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• Atherosclerosis: what are we looking for?

  Authors: George D Giannoglou, Yiannis S Chatzizisis

  Angiology. 63(5):397-9.

• Rapamycin and thrombosis.

  Authors: Qian Ma

  Angiology. 63(5):336.

• Increased Carotid and Brachial Intima-Media Thickness is Related to Diffuse Coronary Involvement Rather Than Focal Lesions.

  Authors: Aytun Canga, Sinan Altan Kocaman, Murtaza Emre Durakoglugil, Mustafa Cetin, Turan Erdogan, Yüksel Ciçek, Omer Satiroglu

  Angiology.

  We evaluated whether an increased carotid intima-media thickness (cIMT) and brachial artery IMT (bIMT) are related to diffuse coronary involvement rather than focal lesions. Patients (n = 88) with atWe evaluated whether an increased carotid intima-media thickness (cIMT) and brachial artery IMT (bIMT) are related to diffuse coronary involvement rather than focal lesions. Patients (n = 88) with at least 1 significant lesion of the main epicardial coronary arteries (≥50%) were included in the present study. We used a novel score based on length and mean narrowing of all lesions in order to predict diffuse coronary involvement. Both cIMT and bIMT were higher in patients with long coronary lesion than focal lesion (P < .001). The patients with long coronary lesion had a higher rate of total coronary involvement than patients with focal lesion (P < .001). The cIMT had a higher correlation with total atherosclerotic burden in the coronary vasculature (r = .495, P < .001) and the longest lesion length (r = .489, P < .001) than cardiovascular risk factor score (r = .453, P < .001 and r = .324, P = .012, respectively). These findings may be valuable for clarifying the prognostic value of IMT measurements.

• Cholesteryl Ester Transfer Protein and ATP-Binding Cassette Transporter A1 Genotype Alter the Atorvastatin and Simvastatin Efficacy: Time for Genotype-Guided Therapy?

  Authors: Genovefa Kolovou, Vana Kolovou, Constantinos Mihas, Vasiliki Giannakopoulou, Iannis Vasiliadis, Elena Boussoula, Aikaterini Kollia, Maria Boutsikou, Niki Katsiki, Sophie Mavrogeni

  Angiology.

  We compared the efficacy of atorvastatin with simvastatin according to cholesteryl ester transfer protein (CETP) and adenosine triphosphate-binding cassette transporter A1 (ABCA1) genes. PatientsWe compared the efficacy of atorvastatin with simvastatin according to cholesteryl ester transfer protein (CETP) and adenosine triphosphate-binding cassette transporter A1 (ABCA1) genes. Patients treated with atorvastatin (n = 254) or simvastatin (n = 332) were genotyped for CETP (TaqIB and I405V) and ABCA1 (R219K) genetic variants. For genotype B1B2, atorvastatin compared with simvastatin treatment resulted in a greater decrease in total cholesterol (35.4% vs 31.6%, P = .035) and a lower increase in high-density lipoprotein cholesterol (2% vs 8%, P = .05). For genotype B2B2, atorvastatin compared with simvastatin treatment resulted in a lower decrease in low-density lipoprotein cholesterol (31.85 vs 42%, P = .029). For genotypes RR and KK, atorvastatin compared with simvastatin treatment resulted in a greater decrease of triglycerides (27% vs 17% and 35% vs 15%, respectively; P = .02 for all comparisons). ΤThe TaqIB and R219K (opposite to I405V) gene polymorphisms seem to modify the response to lipid-lowering therapy with simvastatin or atorvastatin treatment.

• A High Prevalence of Carotid Artery Stenosis in Male Patients Older Than 65 Years, Irrespective of Presenting Clinical Manifestation of Atherosclerotic Diseases.

  Authors: Seyyed Mohammad Reza Kazemi-Bajestani, Maureen van der Vlugt, Frank-Erik de Leeuw, Jan D Blankensteijn, Sebastian J H Bredie

  Angiology.

