Associations of candidate biomarkers of vascular disease with the ankle-brachial index and peripheral arterial disease.

BACKGROUND: The use of multiple biomarkers representing various etiologic pathways of atherosclerosis may improve the prediction of interindividual variation in the ankle-brachial index (ABI). To this end, we investigated associations of 47 candidate biomarkers with the ABI and presence of peripheral arterial disease (PAD) in African-Americans (AAs) and non-Hispanic whites (NHWs). METHODS: Study participants included 1,291 AAs (71.1% women, mean age, 63.4±9.3 years) and 1,152 NHWs (57.5% women, mean age 58.5±10.1 years) belonging to hypertensive sibships. Peripheral arterial disease was defined as an ABI ≤ 0.90. Circulating levels of 47 candidate biomarkers were log-transformed before analysis because of skewed distribution. Multivariate regression analyses were used to identify biomarkers associated with ABI or PAD independently of age, sex, conventional risk factors, and medication use. RESULTS: After adjustment for covariates, higher levels of nine biomarkers were associated with a lower ABI in AAs (all P ≤ 0.005); these biomarkers were C-reactive protein (CRP), interleukin-6, tumor necrosis factor receptor-II (TNF-R II), lipoprotein(a), N-terminal pro-brain natriuretic peptide (NT-proBNP), pro-atrial natriuretic peptide, C-terminal pro-arginine vasopressin, osteoprotegerin, and fibrinogen. Three biomarkers - myeloperoxidase, NT-proBNP, and D-dimer - were associated with ABI in NHWs (all P ≤ 0.01). C-reactive protein, interleukin-6, TNF-R II, lipoprotein(a), NT-proBNP, pro-atrial natriuretic peptide, D-dimer, and fibrinogen were associated with PAD (all P ≤ 0.005) in AAs after adjustment for covariates. None of the biomarkers were independently associated with PAD in NHWs. CONCLUSION: A multimarker approach improved the prediction of interindividual variation in the ABI in AAs and NHWs, and improved prediction of the presence of PAD in AAs.

Leveraging informatics for genetic studies: use of the electronic medical record to enable a genome-wide association study of peripheral arterial disease.

BACKGROUND: There is significant interest in leveraging the electronic medical record (EMR) to conduct genome-wide association studies (GWAS). METHODS: A biorepository of DNA and plasma was created by recruiting patients referred for non-invasive lower extremity arterial evaluation or stress ECG. Peripheral arterial disease (PAD) was defined as a resting/post-exercise ankle-brachial index (ABI) less than or equal to 0.9, a history of lower extremity revascularization, or having poorly compressible leg arteries. Controls were patients without evidence of PAD. Demographic data and laboratory values were extracted from the EMR. Medication use and smoking status were established by natural language processing of clinical notes. Other risk factors and comorbidities were ascertained based on ICD-9-CM codes, medication use and laboratory data. RESULTS: Of 1802 patients with an abnormal ABI, 115 had non-atherosclerotic vascular disease such as vasculitis, Buerger's disease, trauma and embolism (phenocopies) based on ICD-9-CM diagnosis codes and were excluded. The PAD cases (66+/-11 years, 64% men) were older than controls (61+/-8 years, 60% men) but had similar geographical distribution and ethnic composition. Among PAD cases, 1444 (85.6%) had an abnormal ABI, 233 (13.8%) had poorly compressible arteries and 10 (0.6%) had a history of lower extremity revascularization. In a random sample of 95 cases and 100 controls, risk factors and comorbidities ascertained from EMR-based algorithms had good concordance compared with manual record review; the precision ranged from 67% to 100% and recall from 84% to 100%. CONCLUSION: This study demonstrates use of the EMR to ascertain phenocopies, phenotype heterogeneity and relevant covariates to enable a GWAS of PAD. Biorepositories linked to EMR may provide a relatively efficient means of conducting GWAS.

Bis(isovalerylacetone)ethylenediimine nickel(II) as mixed stationary phase for gas chromatography.

Bis(isovalerylacetone)ethylenediimine Nickel (II) (IVA(2)enNi) was examined as a mixed stationary phase with OV1 on Chromosorb G/NAW 60-80 mesh size for gas chromatography (GC) separation of aromatic hydrocarbons, heteroaromatics, alcohols, aldehydes, ketones, esters, nitro-, and amino compounds. Forty-six compounds were examined, and the GC results were compared with those obtained with 3% OV1 on Chromosorb G/NAW 60-80 mesh size under similar operating conditions. Improved resolutions, peak asymmetry, number of theoretical plates, and Kovats indices were obtained on the mixed stationary phase 3% OV1 + 5% IVA(2)enNi (w/w) compared to 3% OV1 column. The stability constant (K(m)), enthalpies (DeltaH), entropies (DeltaS), and Gibbs free energies (DeltaG) of the GC elution on column (2 m x 3 mm i.d.) packed with 3% OV1 + 5% IVA(2)enNi (w/w) on Chromosorb have been calculated. Donor-acceptor complexation in the gas phase indicated by the negative values of enthalpy (-DeltaH) were within 9.4-12.38 Kcal/mol, and Gibbs free energy (-DeltaG) ranged from 1.48 to 4.24 Kcal/mol. The retention time transformation on both the phases were calculated. The obtained ratios from the stationary phases 3% OV1 and 3% OV1 + 5% IVA(2)enNi (w/w) were plotted on the x-axis and y-axis, respectively. Two-dimensional chromatographic plots for alkanes, aromatics, heteroaromatics, ketones, alcohols, esters, and nitro compounds were obtained with coefficient of determination within 0.4934 and 0.9617, which is indicative of some different kinds of interaction of two stationary phases with the solutes.

