Prevalence of lower extremity arterial disease, correlation with diastolic dysfunction of the left ventricle and plasma concentration of asymmetric dimethylarginine in the general population aged 40-65 years - a cross-sectional study

    Authors

    Keywords

    peripheral artery disease, ankle-brachial index, left ventricular dysfunction, asymmetric dimethylarginine

    DOI

    https://doi.org/10.15836/ccar2024.540

    Full Text

    **Introduction:** Although lower extremity arterial disease (LEAD) is the third leading cause of atherosclerotic morbidity, it is still underdiagnosed and undertreated. In most cases, it is discovered in advanced stages. Ankle-brachial index (ABI) is the first-line noninvasive diagnostic method for LEAD. (1-3) The primary goals of our research were: to determine the prevalence of LEAD in the general population and to compare it with the prevalence of two early predictors of endothelial dysfunction - left ventricular diastolic dysfunction (LVDD) and plasma concentrations of asymmetric dimethylarginine (ADMA). Secondary goal was to evaluate the effect of drugs on ADMA concentration. **Patients and Methods:** We conducted a cross-sectional study which included 165 subjects from general population aged 40 to 65 years. We used transthoracic echocardiography to assess left ventricular diastolic function (LVDF). For assessment of LEAD we used ABI, and additionaly duplex ultrasound if ABI was ≤ 1.0 or ≥ 1.4. ADMA was determined from venous blood sample using ELISA method. Subjects were divided into 3 groups: the 1st group - with normal left ventricular diastolic function (LVDF), the 2nd group – with LVDD only and the 3rd group – with coexisting LVDD and LEAD. **Results:** LEAD was confirmed in 21 (13%) participants, the majority were smokers, had diabetes mellitus, heart failure, coronary artery disease, atrial fibrillation and chronic kidney disease. Even 14 of them (67%) were asymptomatic. Participants with normal LVDF had the highest and those with coexisting LEAD and LVDD the lowest plasma ADMA values. Most antihypertensives, as well as acetylsalicylic acid, MRA, insulin and SGLT2 inhibitors reduced ADMA values, but the most powerful were statins. **Conclusion:** We should look for LEAD more often, considering that the vast majority of patients are asymptomatic. Many drugs that we use today to treat dyslipidemia, hypertension, HF and DM improve endothelial function, but statins are the most effective.

    Literature

    1. Criqui MH, Matsushita K, Aboyans V, Hess CN, Hicks CW, Kwan TW, et al. Lower Extremity Peripheral Artery Disease: Contemporary Epidemiology, Management Gaps, and Future Directions: A Scientific Statement From the American Heart Association. Circulation. 2021 August 31;144(9):e171–91. https://doi.org/10.1161/CIR.0000000000001005
    2. Ziegler L, Hedin U, Gottsäter A. Circulating Biomarkers in Lower Extremity Artery Disease. Eur Cardiol. 2022 March 23;17:e09. https://doi.org/10.15420/ecr.2021.58
    3. Mazzolai L, Teixido-Tura G, Lanzi S, Boc V, Bossone E, Brodmann M, et al. 2024 ESC Guidelines for the management of peripheral arterial and aortic diseases. Eur Heart J. 2024 September 29;45(36):3538–700. https://doi.org/10.1093/eurheartj/ehae179
    Cardiologia Croatica
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    Prevalence of lower extremity arterial disease, correlation with diastolic dysfunction of the left ventricle and plasma concentration of asymmetric dimethylarginine in the general population aged 40-65 years - a cross-sectional study

    Extended Abstract
    Issue11-12
    Published
    Pages540
    PDF via DOIhttps://doi.org/10.15836/ccar2024.540
    peripheral artery disease
    ankle-brachial index
    left ventricular dysfunction
    asymmetric dimethylarginine

    Authors

    Livija Sušić*ORCIDHealth Center of Osijek-Baranja County, Osijek, Croatia
    Lana MaričićORCIDUniversity Josip Juraj Strossmayer Faculty of Medicine Osijek, Osijek, Croatia
    Kristina KralikORCIDUniversity Josip Juraj Strossmayer Faculty of Medicine Osijek, Osijek, Croatia
    Ines ŠahinovićORCIDUniversity Hospital Center Osijek, Osijek, Croatia
    Tihomir SušićORCIDThe Information Institute Osijek, Osijek, Croatia
    Marina VidosavljevićORCIDHealth Center of Osijek-Baranja County, Osijek, Croatia
    Mateja ĆosićORCIDHealth Center of Osijek-Baranja County, Osijek, Croatia

    *Correspondence email: livija.susic@gmail.com

    Full Text

    Introduction: Although lower extremity arterial disease (LEAD) is the third leading cause of atherosclerotic morbidity, it is still underdiagnosed and undertreated. In most cases, it is discovered in advanced stages. Ankle-brachial index (ABI) is the first-line noninvasive diagnostic method for LEAD. (1–3) The primary goals of our research were: to determine the prevalence of LEAD in the general population and to compare it with the prevalence of two early predictors of endothelial dysfunction - left ventricular diastolic dysfunction (LVDD) and plasma concentrations of asymmetric dimethylarginine (ADMA). Secondary goal was to evaluate the effect of drugs on ADMA concentration.

    Patients and Methods: We conducted a cross-sectional study which included 165 subjects from general population aged 40 to 65 years. We used transthoracic echocardiography to assess left ventricular diastolic function (LVDF). For assessment of LEAD we used ABI, and additionaly duplex ultrasound if ABI was ≤ 1.0 or ≥ 1.4. ADMA was determined from venous blood sample using ELISA method. Subjects were divided into 3 groups: the 1st group - with normal left ventricular diastolic function (LVDF), the 2nd group – with LVDD only and the 3rd group – with coexisting LVDD and LEAD.

    Results: LEAD was confirmed in 21 (13%) participants, the majority were smokers, had diabetes mellitus, heart failure, coronary artery disease, atrial fibrillation and chronic kidney disease. Even 14 of them (67%) were asymptomatic. Participants with normal LVDF had the highest and those with coexisting LEAD and LVDD the lowest plasma ADMA values. Most antihypertensives, as well as acetylsalicylic acid, MRA, insulin and SGLT2 inhibitors reduced ADMA values, but the most powerful were statins.

    Conclusion: We should look for LEAD more often, considering that the vast majority of patients are asymptomatic. Many drugs that we use today to treat dyslipidemia, hypertension, HF and DM improve endothelial function, but statins are the most effective.

    Literature

    1. 1.
      Criqui MH, Matsushita K, Aboyans V, Hess CN, Hicks CW, Kwan TW, et al. Lower Extremity Peripheral Artery Disease: Contemporary Epidemiology, Management Gaps, and Future Directions: A Scientific Statement From the American Heart Association. Circulation. 2021 August 31;144(9):e171–91.DOI
    2. 2.
      Ziegler L, Hedin U, Gottsäter A. Circulating Biomarkers in Lower Extremity Artery Disease. Eur Cardiol. 2022 March 23;17:e09.DOI
    3. 3.
      Mazzolai L, Teixido-Tura G, Lanzi S, Boc V, Bossone E, Brodmann M, et al. 2024 ESC Guidelines for the management of peripheral arterial and aortic diseases. Eur Heart J. 2024 September 29;45(36):3538–700.DOI