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Article ; Online: Inflammation in peripheral artery disease.

Brevetti, Gregorio / Giugliano, Giuseppe / Brevetti, Linda / Hiatt, William R

2010 Volume 122, Issue 18, Page(s) 1862–1875

MeSH term(s)	Carotid Artery Diseases/epidemiology ; Comorbidity ; Endothelium, Vascular/physiopathology ; Humans ; Inflammation/physiopathology ; Peripheral Arterial Disease/epidemiology ; Peripheral Arterial Disease/physiopathology ; Risk Factors ; Stroke/epidemiology
Language	English
Publishing date	2010-11-02
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	80099-5
ISSN	1524-4539 ; 0009-7322 ; 0069-4193 ; 0065-8499
ISSN (online)	1524-4539
ISSN	0009-7322 ; 0069-4193 ; 0065-8499
DOI	10.1161/CIRCULATIONAHA.109.918417
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Article ; Online: Carotid artery disease and stroke in patients with peripheral arterial disease. The role of inflammation

Giusy Sirico / Lucrezia Spadera / Mario De Laurentis / Gregorio Brevetti

Monaldi Archives for Chest Disease, Vol 72, Iss

2016 Volume 1

Abstract: Although during the last decade there have been great advances in our knowledge of the epidemiology and pathophysiology of multi-district atherosclerotic disease, little is known about the association between peripheral arterial disease and carotid ... ...

Abstract	Although during the last decade there have been great advances in our knowledge of the epidemiology and pathophysiology of multi-district atherosclerotic disease, little is known about the association between peripheral arterial disease and carotid artery disease. This review was conceived to cast some light on this topic, paying special attention to inflammation which plays a pivotal role in atherosclerosis. An aspect of pathophysiologic and clinical relevance is that the coexistence of carotid disease is more frequent in peripheral arterial disease than in coronary artery disease, not only in terms of carotid stenosis, but also with respect to the presence of hypoechoic unstable plaque. These latter plaques present a large infiltration of macrophages and are associated to high levels of inflammatory markers. In particular, the greater prevalence of hypoechoic carotid plaques in peripheral arterial disease compared to patients with carotid artery disease was poorly related to classic risk factors, but showed an independent association with an increased number of leukocyte and neutrophil cells, which are reliable markers of inflammation. The greater prevalence of hypoechoic unstable carotid plaques could explain why peripheral arterial disease portends higher risk of stroke than coronary artery disease.
Keywords	peripheral arterial disease ; carotid artery disease ; stroke ; polyvascular disease ; inflammation ; Medicine ; R
Subject code	610
Language	English
Publishing date	2016-01-01T00:00:00Z
Publisher	PAGEPress Publications
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Peripheral arterial disease: the magnitude of the problem and its socioeconomic impact.

Brevetti, Gregorio / Chiariello, Massimo

Current drug targets. Cardiovascular & haematological disorders

2004 Volume 4, Issue 3, Page(s) 199–208

Abstract: Peripheral arterial disease is a common disease in adults and its complications take a great toll in terms of quality of life and treatment costs. As healthcare budgets have taken up more of the economy, and as employers and patients have become ... ...

Abstract	Peripheral arterial disease is a common disease in adults and its complications take a great toll in terms of quality of life and treatment costs. As healthcare budgets have taken up more of the economy, and as employers and patients have become concerned about the escalating costs of healthcare, we have entered an era in which individual doctors must become concerned about the costs of a service relative to its benefits. The purpose of this article is to review the literature on the pharmacoeconomics of the diagnostic and therapeutic procedures for peripheral arterial disease. It emerges that peripheral arterial disease places a great burden on healthcare systems and on society as a whole. Some of these costs, including indirect and intangible costs (i.e. those related to lost productivity, and reduced quality of life, respectively) could be reduced if the condition were to be recognized and correctly treated at an early stage.
MeSH term(s)	Arteriosclerosis/diagnosis ; Arteriosclerosis/economics ; Arteriosclerosis/therapy ; Clinical Trials as Topic ; Cost-Benefit Analysis ; Humans ; Peripheral Vascular Diseases/diagnosis ; Peripheral Vascular Diseases/economics ; Peripheral Vascular Diseases/therapy ; Quality of Life ; Risk Factors ; Socioeconomic Factors
Language	English
Publishing date	2004-06-30
Publishing country	Netherlands
Document type	Journal Article ; Review
ZDB-ID	2064870-4
ISSN	1875-5895 ; 1568-0061
ISSN (online)	1875-5895
ISSN	1568-0061
DOI	10.2174/1568006043336140
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Article ; Online: Endothelial dysfunction: a key to the pathophysiology and natural history of peripheral arterial disease?

Brevetti, Gregorio / Schiano, Vittorio / Chiariello, Massimo

Atherosclerosis

2008 Volume 197, Issue 1, Page(s) 1–11

Abstract: Dysfunctional endothelium plays a crucial role in all stages of atherosclerosis and thus the accurate assessment of this organ is a valuable tool, especially if such assessments are clinically relevant. In peripheral arterial disease (PAD), which affects ...

