Journal of the Chinese Medical Association
Volume 69, Issue 1 , Pages 14-20, January 2006

Prevalence of Arteriosclerosis and Atherosclerosis in Stable Patients at a Cardiovascular Outpatient Clinic: Potential for Better Care

  • Hao-Min Cheng

      Affiliations

    • Department of Medicine, Taipei Veterans General Hospital, Taiwan, R.O.C.
    • ,
  • Wen-Chung Yu

      Affiliations

    • Department of Medicine, Taipei Veterans General Hospital, Taiwan, R.O.C.
    • ,
  • Chen-Huan Chen

      Affiliations

    • Department of Medicine, Taipei Veterans General Hospital, Taiwan, R.O.C.
    • Cardiovascular Research Center, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • Department of Social Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, R.O.C.
    • Corresponding Author InformationCorrespondence to: Dr. Chen-Huan Chen, Division of Cardiology, Taipei Veterans General Hospital, 201, Section 2, Shih-Pai Road, Taipei 112, Taiwan, R.O.C.

Received 4 April 2005; accepted 3 November 2005.

Article Outline

Background

Cardiovascular treatment guidelines for stable patients who are regularly followed up at medical center clinics have long been practiced and are intended to improve arteriosclerosis and atherosclerosis in these patients. The present study investigated the prevalence of arteriosclerosis and atherosclerosis in patients attending one such clinic, and explored the potential for better care.

Methods

A total of 124 outpatients randomly selected from 586 stable outpatients on regular visits to the same senior cardiologist were invited to receive measurements of brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index (ABI) using a novel device during their clinic visits. Abnormally high baPWV was defined using the age- and sex-stratified reference ranges obtained from a previous community survey.

Results

The prevalence of high baPWV in the studied outpatients was 24.2% and the prevalence of low ABI (< 0.9) was 8.1%. Based on the reports of baPWV and ABI at the point of care, medications were adjusted in 56 patients (45.2%). In 22 patients who had adjusted antihypertensive medication and repeat examinations of baPWV and ABI at subsequent visits, systolic blood pressure fell by 11 mmHg (p = 0.012), and baPWV fell by 0.2 m/s (p = 0.001).

Conclusion

Abnormal baPWV and ABI are not uncommon in stable patients who are regularly followed up at a cardiology clinic where treatment guidelines are completely followed. Fast assessment of arteriosclerosis and atherosclerosis at the point of care may provide better care for this group of patients.

Key Words:  ankle-brachial index , arteriosclerosis , atherosclerosis , pulse wave velocity

No full text is available. To read the body of this article, please view the PDF online.

 

