2,4 More specifically, associated mechanisms of medial VC include an accompanying decrease in inhibition of antimineralization factors, such as pyrophosphate, which is expressed by blood vessels.
Medial calcification (Mönckeberg sclerosis) is more prevalent in intra-abdominal and lower extremity arteries, and the complex pathophysiology of medial arteriosclerosis is thought to be associated with an upregulation of bone-associated proteins and osteoblast differentiation factors. Intimal calcification occurs in association with a classically obstructive atherosclerotic plaque. When it occurs, calcium deposition is typically seen in two of the three anatomic layers of arteries, specifically the intima and media. Calcification of the vasculature is triggered by inflammation as an active pathologic response to systemic disease. 1-3 The pathophysiology of VC was previously attributed to elevated serum calcium levels however, this theory has recently fallen out of favor. This is especially true because VC is ubiquitous, found in up to 47% to 72% of PAD patients. All rights reserved.Vascular calcification (VC) in peripheral artery disease (PAD) presents a treatment challenge. These findings support the recognition of NCAD as a high-risk phenotype and provide additional relevance to ABI screening in diabetics.ĪBI Ankle–brachial index CAC CVD Cardiovascular disease HDL-c LDL-c Medial artery calcification NCAD PAD PDHS Penn Diabetes Health Study Subclinical atherosclerosis Vascular stiffness ankle–brachial index cIMT cardiovascular disease carotid intima–media thickness coronary artery calcium eGFR estimated glomerular filtration rate high-density lipoprotein cholesterol low-density lipoprotein cholesterol non-compressible arterial disease peripheral arterial disease.Ĭopyright © 2013 Elsevier Ireland Ltd. NCAD bears a distinct relationship to traditional CVD risk factors among diabetics, though like PAD is independently associated with increased CAC. Both PAD and NCAD were independently associated with increased CAC compared to those with normal ABI, and these relationships were not attenuated in multiply adjusted models. Multivariate logistic and Tobit linear regression were used to compare CVD risk factors and coronary artery (CAC) among 1863 subjects with PAD (ABI ≤ 0.9), NCAD (ABI ≥ 1.4 or non-compressible) or normal ABI (0.91-1.39).Ĭompared to those with normal ABI, PAD was associated with smoking, obesity, and lower HDL-c while diabetes duration and reduced renal function were associated with NCAD. The Penn Diabetes Heart Study (PDHS) is a prospective observational cohort of diabetic individuals without clinically evident CVD. Our objective is to investigate whether low and high ABI have distinct patterns of association with cardiovascular disease (CVD) risk factors and subclinical atherosclerosis in individuals with type-II diabetes mellitus. A high ABI represents non-compressible arterial disease (NCAD), and is also associated with increased mortality and vascular events. A low ABI identifies obstructive lower extremity vascular disease and predicts CVD events and increased mortality.
Ankle-brachial index (ABI) screening is recommended for the detection of asymptomatic peripheral arterial disease (PAD) in at-risk populations, including diabetics.
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