A simple screening method for peripheral arterial occlusive disease.
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Arterial Occlusive Diseases↗
Biomedical subjects
H S Feigelson
Publications and source records attributed to H S Feigelson.
Screening for peripheral arterial disease: the sensitivity, specificity, and predictive value of noninvasive tests in a defined population.
Large vessel peripheral arterial disease (LV-PAD) is a common condition that causes significant morbidity and disability. The authors evaluated the individual components of a comprehensive noninvasive vascular examination to identify the most sensitive and specific measurements for diagnosing LV-PAD. This cohort, initially screened between 1979 and 1981 in Rancho Bernardo, California, included 421 normal subjects and 63 subjects with LV-PAD. Segmental blood pressure ratios and flow velocities by Doppler ultrasound were used to define cases of LV-PAD. The sensitivity, specificity, positive predictive value, and negative predictive value of each individual component of the diagnostic algorithm were determined. Overall, measurements of posterior tibial flow showed the highest sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy. In addition, an absent or non-recordable posterior tibial peak forward flow, occurring in 96% of all limbs with isolated posterior tibial disease, or an ankle ratio < or = 0.8 considered in parallel yielded a test with sensitivity of 89%, specificity of 99%, positive predictive value of 90%, negative predictive value of 99%, and overall accuracy of 98%. These results indicate that the vast majority of LV-PAD cases can be detected with a single measurement using a handheld Doppler flowmeter employed at the ankle.
Adult↗
The low HDL cholesterol/high triglyceride trait.
In 748 probands and 3,283 first-degree relatives from the Collaborative Lipid Research Clinics (LRC) Family Study, our specific aim was to examine the degree to which low (bottom decile) high density lipoprotein cholesterol (HDL-C, hypoalpha) and high (top decile) triglyceride (TG, hyperTG) levels occur conjointly (CT) and the extent to which these characteristics were shared within families. To control for family size and permit a comparison with the proband percentages, mean familial percentages of HDL-C/TG abnormalities were calculated. Concurrent low HDL-C and high TG levels were present in 2.7% of the probands, a value that was enriched to 12.7% (p = 0.003) of their associated first-degree relatives. If the proband had a low HDL-C value, 7.7% (p = 0.013) of relatives had CT. Familial (proband and at least one first-degree family member share the same lipoprotein/lipid phenotype) hypoalpha was observed in 2.4% of families while familial hyperTG was observed in 4.1%. Familial CT was seen in approximately 0.7%. If the proband had CT, 80% of their families had at least one other first-degree member with an HDL-C/TG abnormality, whereas the corresponding percentage for families associated with probands with only hypoalpha was 64% and for those with hyperTG alone, 54%. A broadly shared environmental factor cannot easily explain the familial association of hypoalpha, hyperTG, and CT. In probands with low HDL-C values alone or the conjoint low-HDL-C/high-TG trait, family screening is extremely valuable because low HDL-C/high TG is enriched in the respective family members, a conjoined trait closely associated with increased coronary heart disease risk.
Cholesterol, HDL↗
Mortality over a period of 10 years in patients with peripheral arterial disease.
BACKGROUND: Previous investigators have observed a doubling of the mortality rate among patients with intermittent claudication, and we have reported a fourfold increase in the overall mortality rate among subjects with large-vessel peripheral arterial disease, as diagnosed by noninvasive testing. In this study, we investigated the association of large-vessel peripheral arterial disease with rates of mortality from all cardiovascular diseases and from coronary heart disease. METHODS: We examined 565 men and women (average age, 66 years) for the presence of large-vessel peripheral arterial disease by means of two noninvasive techniques--measurement of segmental blood pressure and determination of flow velocity by Doppler ultrasound. We identified 67 subjects with the disease (11.9 percent), whom we followed prospectively for 10 years. RESULTS: Twenty-one of the 34 men (61.8 percent) and 11 of the 33 women (33.3 percent) with large-vessel peripheral arterial disease died during follow-up, as compared with 31 of the 183 men (16.9 percent) and 26 of the 225 women (11.6 percent) without evidence of peripheral arterial disease. After multivariate adjustment for age, sex, and other risk factors for cardiovascular disease, the relative risk of dying among subjects with large-vessel peripheral arterial disease as compared with those with no evidence of such disease was 3.1 (95 percent confidence interval, 1.9 to 4.9) for deaths from all causes, 5.9 (95 percent confidence interval, 3.0 to 11.4) for all deaths from cardiovascular disease, and 6.6 (95 percent confidence interval, 2.9 to 14.9) for deaths from coronary heart disease. The relative risk of death from causes other than cardiovascular disease was not significantly increased among the subjects with large-vessel peripheral arterial disease. After the exclusion of subjects who had a history of cardiovascular disease at base line, the relative risks among those with large-vessel peripheral arterial disease remained significantly elevated. Additional analyses revealed a 15-fold increase in rates of mortality due to cardiovascular disease and coronary heart disease among subjects with large-vessel peripheral arterial disease that was both severe and symptomatic. CONCLUSIONS: Patients with large-vessel peripheral arterial disease have a high risk of death from cardiovascular causes.
Adult↗
Coronary disease and stroke in patients with large-vessel peripheral arterial disease.
Previous reports have indicated an excess of mortality from coronary heart disease (CHD), cardiovascular disease (CVD), and all causes in subjects with large-vessel peripheral arterial disease (LV-PAD). However, there is little information available concerning the risk of nonfatal events (morbidity) in this patient group. In a population-based study of 67 patients with LV-PAD and 408 control subjects without this condition, nonfatal CHD and stroke, and total CVD events, morbidity and mortality were evaluated in both men and women. Those with LV-PAD had a 3-fold excess of CVD morbidity at baseline compared with control subjects of the same sex. However, the absolute CVD rates were greater in men than women. During the 10 years of follow-up, women with LV-PAD had more nonfatal CVD events than men, resulting in comparable overall morbidity rates. In logistic regression models adjusted for other CVD risk factors, total CVD morbidity and mortality combined with 2.5 times as great in men and 5 times as great in women with LV-PAD as in those without peripheral arterial disease. These results suggest that the total morbidity and mortality burden are dramatically increased in both men and women with LV-PAD.
Adult↗
Use of prenatal services by Hispanic women in San Diego County. A comparison of urban and rural settings.
The purpose of this study was to investigate patterns of prenatal care use among urban and rural Hispanic women in San Diego County, California. A cohort study of Hispanic women delivering at one of five San Diego County hospitals between July 1991 and January 1992 was conducted (N = 587). Data were collected by in-person interview and medical record abstraction. Logistic regression was used to identify variables associated with late entry into prenatal care, while simultaneously adjusting for important confounding variables. Three factors were found to be significantly associated with late entry into prenatal care. Women who resided in urban areas were two times more likely to enter prenatal care late as compared to women who lived in rural areas (odds ratio = 2.11; 95% confidence intervals (CI) = 1.12, 4.0). Women who reported not having initially "wanted" the pregnancy were 2.2 times more likely to enter prenatal care late (95% CI = 1.05, 4.59). The risk of entering prenatal care late increased by 20% for each additional barrier to care that was reported (95% CI = 1.09, 1.34). Results indicate that timely entry into prenatal care may be improved among San Diego Hispanic women by targeting specific barriers to prenatal care identified in this study and by providing greater family planning assistance to this population to decrease unwanted pregnancies.
Adult↗