Association of serum myeloperoxidase with the ankle-brachial index and peripheral arterial disease.

Myeloperoxidase (MPO) is an enzymatic mediator of several inflammatory cascades and higher serum levels have been associated with increased risk of adverse cardiovascular events. We investigated the association of serum MPO with the ankle-brachial index (ABI) and peripheral arterial disease (PAD) in a bi-ethnic cohort of African-Americans and non-Hispanic white individuals. Participants included 1324 African-Americans (mean age 64 years, 71% women) and 1237 non-Hispanic white individuals (mean age 59 years, 57% women) belonging to hypertensive sibships. Serum levels of MPO were measured by solid phase sandwich immunoassay. ABI was measured using a standard protocol and PAD was defined as an ABI < 0.90. Multivariable regression analysis using generalized estimating equations were performed to assess whether serum MPO levels were associated with ABI and the presence of PAD. After adjustment for age and sex, higher MPO levels were significantly associated with lower ABI and the presence of PAD in African-Americans (p = 0.004 and p = 0.005, respectively) and in non-Hispanic white individuals (p = 0.001 and p = 0.016, respectively). After additional adjustment for conventional risk factors (diabetes, smoking status, total and high-density lipoprotein cholesterol, waist circumference, hypertension), prior history of myocardial infarction or stroke, and medication use (statins, aspirin, estrogen), higher MPO levels remained significantly associated with lower ABI and the presence of PAD in both African-Americans (p = 0.008 and p = 0.010, respectively) and non-Hispanic white individuals (p = 0.001 and p = 0.018, respectively). We conclude that higher MPO levels are associated with lower ABI and the presence of PAD in African-Americans and non-Hispanic white individuals.

Association of serum osteoprotegerin with ankle-brachial index and urine albumin: creatinine ratio in African-Americans and non-Hispanic whites.

Osteoprotegerin (OPG), a member of tumor necrosis factor receptor superfamily, has been implicated in vascular disease. We investigated the association of serum OPG with the ankle-brachial index (ABI) and urine albumin:creatinine ratio (UACR), in a bi-ethnic cohort of 1324 African-Americans (mean age 64 years, 71% women) and 1237 non-Hispanic whites (mean age 59 years, 57% women) belonging to hypertensive sibships. Serum levels of OPG were measured by solid phase sandwich immunoassay. ABI was measured using a standard protocol and peripheral arterial disease (PAD) defined as ABI<0.90. UACR was expressed as mg albumin/gm creatinine. Multivariable regression analysis using generalized estimating equations (GEE) were performed to assess whether serum OPG levels were associated with ABI and UACR. After adjustment for conventional risk factors (age, sex, diabetes, waist circumference, history of smoking, total and HDL cholesterol, hypertension), prior history of myocardial infarction or stroke, and medication (renin-angiotensin-aldosterone system inhibitors, statins, aspirin, estrogen) use, higher OPG levels were significantly associated with lower ABI and higher UACR in African-Americans (P=0.001 and P<0.0001, respectively) and non-Hispanic whites (P=0.017 and P=0.002, respectively); the association remained significant after further adjustment for plasma C-reactive protein (CRP) in both ethnic groups. In multivariable logistic regression analysis, higher OPG levels were associated with PAD in African-Americans, independent of the covariates listed above (P=0.026); the association remained significant after additional adjustment for plasma CRP (P=0.047). In non-Hispanic whites, the association of higher OPG levels with PAD was of borderline significance after adjustment for the relevant covariates (P=0.106). We conclude that higher OPG levels are associated with lower ABI and higher UACR, independent of conventional risk factors and plasma CRP.

Brachial-ankle pulse wave velocity is associated with walking distance in patients referred for peripheral arterial disease evaluation.