  This study investigated the prevalence of carotid artery stenosis (CS) and the association with various risk factors in male patients (>65 years) diagnosed with cardiovascular diseases. DuplexThis study investigated the prevalence of carotid artery stenosis (CS) and the association with various risk factors in male patients (>65 years) diagnosed with cardiovascular diseases. Duplex sonography of the carotid arteries was performed in 434 of 473 eligible patients of whom 118 (27.8%) patients had significant CS ≥50%. The prevalence and severity of CS did not differ between patients who presented with neurological symptoms or acute coronary syndrome/peripheral artery disease (30.8% vs 25.9%, respectively). Among patients with CS, a higher rate of current smoking, a higher systolic blood pressure, and a lower glomerular filtration rate were observed compared with patients without CS. A history of coronary artery bypass graft was a significant predictor of the presence of CS (P = .003, odds ratio [OR] = 2.70 [1.40-5.19]). The prevalence of CS in elderly males with manifest atherosclerotic disease is high, irrespective of presenting clinical manifestation.

• The Vasa Vasorum and Associated Endothelial Nitric Oxide Synthase Is More Important for Saphenous Vein Than Arterial Bypass Grafts.

  Authors: Mats Dreifaldt, Domingos Souza, Lennart Bodin, Xu Shi-Wen, Audrey Dooley, John Muddle, Andrzej Loesch, Michael R Dashwood

  Angiology.

  No-touch (NT) saphenous vein (SV) grafts are superior to SVs harvested by the conventional technique (CT), with a patency comparable with the internal thoracic artery (ITA). Preservation of the vasaNo-touch (NT) saphenous vein (SV) grafts are superior to SVs harvested by the conventional technique (CT), with a patency comparable with the internal thoracic artery (ITA). Preservation of the vasa vasorum is implicated in the success of NT harvesting. We compared the vasa vasorum and endothelial nitric oxide synthase (eNOS) in NT SV with ITA and radial artery (RA) grafts. Skeletonized SV (SSV) was also analyzed. The NT SV had a higher number and larger vasa vasorum compared with ITA (P = .0001) and RA (P = .0004) that correlated with eNOS protein. Activity of eNOS in SSV grafts was significantly lower than NT SV grafts (P = 004). Since a high proportion of the vasa vasorum are removed in SSV using the CT, we suggest that preservation of the vasa vasorum and eNOS-derived NO contributes to the high patency for NT as compared with SSV grafts.

• Gender Differences in Acute Coronary Syndrome in Arab Emirati Women--Implications for Clinical Management.

  Authors: Abdulla Shehab, Javed Yasin, Muhammad Jawad Hashim, Bayan Al-Dabbagh, Wael Al Mahmeed, Nazar Bustani, Amrish Agrawal, Afzalhussein Yusufali, Adel Wassef, Abdulla Alnaeemi

  Angiology.

  Gender differences exist in many aspects of acute coronary syndrome (ACS), including presentation and delay in diagnosis and treatment. The aim of the study was to evaluate gender-related differencesGender differences exist in many aspects of acute coronary syndrome (ACS), including presentation and delay in diagnosis and treatment. The aim of the study was to evaluate gender-related differences in ACS patients in the United Arab Emirates (UAE). We analyzed a subset (n = 1697) of the Gulf Registry of Acute Coronary Events (Gulf RACE) data collected in 2007 of patients with ACS from 18 UAE hospitals. Women were significantly older (mean age: 64.0 ± 12.4 years for females and 50.9 ± 10.6 years for males, P < .001), more often had cardiac risk factors and were significantly less treated with β-blockers and reperfusion therapy. The adjusted mortality rate of women was 4.6% versus 1.2% in men (P < .001). Heart failure was higher in females compared with men (24.6% vs 12.5%; P < .001). Reasons for the high in-hospital mortality in women need to be investigated further.

• Preoperative Assessment and Perioperative Management of Cardiovascular Risk.

