Epidemiology of Peripheral Vascular Disease

Section I: Measurement in Communities.- 1 Review of Simple Measuring Techniques.- Definition of Atherosclerotic Peripheral Vascular Disease.- Questionnaire for Intermittent Claudication.- Palpation of Peripheral Pulses.- Ankle-Brachial Systolic Pressure Ratio.- Stress Tests.- Exercise.- Reactive Hyperaemia.- Toe Pulse Reappearance Time.- Conclusion: Measurement in Epidemiological Research.- 2 Non-invasive Tests.- Exercise Testing.- Segmental Pressures.- Doppler Ultrasonography.- Plethysmography.- Transcutaneous Oxygen Tension.- Laser Doppler.- Magnetic Resonance Spectroscopy.- Biochemical Parameters.- 3 Questionnaires.- Development of a Questionnaire.- Types of Question.- Wording, Sequence, Layout.- Evaluation of a Questionnaire.- Validity.- Reliability.- Pre-test.- Administered or Self-Âdministered Questionnaires.- WHO/Rose Questionnaire for Intermittent Claudication.- Development of WHO/Rose Questionnaire.- Validation.- Reliability.- Modified Classification.- Edinburgh Claudication Questionnaire.- 4 Duplex Ultrasound.- History.- Basic Principles.- High Resolution Imaging.- Doppler Information.- Ultrasound as a Screening Technique.- Advantages of Ultrasound.- Disadvantages of Ultrasound.- Applications of Duplex as a Screening Technique.- Carotids.- Abdominal Aortic Aneurysms.- Peripheral Vascular Disease.- Venous Disease.- The Future.- 5 Magnetic Resonance Imaging.- The Assessment of Atherosis.- Chemical Shift Imaging.- Velocity Mapping.- The Assessment of Sclerosis.- Aortic Compliance.- Aortic Flow Wave Velocity.- Clinical Importance of Sclerosis.- Section II: Descriptive Epidemiology.- 6 Historical Perspectives and the Basle Study.- The Basle Study.- Population Screening Methods.- Incidence and Prevalence.- Relationship to Coronary Heart Disease.- Risk Factors.- Course of the Disease.- Conclusion.- 7 Large Vessel and Isolated Small Vessel Disease.- Pathophysiology.- Non-invasive Measurement Criteria.- Symptomatology.- Physical Findings.- Prevalence.- Risk Factors.- Natural History.- Morbidity and Mortality.- Future Research.- 8 Symptomatic and Asymptomatic Disease.- Difficulties in Assessing Severity of Disease.- Edinburgh Artery Study: Methods.- Study Population.- Clinical Examination.- Data Analysis.- Edinburgh Artery Study: Symptomatic and Asymptomatic Disease.- Prevalence.- Age and Sex Distribution.- Relationship with Ischaemic Heart Disease.- Possible Bias in Estimating Prevalence of Disease.- Surveys of Symptomatic and Asymptomatic Disease.- 9 Prevalence in General Practice.- Importance of Peripheral Vascular Disease in General Practice.- Methods of Estimating Prevalence.- The Limburg Peripheral Arterial Occlusive Disease (PAOD) Study.- Comparison of Prevalences in Different Studies.- Questions for Further Study.- 10 Intermittent Claudication in Scotland.- The Scottish Heart Health Study.- Prevalence of Intermittent Claudication.- Risk Factors for Intermittent Claudication.- Intermittent Claudication in Epidemiological Studies.- Summary: Scottish Heart Health Study.- Section III: Vascular Risk Factors.- 11 Risk Factors and Cardiovascular Outcome Calf Pain on Walking, Risk Factors and Cardiovascular Outcome in Middle-aged British Men.- British Regional Heart Study: Methods.- Measurement of Calf Pain on Walking.- Follow-up of Subjects.- British Regional Heart Study: Calf Pain on Walking.- Cardiovascular Risk Factors and Calf Pain.- Prevalence of Ischaemic Heart Disease and Calf Pain.- Cardiovascular Mortality and Morbidity and Calf Pain.- Discussion: Calf Pain on Walking.- Prevalence.- Risk Factors.- Outcome.- Summary.- 12 Smoking.- Smoking: The Risk Factor for Peripheral Vascular Disease.- How Does Smoking Cause Peripheral Vascular Disease?.- Smoking and Progression of Peripheral Vascular Disease.- Conclusions: Stop Smoking.- 13 Lipids: Outstanding Questions.- Areas of Agreement.- Outstanding Questions.- Cholesterol and Atheroma.- Regression of Atheroma.- Cholesterol as a Risk Factor.- Reduction of Hypercholesterolemia.- Cholesterol and Women.- Age and Cholesterol.- Other Lipids as Risk Factors.- Fatty Acids.- Lipids and Thrombosis.- Education.- 14 Lipids: Epidemiology.- Possible Role of Lipids in Atherogenesis.- Lipids and Peripheral Vascular Disease: Epidemiological Studies.- Triglycerides.- Cholesterol.- HDL Cholesterol.- Apolipoproteins.- Essential Fatty Acids.- Lipid Peroxides.- Effect of Modifying Lipid Profiles on Peripheral Vascular Disease.- Peripheral Vascular Disease and Ischaemic Heart Disease.- 15 Blood Pressure.- Measurement of Peripheral Vascular Disease.- Relationship between Intermittent Claudication and Blood Pressure.- Lack of Foot Pulses and Brachial Pressure.- Low Systolic Pressure in the Foot and Brachial Pressure.- Causal Association?.- 16 Diabetes Mellitus.- Diabetes and Clinical Manifestations of Peripheral Vascular Disease.- Intermittent Claudication.- Pulse Deficits.- Lower Extremity Amputations.