OBJECTIVE: Impaired functional capacity predicts morbidity and increased mortality in patients with PAD. We hypothesized that brachial-ankle pulse wave velocity (baPWV), a measure of arterial stiffness, is associated with functional capacity in patients undergoing noninvasive evaluation for peripheral arterial disease (PAD). METHODS: We studied 114 patients (age 68+/-10 years) referred to Mayo Clinic's noninvasive vascular laboratory. Functional capacity was estimated in terms of distance walked in 5 min on a treadmill at a speed of 1.0-2.0 mph. Ankle-brachial index (ABI) was obtained with Doppler method before and 1 min after exercise. baPWV was estimated noninvasively using an oscillometric device. The association of baPWV with walking distance was assessed using accelerated failure time and Cox proportional-hazards models. RESULTS: The mean baPWV was higher in patients who were unable to complete the walk test compared to those who successfully completed the test (P=0.008). Higher baPWV was associated with a lower walking distance after adjustment for heart rate, mean arterial pressure, and cardiovascular risk factors (P=0.017) and after additional adjustment for pulse pressure (P=0.034) and ABI (P=0.030). Higher baPWV was associated with failure to complete the treadmill walk test, after adjustment for heart rate, mean arterial pressure, and cardiovascular risk factors (P=0.025) and after additional adjustment for pulse pressure (P=0.041) and ABI (P=0.039). CONCLUSION: Increased baPWV, a measure of arterial stiffness, is associated with impaired functional capacity in patients undergoing evaluation for PAD.

Association of soluble cell adhesion molecules with ankle-brachial index in a biethnic cohort of predominantly hypertensive individuals.

BACKGROUND: Higher plasma concentrations of soluble adhesion molecules have been shown to be associated with increased risk of cardiovascular events. We investigated the association of soluble intercellular adhesion molecule-1 (sICAM-1) and soluble vascular cell adhesion molecule-1 (sVCAM-1) with ankle-brachial index (ABI), a measure of peripheral arterial disease (PAD), in a biethnic cohort of adults without known coronary heart disease or stroke. METHODS: Participants included 1102 blacks (mean age, 63 years; 74% women) and 1013 non-Hispanic whites (mean age, 58 years; 59% women) belonging to sibships ascertained on the basis of hypertension. We measured plasma concentrations of sICAM-1 and sVCAM-1 using high-sensitivity immunoassays and ABI using a standard protocol; PAD was defined as ABI <0.9. We used generalized estimating equations to assess whether sICAM-1 and sVCAM-1 were associated with ABI and PAD, independently of conventional risk factors. RESULTS: After adjustment for conventional risk factors, blacks with sICAM-1 and sVCAM-1 concentrations in the highest quartiles had lower ABIs than those in the lowest quartiles (mean ABI 1.02 vs 0.98, P = 0.007, vs 1.02 vs 0.99, P = 0.003, respectively). In multivariable logistic regression analysis, sICAM-1 and sVCAM-1 concentrations in the highest quartiles were each associated with a higher odds ratio of having PAD, compared with the lowest quartiles: odds ratio (95% CI): 5.2 (1.8-15.2) and 2.2 (1.0-4.8), respectively. In contrast, in non-Hispanic whites, sICAM-1 and sVCAM-1 concentrations were not associated with ABI or PAD. CONCLUSIONS: Higher sICAM-1 and sVCAM-1 concentrations were independently associated with lower ABI and PAD in blacks, but not in non-Hispanic whites.

Palladium(II) chelate of tetradentate Schiff base as mixed stationary phase for gas chromatography.

Bis(acetylacetone)ethylenediiminepalladium(II) (PdAA2en) was examined as a mixed stationary phase with OV-1 on Chromosorb G/NAW 60-80 mesh size for the GC separation of aromatic hydrocarbons, heteroaromatics, alcohols, aldehydes, ketones, esters, and nitro compounds. Forty-two compounds were examined and the GC results were compared with those obtained with 3% OV-1 on Chromosorb G/NAW 60-80 mesh size under similar operating conditions. Improved resolution, peak asymmetry, theoretical plate numbers, and Kovats indices were obtained on the mixed stationary phase of 3% OV-1 + 5% PdAA2en compared to 3% OV-1 column. The stability constant (Km), enthalpies (deltaH), entropies (deltaS), and Gibbs free energies (deltaG) of the GC elution on the column (2 m x 3 mm id) packed with 3% OV-1 + 5% PdAA2en on Chromosorb G/NAW 60-80 mesh size have been calculated. Donor-acceptor complexation in the gas phase is indicated by negative values of enthalpy (-deltaH) within 5.81 to 10.89 kcal/mol and Gibbs free energy (-deltaG) from 1.34 to 4.08 kcal/mol. The retention time transformations on both the phases were calculated and the ratios obtained from the stationary phases 3% OV-1 and 3% OV-1 + 5% PdAA2en were plotted on the x-axis and the y-axis, respectively, and the coefficients of determination for alkanes, aromatic and heteroaromatics, ketones, and alcohols were observed to lie within 0.5253 to 0.9742, indicative of some different kinds of interaction of the two stationary phases with the solutes.