  Authors: Juergen Schiefermueller, Saul Myerson, Ashok I Handa

  Angiology.

  Preoperative cardiovascular evaluation of patients scheduled to undergo surgery requires a multidisciplinary approach involving anesthetists, surgeons, and cardiologists. Within the last 5 to 10Preoperative cardiovascular evaluation of patients scheduled to undergo surgery requires a multidisciplinary approach involving anesthetists, surgeons, and cardiologists. Within the last 5 to 10 years, there have been considerable scientific advances in this field, and the European Society of Cardiology (ESC) and the American College of Cardiology/American Heart Association(ACC/AHA) have updated their guidelines.(1,11) Greater emphasis now lies on preoperative clinical risk stratification and less on routine cardiac testing. Prophylactic coronary revascularization is now also seen as rarely indicated simply to lower the risk of surgery.(1) This review will give a brief summary of the guidelines and suggests a practical stepwise approach to evaluate the patient preoperatively.

• Dental management of antiplatelet-receiving patients: is uninterrupted antiplatelet therapy safe?

  Authors: Konstantinos C Koskinas, Theodoros Lillis, Anastasios Tsirlis, Niki Katsiki, George D Giannoglou, Antonios G Ziakas

  Angiology. 63(4):245-7.

• Prevalence of Unrecognized Diabetes Mellitus in Patients Admitted With Acute Coronary Syndrome.

  Authors: Waleed W K, Al-Aqeedi R F, Dabdoob W, Hajar H A, Bener A, Gehani A A

  Angiology.

  We assessed the prevalence of unrecognized diabetes mellitus (DM) in patients with acute coronary syndrome (ACS) as determined by elevated glycosylated hemoglobin (HbA1c), fasting plasma glucoseWe assessed the prevalence of unrecognized diabetes mellitus (DM) in patients with acute coronary syndrome (ACS) as determined by elevated glycosylated hemoglobin (HbA1c), fasting plasma glucose (FPG), and random plasma glucose (RPG) levels. This prospective study recruited 583 patients admitted with ACS without previous diagnosis of DM during 1-year period. Glycosylated hemoglobin was checked for most patients especially those with high values of FPG and or RPG. Patients were classified according to their glycemic state into 123 (21.1%) with DM, 82 (14.1%) with prediabetes, and 57(9.8%) with stress hyperglycemia, while 321 (55%) were classified as nondiabetics. Glycosylated hemoglobin estimation in the setting of ACS was helpful in the diagnosis of DM to eliminate the effect of stress-induced hyperglycemia that might accompany this condition.

• Changes in Small Dense Low-Density Lipoprotein Levels Following Acute Coronary Syndrome.

  Authors: Mahdi Reza Emadzadeh, Maryam-Sadat Alavi, Mohammad Soukhtanloo, Toktam Mohammadpour, Amir Ali Rahsepar, Shima Tavallaie, Roshanak Khojasteh, Roghayeh Paydar, Maral Amini, Seyyed Mohammad Reza Parizadeh, Saeed Akhlaghi, Majid Ghayour-Mobarhan, Gordon A Ferns

  Angiology.

  Low-density lipoprotein (LDL), especially small dense LDL (sdLDL), plays a role in atherogenesis. We compared baseline sdLDL levels between healthy controls and patients with acute coronary syndromeLow-density lipoprotein (LDL), especially small dense LDL (sdLDL), plays a role in atherogenesis. We compared baseline sdLDL levels between healthy controls and patients with acute coronary syndrome (ACS). Blood samples were taken from patients diagnosed with myocardial infarction ([MI] n = 104) and unstable angina ([UA] n = 100). Both sdLDL and high-sensitivity C-reactive protein (hsCRP) levels were determined on admission and in the next 24 hours after the onset of symptoms. Baseline concentration of sdLDL was significantly higher in patients presenting with ACS than controls (P < .05). In the 24 hours following ACS, the sdLDL levels decreased insignificantly in both groups of patients with ACS (P > .05). The changes in sdLDL values were not significantly different between MI and UA participants (P > .05). Patients with ACS have higher concentration of sdLDL compared with the controls.

