EFFECT OF LIPID MODIFICATION ON PERIPHERAL ARTERIAL DISEASE AFTER ENDOVASCULA

脂质修饰对血管内术后周围动脉疾病的影响

• 批准号: 7375042
• 负责人: ALAN LUMSDEN
• 金额: $ 2.36万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-12-01 至 2006-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7375042
• 关键词: EFFECT; LIPID; MODIFICATION; PERIPHERAL; ARTERIAL; EFFECT; LIPID; MODIFICATION; PERIPHERAL; ARTERIAL

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. It is estimated that peripheral arterial disease (PAD), a manifestation of systemic atherosclerosis, occurs in approximately 12% of the adult population and affects about 8 million to 10 million people in the United States. The most common symptomatic manifestation of mild to moderate PAD is intermittent claudication occurring at an annual incidence of 2% in people over 65 years of age. These patients are at a significantly higher risk of death compared with healthy controls of a similar age. However, despite the high prevalence of PAD and its strong association with cardiovascular morbidity and mortality, the disease receives relatively little attention, and PAD patients are less likely to receive appropriate treatment for their atherosclerotic risk factors than those with coronary artery disease. The most common cardiovascular risk factors for coronary artery and PAD include smoking, diabetes, hypertension, dyslipidemia, and abnormalities of homocysteine metabolism. Several large clinical trials have determined the benefits of lowering cholesterol concentrations in patients with coronary artery disease. In PAD, treatment therapy with a statin not only lowers serum cholesterol concentrations, but also improves endothelial function, as well as other markers of atherosclerotic risk, such as serum P-selectin concentrations. Treatment may improve cardiovascular outcomes in persons with peripheral arterial disease. Not only are cardiovascular morbidity and mortality increased with PAD, but functional status is often severely impaired in patients with intermittent claudication. Peak exercise performance in the claudicating patient is about 50% that of age-matched controls, which is equivalent to moderate to severe heart failure using New York Heart Association criteria. The limited ability to ambulate leads to a disability that is particularly detrimental to quality of life because both leisure and work activities are often severely curtailed. This disability can limit normal activities substantially and because improvement in the absence of an intervention is rare, therapy to relieve intermittent claudication is essential. Several therapeutic techniques currently exist for the treatment of PAD in the lower extremities. Surgical revascularization is a viable alternative because the associated risks of periprocedural mortality and morbidity are low, even at an early stage. In addition, PTA (percutaneous angioplasty) procedures have favorable complication and long-term patency rates which have improved with the advent of endovascular stents. The diagnosis of PAD which is reflected in a lowered ankle-brachial blood pressure index (ABI), is highly correlated with the risk of cardiac and cerebrovascular events. This recognition has led to the recommendation that the diagnosis should lead to increased risk modification. Although lowered ankle brachial index is well documented as a marker for cardiovascular morbidity in general, there is less data on the patient who presents with claudication, where intervention is performed for claudication and in whom the lower extremity progression of atherosclerosis is likely to be the ultimate determinant of patency and relief of symptoms. This study will examine the outcomes of risk factor modification in symptomatic PAD patients by evaluating the effects of administering an intensive combination lipid modifying therapy versus a standard lipid modifying therapy in a novel approach to preventing progression of atherosclerosis and restenosis following an endovascular intervention.

该子项目是利用NIH/NCRR资助的中心赠款提供的资源的许多研究子项目之一。子弹和调查员（PI）可能已经从其他NIH来源获得了主要资金，因此可以在其他清晰的条目中代表。列出的机构适用于该中心，这不一定是调查员的机构。据估计，周围动脉疾病（PAD）是全身性动脉粥样硬化的表现，发生在大约12％的成年人口中，在美国影响约800万至1000万人。最常见的轻度至中度垫的症状表现是65岁以上的人每年发生2％的发病率。与类似年龄的健康对照相比，这些患者的死亡风险明显更高。然而，尽管PAD的患病率很高及其与心血管发病率和死亡率的密切相关性，但该疾病受到相对较少的关注，而PAD患者比患有冠状动脉疾病的患者对动脉粥样硬化危险因素的适当治疗较小。冠状动脉和垫的最常见的心血管危险因素包括吸烟，糖尿病，高血压，血脂异常以及同型半胱氨酸代谢的异常。几项大型临床试验确定了降低冠状动脉疾病患者胆固醇浓度的好处。在PAD中，他汀类药物的治疗疗法不仅降低了血清胆固醇浓度，还可以改善内皮功能以及动脉粥样硬化风险的其他标志物，例如血清P-负蛋白浓度。治疗可以改善周围动脉疾病患者的心血管结局。 PAD不仅心血管发病率和死亡率增加，而且间歇性lau不平患者的功能状况通常会严重受损。在laudiciation脚的患者中的峰值运动表现约为年龄匹配对照的50％，这相当于使用纽约心脏协会标准中度至重度心力衰竭。有限的行动能力会导致残疾特别损害生活质量，因为休闲和工作活动通常会严重减少。这种残疾可能会大大限制正常活动，并且由于在没有干预的情况下进行改善是罕见的，因此可以减轻间歇性lau不平的治疗。目前存在几种治疗下肢治疗PAD的治疗技术。手术血运重建是一种可行的替代方法，因为即使在早期阶段，围围骨死亡率和发病率的相关风险也很低。此外，PTA（经皮血管成形术）程序具有有利的并发症和长期通畅率，随着血管内支架的出现，可以提高。反映在降低的脚踝血压指数（ABI）中的PAD的诊断与心脏和脑血管事件的风险高度相关。这种认识导致建议诊断应导致风险改变增加。尽管一般来说，降低的踝臂指数是心血管发病率的标志，但对患者的患者的数据较少，在这种情况下进行了claurauration，在这种情况下进行干预以进行clauraudation，而动脉粥样硬化的下肢进展可能是症状的最终决定性和症状的最终决定性。这项研究将通过评估在新的方法中，在一种新的方法中，在一种新的方法中，在症状性PAD患者中检验了症状PAD患者的危险因素修饰的结果，与标准的脂质修饰疗法相对于标准的脂质修饰疗法，以防止动脉粥样硬化的进展和内脊椎病后再狭窄。