Format

Send to

Choose Destination
See comment in PubMed Commons below
J Vasc Surg. 2014 Apr;59(4):1025-34. doi: 10.1016/j.jvs.2013.10.084. Epub 2014 Jan 11.

Walking disability in patients with peripheral artery disease is associated with arterial endothelial function.

Author information

1
Department of Surgery, University of California San Francisco, San Francisco, Calif; Department of Surgery, Veterans Affairs Medical Center, San Francisco, Calif; VIPERx Laboratory, San Francisco, Calif. Electronic address: marlene.grenon@ucsfmedctr.org.
2
Department of Surgery, University of California San Francisco, San Francisco, Calif; VIPERx Laboratory, San Francisco, Calif.
3
Department of Surgery, University of California San Francisco, San Francisco, Calif; Department of Surgery, Veterans Affairs Medical Center, San Francisco, Calif; VIPERx Laboratory, San Francisco, Calif.
4
Department of Surgery, University of California San Francisco, San Francisco, Calif.
5
Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, Calif; Department of Medicine, University of California San Francisco, San Francisco, Calif.

Abstract

OBJECTIVE:

Patients with peripheral artery disease (PAD) have varying degrees of walking disability that do not completely correlate with ankle-brachial index (ABI) or angiographic anatomy. We hypothesized that endothelial function (EF) is an independent predictor of symptom severity in PAD patients.

METHODS:

This was a cross-sectional study of 100 PAD patients presenting to a vascular surgery clinic. All patients received ABI testing and brachial artery flow-mediated, endothelium-dependent vasodilation (FMD) to assess arterial EF. Symptom severity and walking disability reported by Rutherford category was based on the patient's self-report during the clinic visit and recorded by the investigator-vascular surgeons. Demographic, biochemical, and physiologic parameters were entered into regression equations to determine association with symptom severity.

RESULTS:

Patients were a mean age of 66 ± 8 years, and 43% had diabetes. Mean FMD was 7.4%, indicating impaired EF. EF progressively declined as Rutherford category increased (P = .01). Brachial artery FMD, ABI, systolic blood pressure, C-reactive protein, low-density lipoprotein, high-density lipoprotein, β-blocker use, and a history of diabetes or coronary artery disease were all associated with Rutherford category (all P < .05). Multivariable regression showed EF (P < .02) and ABI (P < .0001) were independently associated with walking disability. When the cohort was restricted to claudicant patients (n = 73), EF remained associated with walking disability after adjustment for other covariates (P = .0001).

CONCLUSIONS:

Symptom severity in PAD is multifactorial, reflecting impaired hemodynamics and vascular dysfunction. This is the first report demonstrating that walking disability in PAD is associated with arterial EF. The mechanistic link underlying these observations remains to be defined.

PMID:
24423479
PMCID:
PMC3966931
DOI:
10.1016/j.jvs.2013.10.084
[Indexed for MEDLINE]
Free PMC Article
PubMed Commons home

PubMed Commons

0 comments
How to join PubMed Commons

    Supplemental Content

    Full text links

    Icon for Elsevier Science Icon for PubMed Central
    Loading ...
    Support Center