• Recovery of Endothelial Function After Sirolimus-Eluting Stent Implantation: A Pilot Study.

  Authors: Hideki Kitahara, Yoshihide Fujimoto, Keishi Ishikawa, Yasuhiro Aoki, Yo Iwata, Tadayuki Kadohira, Tomoki Morino, Kenji Ohkubo, Kazumasa Sugimoto, Yoshio Kobayashi

  Angiology.

  Whether endothelial dysfunction after sirolimus-eluting stent (SES) implantation is persistent has not been fully evaluated. Endothelial function was evaluated in 152 lesions that underwent follow-upWhether endothelial dysfunction after sirolimus-eluting stent (SES) implantation is persistent has not been fully evaluated. Endothelial function was evaluated in 152 lesions that underwent follow-up coronary angiography after SES implantation. Lesions were classified into 2 groups according to the duration between SES implantation and follow-up: ≤12 months (n = 95) and >12 months (n = 57). Changes in coronary diameter in response to 10(-8) mol/L (-2.4% ± 6.3% vs -4.9% ± 3.8%, P < .01) and 10(-7) mol/L acetylcholine (Ach; -4.6% ± 7.6% vs -10.7% ± 9.1%, P < .001) in segment proximal to SES were significantly attenuated in the >12-month group than in the ≤12-month group. There were less changes in coronary diameter in response to 10(-8) mol/L (-2.3% ± 4.6% vs -6.9% ± 5.0%, P < .001) and 10(-7) mol/L Ach (-6.5% ± 11.4% vs -16.8% ± 10.5%, P < .001) in segment distal to SES in the >12-month group. Endothelial dysfunction may diminish long after SES implantation.

• Response to the Letter to Editor ''Serum Uric Acid level as a Part of the Metabolic Syndrome Impairs the Coronary Collateral Formation''

  Authors: Mustafa Duran

  Angiology.

• Response to Letter: Mean Platelet Volume in Patients With Dilated Cardiomyopathy and Left Ventricular Thrombus.

  Authors: Gulacan Tekin, Yusuf Kenan Tekin, Nasir Sivri, Ertan Yetkin

  Angiology.

• Relationship Between High-Sensitivity C-Reactive Protein and Risk Factors in Patients With Peripheral Arterial Disease : A Cross-Sectional Study.

  Authors: Milos Maksimovic, Hristina Vlajinac, Djordje Radak, Jelena Marinkovic, Jagoda Jorga

  Angiology.

  We investigated whether patients with peripheral arterial disease (PAD) with various serum levels of high-sensitivity C-reactive protein (hsCRP) differ in the frequency of atherosclerotic riskWe investigated whether patients with peripheral arterial disease (PAD) with various serum levels of high-sensitivity C-reactive protein (hsCRP) differ in the frequency of atherosclerotic risk factors. Among 388 patients, hsCRP levels were (1) low, <1 mg/L, in 41 (10.6%) participants; (2) medium, from 1 to 3 mg/L, in 152 (39.2%) participants, and (3) high, >3 mg/L, in 195 (50.2%) individuals. According to multivariate logistic regression analysis, in comparison with patients with hsCRP level ≤3.0 mg/L, those with higher hsCRP levels had more frequently a severe form of PAD (gangrene, P ranged from .045 to <.001; ankle-brachial index ≤.40, P = .059) and had more frequently some of atherosclerotic risk factors (metabolic syndrome, P = .007; hypertension, P = .013; abdominal obesity, P = .007; high levels of uric acid, P = .022; high level of fibrinogen, P < .001; and depression, P = .015).

• Monocyte Chemoattractant Protein 1 Is Correlated With Glycemic Control and Peripheral Arterial Disease in Type 2 Diabetic Patients With Metabolic Syndrome.