Back to Article Outline

References 

  1. Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL, et al  The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report . JAMA . 2003;289:2560–2572
  2. Anonymous  . 2003 European Society of Hypertension-European Society of Cardiology guidelines for the management of arterial hypertension . J Hypertens . 2003;21:1011–1053
  3. Anonymous  . Executive summary of the third report of the National Cholesterol Education Program (NCEP) expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) . JAMA . 2001;285:2486–2497
  4. De Backer G, Ambrosioni E, Borch-Johnsen K, Brotons C, Cifkova R, Dallongeville J, et al  European guidelines on cardiovascular disease prevention in clinical practice. Third joint task force of European and other societies on cardiovascular disease prevention in clinical practice . Eur Heart J . 2003;24:1601–1610
  5. Gibbons RJ, Abrams J, Chatterjee K, Daley J, Deedwania PC, Douglas JS, et al  ACC/AHA 2002 guideline update for the management of patients with chronic stable angina-summary article: a report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee on the Management of Patients with Chronic Stable Angina) . Circulation . 2003;107:149–158
  6. Andrade SE, Gurwitz JH, Field TS, Kelleher M, Majumdar SR, Reed G, et al. Hypertension management: the care gap between clinical guidelines and clinical practice . Am J Manag Care . 2004;10:481–486
  7. LaBresh KA , Ellrodt AG , Gliklich R , Liljestrand J , Peto R . Get with the guidelines for cardiovascular secondary prevention: pilot results . Arch Intern Med . 2004;164:203–209
  8. Iglseder B , Moroder T , Staffen W , Ladurner G . Inadequate management of cerebrovascular risk factors in participants of a public stroke prevention program in Austria . Eur J Neurol . 2004;11:679–685
  9. Blacher J , Asmar R , Djane S , London GM , Safar ME . Aortic pulse wave velocity as a marker of cardiovascular risk in hypertensive patients . Hypertension . 1999;33:1111–1117
  10. O'Rourke MF , Mancia G . Arterial stiffness . J Hypertens . 1999;17:1–4
  11. O'Leary DH , Polak JF , Kronmal RA , Manolio TA , Burke GL , Wolfson SK . Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group . N Engl J Med . 1999;340:14–22
  12. Lonn EM, Yusuf S, Dzavik V, Doris C, Yi Q, Smith S, et al  Effects of ramipril and vitamin E on atherosclerosis: the study to evaluate carotid ultrasound changes in patients treated with ramipril and vitamin E (SECURE) . Circulation . 2001;103:919–925
  13. Guerin AP , Blacher J , Pannier B , Marchais SJ , Safar ME , London GM . Impact of aortic stiffness attenuation on survival of patients in end-stage renal failure . Circulation . 2001;103:987–992
  14. Et-Taouil K , Safar M , Plante GE . Mechanisms and consequences of large artery rigidity . Can J Physiol Pharmacol . 2003;81:205–211
  15. Papamichael CM, Lekakis JP, Stamatelopoulos KS, Papaioannou TG, Alevizaki MK, Cimponeriu AT, et al  Ankle-brachial index as a predictor of the extent of coronary atherosclerosis and cardiovascular events in patients with coronary artery disease . Am J Cardiol . 2000;86:615–618
  16. Anonymous  . Clinical practice recommendations 2005 . Diabetes Care . 2005;28(Suppl):1–79
  17. Hunt SA, Baker DW, Chin MH, Cinquegrani MP, Feldman AM, Francis GS, et al  ACC/AHA guidelines for the evaluation and management of chronic heart failure in the adult: executive summary a report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee to Revise the 1995 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the International Society for Heart and Lung Transplantation; endorsed by the Heart Failure Society of America . Circulation . 2001;104:2996–3007
  18. Yamashina A, Tomiyama H, Takeda K, Tsuda H, Arai T, Hirose K, et al  Validity, reproducibility, and clinical significance of noninvasive brachial-ankle pulse wave velocity measurement . Hypertens Res . 2002;25:359–364
  19. Darling RC , Raines JK , Brener BJ , Austen WG . Quantitative segmental pulse volume recorder: a clinical tool . Surgery . 1972;72:873–877
  20. Chuang SY , Chen CH , Cheng CM , Chou P . Combined use of brachial-ankle pulse wave velocity and ankle-brachial index for fast assessment of arteriosclerosis and atherosclerosis in a community . Int J Cardiol . 2005;98:99–105
  21. Weitz JI, Byrne J, Clagett GP, Farkouh ME, Porter JM, Sackett DL, et al  Diagnosis and treatment of chronic arterial insufficiency of the lower extremities: a critical review . Circulation . 1996;94:3026–3049
  22. Laurent S , Kingwell B , Bank A , Weber M , Struijker-Boudier H . Clinical applications of arterial stiffness: therapeutics and pharmacology . Am J Hypertens . 2002;15:453–458
  23. Hiatt WR . Medical treatment of peripheral arterial disease and claudication . N Engl J Med . 2001;344:1608–1621
  24. Kubo T , Miyata M , Minagoe S , Setoyama S , Maruyama I , Tei C . A simple oscillometric technique for determining new indices of arterial distensibility . Hypertens Res . 2002;25:351–358
  25. Belch JJ, Topol EJ, Agnelli G, Bertrand M, Califf RM, Clement DL, et al  Critical issues in peripheral arterial disease detection and management: a call to action . Arch Intern Med . 2003;163:884–892
  26. Yusuf S , Sleight P , Pogue J , Bosch J , Davies R , Dagenais G . Effects of an angiotensin-converting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients . N Engl J Med . 2000;342:145–153
  27. Burns P , Gough S , Bradbury AW . Management of peripheral arterial disease in primary care . BMJ . 2003;326:584–588

PII: S1726-4901(09)70105-4

doi:10.1016/S1726-4901(09)70105-4

Journal of the Chinese Medical Association
Volume 69, Issue 1 , Pages 14-20, January 2006

Article Tools