Can peripheral arterial disease be early screened for in a podiatric setting? A preliminary study in a cohort of asymptomatic adults.

BACKGROUND: Peripheral arterial disease (PAD) is a strong marker of cardiovascular disease but remains an under-diagnosed problem. Moreover, PAD frequently leads to foot problems requiring particular care and surveillance. AIM: The aims of this study were (1) to determine the prevalence of undiagnosed PAD in a cohort of asymptomatic subjects referred to a podiatric clinic and (2) to evaluate whether a four-item form assessing medical history for the presence of cardiovascular risk factors could identify subjects at high risk for asymptomatic PAD. PATIENTS AND METHODS: This study included 717 consecutive subjects (121 males, age 50.9±13.9 y) referring to a podiatric clinic who were asymptomatic for PAD and free of cardiovascular disease. The ankle brachial index (ABI) was measured in all subjects. Each subject also completed a self-administered form to identify cardiovascular risk factors. RESULTS: Among the entire cohort, the prevalence of PAD was 8.3% in males and 1.2% in females. Three subgroups were identified according to the number of risk factors reported (no risk factors, one risk factor, and two or more risk factors), and the prevalence of PAD differed between each subgroup (0.2%, 3.2%, and 18.9%, respectively; p < 0.001). CONCLUSIONS: In an unselected cohort of subjects referring to a podiatric clinic, who were asymptomatic for PAD and free from cardiovascular diseases, a remarkable prevalence of PAD was found among subjects reporting a minimum of two cardiovascular risk factors. In a podiatric setting, screening with a self-administered form for the presence of cardiovascular risk factors might lead to an early diagnosis of PAD.

Relationship between tissue glycation measured by autofluorescence and pulse wave velocity in young and elderly non-diabetic populations.

OBJECTIVE: Advanced glycation end-products (AGEs) and pulse wave velocity (PWV) are pivotal indices of the processes of arterial ageing and damage accumulation. The aim of the present study was to investigate the impact of AGEs, as measured by a non-invasive skin autofluorescence method, on arterial stiffness, estimated by PWV, in two different age groups of non-diabetic subjects. METHODS AND PATIENTS: A total of 116 non-diabetic subjects were classified into two groups, with 55 subjects in the group aged < 65 years and 61 in the group aged ≥ 65 years. AGEs were measured by skin autofluorescence while carotid-femoral PWV was assessed by tonometry. RESULTS: A significant (positive) association was observed between PWV and AGE skin autofluorescence in the younger age group (r = 0.51; P < 0.0001). However, this association was no longer significant after further adjustments for age and other factors on multiple regression analyses. In contrast, this correlation was not found in the elderly group (r = 0.098; P = 0.454). CONCLUSION: Younger non-diabetic subjects exhibit a different correlation profile between AGEs accumulated in skin and cfPWV as an index of arterial stiffness compared with elderly subjects. AGEs were significantly associated with cfPWV in younger individuals, but not in the elderly. A further study with a larger number of subjects is proposed to confirm the contribution of AGEs, the formation of which is manageable, as a determinant of arterial stiffness in younger subjects.

Febrile illness in successive cohorts of tourists at a hotel on the Italian Adriatic coast: evidence for a persistent focus of Legionella infection.

Outbreaks of febrile illness consistent with legionellosis occurred in successive groups of vacationers at an Adriatic resort in 1980. Illness was associated with one of two hotels used by the groups. A cohort study of guests of the suspect hotel revealed 23 cases of febrile illness with pulmonary symptoms, significant antibody titers to Legionella pneumophila, or both, among 291 persons at risk. Two patients died. Attack rates ranged from 0-19% in the nine cohorts of vacationers and were highest among the most elderly. Febrile illness in the last two cohorts of the season was associated with an antibody titer greater than or equal to 128. L. pneumophila was isolated from shower heads in the suspect hotel, but no association was found between showering and illness or seropositivity. Bacteria identified as L. pneumophila by direct immunofluorescence were also found in water from an adjacent hotel and from the outflow from a common well. No cases were associated with the adjacent hotel.