  Authors: K Papatheodorou, N Papanas, D Papazoglou, T Gioka, C Antonoglou, D Glaros, E Maltezos

  Angiology.

  We evaluated the serum levels of monocyte chemoattractant protein 1 (MCP-1) and their association with peripheral arterial disease (PAD) in 199 patients with type 2 diabetes mellitus (T2DM) andWe evaluated the serum levels of monocyte chemoattractant protein 1 (MCP-1) and their association with peripheral arterial disease (PAD) in 199 patients with type 2 diabetes mellitus (T2DM) and metabolic syndrome ([MetS], group A) in comparison with 109 healthy controls (group B). In group A, MCP-1 levels were significantly (P < .001) higher than group B and exhibited a positive correlation with HbA(1c) (P < .001) and a negative correlation with ankle-brachial index (P < .001). In the same group, patients with PAD had significantly higher MCP-1 levels compared with those without PAD (P < .001). In conclusion, T2DM patients with MetS exhibit higher serum MCP-1 levels. The latter is associated with worse glycemic control and PAD. These results suggest a potential contributory role for MCP-1 in the pathogenesis of PAD in the presence of hyperglycemia and MetS in T2DM.

• Why the US Center for Medicare and Medicaid Services Should Not Extend Reimbursement Indications for Carotid Artery Angioplasty/Stenting.

  Authors: Anne L Abbott

  Angiology.

• Serum γ-Glutamyltransferase Activity in Patients With Nonvalvular Atrial Fibrillation.

  Authors: Gulacan Tekin, Yusuf Kenan Tekin, Dilsad Amanvermez Senarslan, Ayse Yesim Gocmen, Omer Senarslan, Ali Riza Erbay

  Angiology.

  Procoagulant and prothrombotic states in patients with chronic atrial fibrillation (AF) are higher than those in patients with normal sinus rhythm. We assessed and compared serum γ-glutamyltranferaseProcoagulant and prothrombotic states in patients with chronic atrial fibrillation (AF) are higher than those in patients with normal sinus rhythm. We assessed and compared serum γ-glutamyltranferase (GGT) activity in elderly patients with nonvalvular AF and control participants with normal sinus rhythm. Consecutive patients (n = 81) with nonvalvular chronic AF and 210 age- and gender-matched control participants with normal sinus rhythm were retrospectively included in the study from the outpatient cardiology clinic. Presence of coronary artery disease, hypertension, gender, hyperlipidemia, diabetes mellitus, smoking status, glucose, total cholesterol, triglycerides, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, and ejection fraction were comparable between the 2 groups (P > .05 for all). However, serum γ-GGT activity was significantly higher (P = .003) in patients with AF compared with those without AF. We have shown that serum γ-GGT activity is independently associated with chronic nonvalvular AF.

• Bilirubin Levels and the Burden of Coronary Atherosclerosis in Patients With STEMI.

  Authors: Omer Sahin, Mahmut Akpek, Deniz Elcik, Serhat Karadavut, Vedat Simsek, Murat Tulmac, Ozcan Orscelik, Bekir Calapkorur, Ali Ergin, Mehmet G Kaya

  Angiology.

  We investigated whether serum bilirubin level (a marker of heme oxygenase activity) is a predictor of high levels of SYNTAX score (SXscore) in patients with acute myocardial infarction. Patients (n =We investigated whether serum bilirubin level (a marker of heme oxygenase activity) is a predictor of high levels of SYNTAX score (SXscore) in patients with acute myocardial infarction. Patients (n = 281; male 77%; mean age 60 ± 12) who were admitted with ST-elevation myocardial infarctions (STEMIs) were enrolled. Patients were divided into 2 groups. Group 1 was defined as SXscore <22 and group 2 was defined as SXscore ≥22. Total bilirubin levels were significantly higher in the high-SXscore group than in the low-SXscore group (0.86 ± 0.42 vs 1.02 ± 0.51, P = .005). A significant correlation was detected between total bilirubin and SXscore (r = .42; P = .001). At multivariate analysis, total bilirubin (odds ratio: 1.86, 95% confidence interval 1.04-3.35; P = .038) was an independent risk factor for high SXscore in patients with STEMI. In conclusion, serum bilirubin level is independently associated with SXscore in patients with STEMI.