- Diabetes and Pathological Manifestations of Peripheral Vascular Disease.- Atheroma.- Medial Calcification.- Risk Factors for Peripheral Vascular Disease in Diabetes.- Conclusions.- Section IV: Social and Life Style Factors.- 17 Social Factors.- Social Factors and Health.- Social Deprivation and Peripheral Vascular Disease: Mortality and Hospital Discharges.- Measurement of Social Factors in Edinburgh Artery Study.- Statistical Analysis.- Ankle-Brachial Pressure Index and Social Class, Education, and Deprivation.- Individual Social Factors.- Combinations of Social Factors.- Effect of Cardiovascular Risk Factors.- Explaining Associations of Social Factors and Peripheral Vascular Disease.- 18 Diet and Alcohol.- Dietary Survey Methodology.- Range of Methods.- Food Frequency Questionnaires.- Edinburgh Artery Study and Diet: Methods.- Selection of Cases and Controls.- Dietary Analysis.- Diet in Cases vs. Controls.- Food Frequencies.- Nutrients and Energy.- Interpreting Dietary Differences.- 19 Personality.- Personality and Coronary Heart Disease.- Type A Behaviour Pattern.- Hostility.- Personality and Peripheral Vascular Disease.- Measurement of Personality in Edinburgh Artery Study.- Type A Behaviour Pattern (Bortner).- Personal Deviance (Foulds and Bedford).- The Disease-Prone Personality?.- 20 Exercise.- Exercise and Ischaemic Heart Disease.- Exercise and Peripheral Vascular Disease.- Edinburgh Artery Study: Exercise.- Interpreting Associations of Exercise and Cardiovascular Disease.- 21 Economics of Prevention and Treatment.- Economic Costs of Peripheral Vascular Disease.- The Role of Economic Evaluation.- Competing Interventions.- Primary Prevention.- Secondary Prevention.- New Technology.- Paying for Peripheral Vascular Care.- Priorities for Spending on Peripheral Vascular Disease.- Section V: Genetics, Development and Haemostasis.- 22 Maternal and Fetal Origins of Cardiovascular Disease.- Animal Studies.- Geographical Studies.- Follow-up Studies.- Fetal Growth.- Conclusion.- 23 Genetic Analysis.- Background to “Old” Genetic Analyses.- Vascular Disease and “Old” Genetic Analyses.- Background to “New” Genetic Analyses.- Vascular Disease and “New” Genetic Analyses.- 24 Fibrinogen.- Coagulability.- Ischaemic Heart Disease and Stroke.- Peripheral Vascular Disease.- Implications and Future Research.- 25 von Willebrand Factor, Beta-Thromboglobulin and Platelet Activation.- Role of Platelets in Atherosclerosis and Thrombosis.- Platelet Activation.- Endothelial Injury.- Platelets in Lesion Initiation and Thrombosis.- von Willebrand Factor.- Synthesis and Function of vWF.- Role of vWF in Thrombosis.- vWF and Vascular Disease.- Beta-Thromboglobulin.- Age, Sex, Smoking and ?-TG.- ?-TGand Coronary Heart Disease.- ?-TG and Peripheral and Cerebrovascular Disease.- 26 Blood Rheology.- Blood Rheology Factors in the Circulation.- Blood Rheology in Peripheral Vascular Disease.- Blood Rheology in Critical Limb Ischaemia.- Blood Rheology and Peripheral Arterial Graft Occlusion.- Rheological Therapy in Peripheral Vascular Disease.- Section VI: Natural History and Prevention.- 27 Natural History of Femoral Atheromatous Lesions.- Symptoms of the Lesion.- The Lesion “Under the Microscope”.- Plaque, Stenosis, and “Critical Stenosis”.- Effects of Stenosis.- Occlusion.- Regression of Atherosclerosis.- Progression of Atherosclerosis in Clinical Studies.- Predicting Progression of Disease.- 28 Prognosis of Intermittent Claudication.- Peripheral Vascular Disease: Another Manifestation of Atherosclerosis?.- Whitehall Study: Methods.- Intermittent Claudication in Whitehall Study.- Relation between Claudication and Ischaemic Heart Disease.- Intermittent Claudication and Coronary Risk Factors.- Intermittent Claudication and Subsequent Mortality.- Implications: Intermittent Claudication.- What is the Nature of Possible Claudication?.- 29 Factors Affecting Clinical Progression and Mortality.- Progression of Local Disease.- Factors Affecting Progression of Local Disease.- Overall Fate and Mortality of Claudicants.- Factors Affecting Overall Fate and Mortality of Claudicants.- Fate of the Amputee.- Conclusions.- 30 Asymptomatic Carotid Stenosis in Peripheral Vascular Disease Prevalence, Incidence and Natural History.- Non-Invasive Assessment.- Prevalence of Asymptomatic Carotid Stenosis.- Charing Cross Asymptomatic Carotid Study.- Incidence of Asymptomatic Carotid Stenosis.- Natural History of Patients with Asymptomatic Carotid Stenosis.- Future Research in Asymptomatic Carotid Disease.- 31 Prevention of Vascular Events in Claudicants.- Intermittent Claudication: Indicator of Generalised Atherosclerosis.- Value of Interventions in Claudicants.- Anti-thrombotic Treatment.- Swedish Ticlopidine Multicentre Study (STIMS).- Ketanserin Trial (PACK).- 32 Secondary Prevention of Ischaemic Heart Disease.- Fatty Fish.- Dietary Fibre.- Reduced Dietary Fat.- Exercise.- Drug Prophylaxis.- Need for Further Research.