smoking cessation, cardiovascular risk reduction is critical.
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Abdominal aortic calcium and multisite atherosclerosis: the Multiethnic Study of Atherosclerosis.
By: Wong ND, Lopez VA, Allison M, Detrano RC, Blumenthal RS, Folsom AR, Ouyang P, Criqui MH.

Abdominal aortic calcification (AAC) is a measure of subclinical CVD. Data are limited regarding its relation to other measures of atherosclerosis. Among 1,812 subjects within the population-based MESA, we examined the cross-sectional relation of AAC with CAC, ankle brachial index (ABI), and CIMT, as well as multiple measures of subclinical CVD. Our study found that AAC is associated with an increased likelihood of other vascular atherosclerosis and its additive prognostic value to these other measures is of further interest.

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The relationship between inflammation, obesity and risk for hypertension in the Multi-Ethnic Study of Atherosclerosis (MESA).
By: Lakoski SG, Cushman M, Siscovick DS, Blumenthal RS, Palmas W, Burke G, Herrington DM.
It has been suggested that inflammation is important in the etiology of hypertension and that this may be most relevant among obese persons. To study this, we examined the independent relationships between obesity, inflammation-related proteins (interleukin-6 (IL-6), CRP and fibrinogen) and risk for hypertension in the Multi-Ethnic Study of Atherosclerosis. The relationship between inflammation-related proteins and hypertension risk was predominantly explained by other hypertension risk factors. Obesity, independent of inflammation, remained a potent risk factor for future hypertension.
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Lower extremity peripheral artery disease in the absence of traditional risk factors. The Multi-Ethnic Study of Atherosclerosis.
By: Aboyans V, McClelland RL, Allison MA, McDermott MM, Blumenthal RS, Macura K, Criqui MH.
Lower-extremity peripheral artery disease (LE-PAD) is strongly related to traditional risk factors (smoking, hypertension, dyslipidemia, diabetes). We hypothesized that the prevalence of LE-PAD in the absence of traditional CVD risk factors is not negligible, and that this condition would remain associated with subclinical atherosclerosis in other territories. In the absence of traditional CVD risk factors, LE-PAD is still fairly common and associated with coronary artery disease.
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The ankle-brachial index and incident cardiovascular events in the MESA (Multi-Ethnic Study of Atherosclerosis).
By: Criqui MH, McClelland RL, McDermott MM, Allison MA, Blumenthal RS, Aboyans V, Ix JH, Burke GL, Liu K, Shea S.
Abnormal ABIs, both low and high, are associated with elevated CVD risk. However, it is unknown whether this association is consistent across different ethnic groups, and whether it is independent of both newer biomarkers and other measures of subclinical atherosclerotic CVD. In this study, both a low and a high ABI were associated with elevated CVD risk in persons free of known CVD, independent of standard and novel risk factors, and independent of other measures of subclinical CVD. Further research should address the cost-effectiveness of measuring the ABI in targeted population groups.
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Images in vascular medicine: Giant iliac artery aneurysms.
By: Ratchford EV, Black JH.
A common iliac artery aneurysm is defined as a 50% increase in diameter compared with the normal artery and typically occurs in conjunction with an abdominal aortic aneurysm (AAA), as seen in this case. The majority result from degenerative atherosclerosis, and patients are most often asymptomatic. While open surgery with a prosthetic graft has been the traditional therapy, endovascular repair has emerged as the treatment of choice for common iliac artery aneurysms with suitable anatomy.
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Update on peripheral arterial disease and claudication rehabilitation.
By: Salameh MJ, Ratchford EV
Peripheral arterial disease is often under diagnosed and under treated due to a general lack of awareness on the part of the patient and the practitioner. The evidence-base is growing for the optimal medical management of the patient with peripheral arterial disease; in parallel, endovascular revascularization options continue to improve. Comprehensive care of the peripheral arterial disease patient focuses on the ultimate goals of improving quality of life and reducing cardiovascular morbidity and mortality.
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