• Clinical Presentation and Cardiovascular Risk Profiles in Patients With Left Main Coronary Artery Disease in a Middle Eastern Country.

  Authors: A A Gehani, Ayman El-Menyar, Islam Elgendy, Ahmed Abuzaid, Emad Ahmed, Saiful Haque

  Angiology.

  We evaluated the prevalence and clinical profile of patients with left main coronary artery disease (LMCA) in Qatar between 2006 and 2010. Patients were divided into 2 groups: patients with LMCA andWe evaluated the prevalence and clinical profile of patients with left main coronary artery disease (LMCA) in Qatar between 2006 and 2010. Patients were divided into 2 groups: patients with LMCA and patients without LMCA but had severe 3-vessel disease (VeD) eligible for surgical revascularization. Among 7000 patients who underwent coronary angiography, 210 patients had significant LMCA and 200 patients with severe 3VeD were matched for age and sex. Diabetes mellitus and hypertension were comparable in the 2 groups. Presentations with myocardial infarction or heart failure were comparable in both groups. Isolated LMCA was 4-fold higher in women (P = .02). Dyslipidemia and smoking were more prevalent in patients with distal and proximal lesions, respectively. Renal failure was independent predictor of LMCA (adjusted odds ratio: 2.6; 95% confidence interval: 1.43-4.69). One-year mortality was higher in LMCA (P = .01). The LMCA carries high mortality. Certain cardiovascular risk factors were important predictors of stenosis site.

• Prevalence of Noncalcified Coronary Plaque in Patients With Calcium Score of 0: The Silent Enemy.

  Authors: George Koulaouzidis, Dafni Charisopoulou, Paul J Jenkins, Anastasios Koulaouzidis, Tony McArthur

  Angiology.

  Noncalcified coronary artery plaques (NCAPs) are susceptible to rupture, resulting in coronary artery thrombosis. Using computer tomography coronary angiography (CTCA), we evaluated the prevalenceNoncalcified coronary artery plaques (NCAPs) are susceptible to rupture, resulting in coronary artery thrombosis. Using computer tomography coronary angiography (CTCA), we evaluated the prevalence and degree of stenosis caused by NCAP in patients without coronary artery calcification (CAC). A retrospective analysis of 447 symptomatic patients with 0 CAC score revealed negative CTCA in 400 (89.5%). Noncalcified coronary artery plaques were demonstrated in 47 (10.5%), with 4 presenting stenosis >50%. Patients with positive CTCA, compared to those with normal CTCA, had significantly higher mean age (56.2 years vs 50.6 years, P < .004) and higher pretest coronary artery disease (CAD) probability (26% vs 34%, P < .0001). Noncalcified coronary artery plaque was predominantly developed in the proximal segment of the left anterior descending artery. Noncalcified coronary artery plaque is present in up to 10% of patients with a CAC score of 0. Computer tomography coronary angiography could be of diagnostic value in symptomatic patients with multiple risk factors for CAD, even in the absence of CAC.

• Use of registries to complement clinical trials in renal artery stenting.

  Authors: Pannu Rajmony, Misra Sanjay

  Angiology. 63(3):161-3.

• Novel anticoagulants for atrial fibrillation: a critical appraisal.

  Authors: Stylianos Tzeis, George Andrikopoulos

  Angiology. 63(3):164-70.

  Atrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with an increased risk of thromboembolic complications and stroke. Therefore, the implementation of thromboembolicAtrial fibrillation (AF) is the most common cardiac arrhythmia and is associated with an increased risk of thromboembolic complications and stroke. Therefore, the implementation of thromboembolic preventive treatment is the cornerstone of quality management in AF patients. During the last 60 years, vitamin K antagonists remain at the forefront of antithrombotic management of AF patients. Randomized trials have demonstrated their superiority over aspirin as well as over the combination of aspirin and clopidogrel with similar safety profile. However, the disseminated use of vitamin K antagonists among suitable candidates is hampered by their inherent limitations. As a result, a considerable proportion of AF patients do not receive this life-saving therapy. In the last few years, novel anticoagulants targeting factors IIa (dabigatran) and Xa (rivaroxaban, apixaban, edoxaban) in the coagulation cascade have been developed. Recently completed phase III mega-trials of dabigatran, rivaroxaban and apixaban have provided cumulative evidence in favor of these novel anticoagulants. Their main advantages, apart from their treatment efficacy, include the reduced rate of intracranial hemorrhage, the lack of need for routine coagulation monitoring, the predictable anticoagulation response and the limited interaction with food and drugs. In the present manuscript we present a critical appraisal of the recent trials focusing on issues that are expected to influence decision making on selection of novel anticoagulants.

• Peripheral Arterial Disease Is Prevalent But Underdiagnosed and Undertreated in the Primary Care Setting in Central Greece.

  Authors: Christos Argyriou, Vasileios Saleptsis, Stylianos Koutsias, Athanasios D Giannoukas

  Angiology.

  We investigated the prevalence of peripheral arterial disease (PAD). Primary Care Health Centers (n = 14) in Thessaly (central Greece) recruited 436 participants, mean age 71 (50-79) years.We investigated the prevalence of peripheral arterial disease (PAD). Primary Care Health Centers (n = 14) in Thessaly (central Greece) recruited 436 participants, mean age 71 (50-79) years. Peripheral arterial disease was considered present if the ankle-brachial index (ABI) was <0.9 or >1.4 in at least 1 leg. Asymptomatic PAD was defined as an abnormal ABI and no symptoms or history of limb revascularization. The prevalence of PAD was 13% (mostly asymptomatic, 11.7%). Only 5 (8.77%) of 57 patients with PAD were aware of their disease and only in these patients were the physicians aware of the presence of PAD. The risk factors associated with PAD were age, smoking, and the combination of diabetes mellitus and coronary artery disease. All symptomatic patients were on antiplatelet therapy but 33% did not take statins. For asymptomatic patients, 74.5% were not on antiplatelet therapy and 57% did not receive statins. In the primary health care setting, PAD is underdiagnosed and undertreated.

• Reduced Plasma Eicosapentaenoic Acid-Arachidonic Acid Ratio in Peripheral Artery Disease.

  Authors: Masahiko Fujihara, Mitsuhiro Fukata, Keita Odashiro, Toru Maruyama, Koichi Akashi, Yoshiaki Yokoi

  Angiology.

  A reduced ratio of plasma eicosapentaenoic acid-arachidonic acid (EPA-AA) is a newly recognized atherosclerotic risk factor. This ratio has not been fully investigated in peripheral artery diseaseA reduced ratio of plasma eicosapentaenoic acid-arachidonic acid (EPA-AA) is a newly recognized atherosclerotic risk factor. This ratio has not been fully investigated in peripheral artery disease (PAD). Seventy Japanese patients with atherosclerotic risk factors were enrolled and divided into 2 groups, those with PAD (group A: n = 38) and those without PAD (group B: n = 32). The EPA-AA ratio (P = .001) and ankle-brachial index (ABI: P < .001) in group A were significantly lower than those in group B. Univariate and multivariate analyses demonstrated that EPA-AA, ABI, and prescription of clopidogrel had significant correlation with PAD. Given the appropriate cutoff values, EPA-AA (odds ratio [OR] = 11.7, 95% confidence interval [CI] = 3.0-45.8; P < .001) and ABI (OR = 44.0, 95% CI = 5.4-358.5; P < .001) are factors independently associated with PAD. In conclusion, this study demonstrated that reduced plasma EPA/AA may underlie PAD at least in Japanese.

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