Abstract	Dysfunctional endothelium plays a crucial role in all stages of atherosclerosis and thus the accurate assessment of this organ is a valuable tool, especially if such assessments are clinically relevant. In peripheral arterial disease (PAD), which affects about 27 million of individuals in Europe and North America, increased plasma markers of endothelial dysfunction and reduced endothelium-mediated vasoreactivity, are associated with both the severity and the extent of atherosclerosis in the arteries of the lower limbs, is exacerbated by acute exercise, may help identify subjects with subclinical coronary artery disease, and portends a worse outcome. As a result, endothelial dysfunction is a promising target for therapeutic interventions in PAD. Large clinical trials are needed to verify whether affected individuals with depressed endothelial function benefit from specific treatments.
MeSH term(s)	Endothelium, Vascular/metabolism ; Endothelium, Vascular/pathology ; Endothelium, Vascular/physiopathology ; Humans ; Peripheral Vascular Diseases/metabolism ; Peripheral Vascular Diseases/pathology ; Peripheral Vascular Diseases/physiopathology
Language	English
Publishing date	2008-03
Publishing country	Ireland
Document type	Journal Article ; Review
ZDB-ID	80061-2
ISSN	1879-1484 ; 0021-9150
ISSN (online)	1879-1484
ISSN	0021-9150
DOI	10.1016/j.atherosclerosis.2007.11.002
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Article ; Online: Femoral plaque echogenicity and cardiovascular risk in claudicants.

Schiano, Vittorio / Sirico, Giusy / Giugliano, Giuseppe / Laurenzano, Eugenio / Brevetti, Linda / Perrino, Cinzia / Brevetti, Gregorio / Esposito, Giovanni

JACC. Cardiovascular imaging

2012 Volume 5, Issue 4, Page(s) 348–357

Abstract: Objectives: The present study was designed to verify whether the evaluation of femoral plaque echogenicity might be a useful tool for cardiovascular risk assessment in patients affected by lower extremity peripheral arterial disease.: Background: ... ...

Abstract	Objectives: The present study was designed to verify whether the evaluation of femoral plaque echogenicity might be a useful tool for cardiovascular risk assessment in patients affected by lower extremity peripheral arterial disease. Background: Lower extremity peripheral arterial disease is a common manifestation of atherosclerosis and is associated with a high risk of developing major cardiovascular events. Vulnerable atherosclerotic plaque plays a central role in the occurrence of acute ischemic events in different vascular territories. Furthermore, atherosclerosis is a systemic disease, and the presence of an unstable atherosclerotic plaque in a certain vascular district, characterized by low echogenicity at B-mode ultrasound, is associated to a greater prevalence of unstable plaques in other vascular beds. Methods: Femoral plaque echogenicity of 246 claudicants with ankle/brachial index ≤0.90 was evaluated at B-mode ultrasound by visual analysis and by calculating the grayscale median (GSM) value. In these patients, the occurrence of myocardial infarction and stroke was prospectively assessed. Results: Femoral GSM values and plaque types assessed by visual analysis were highly correlated by Spearman analysis (rho = 0.905, p < 0.001). During a median follow-up of 30 months, 32 patients (13%) had a major cardiovascular event. Compared with patients without events, those who experienced an event during the follow-up had a lower femoral plaque GSM value (42.9 ± 26.2 vs. 58.8 ± 19.3, p = 0.002) and a higher prevalence of hypoechoic femoral plaque at visual analysis (68.8% vs. 19.6%, p < 0.001). At Cox analysis, femoral GSM showed an inverse relationship with cardiovascular risk, even after adjustment for possible confounders (hazard ratio: 0.96, 95% confidence interval [CI]: 0.95 to 0.98, p < 0.001). Furthermore, patients with hypoechoic femoral plaques at visual analysis had a 7.24-fold increased cardiovascular risk compared with patients with hyperechoic plaques after adjustment for possible confounders (95% CI: 3.23 to 16.22, p < 0.001). Conclusions: This study demonstrates that the presence of hypoechoic atherosclerotic femoral plaques is associated with higher cardiovascular risk in lower extremity peripheral arterial disease patients.
MeSH term(s)	Aged ; Cardiovascular Diseases/epidemiology ; Female ; Femoral Artery/diagnostic imaging ; Follow-Up Studies ; Humans ; Intermittent Claudication/complications ; Intermittent Claudication/diagnostic imaging ; Intermittent Claudication/epidemiology ; Italy/epidemiology ; Male ; Middle Aged ; Myocardial Infarction/epidemiology ; Myocardial Infarction/etiology ; Plaque, Atherosclerotic/complications ; Plaque, Atherosclerotic/diagnostic imaging ; Plaque, Atherosclerotic/epidemiology ; Prevalence ; Prognosis ; Prospective Studies ; Risk Factors ; Severity of Illness Index ; Ultrasonography
Language	English
Publishing date	2012-04
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	2491503-8
ISSN	1876-7591 ; 1936-878X
ISSN (online)	1876-7591
ISSN	1936-878X
DOI	10.1016/j.jcmg.2012.01.011
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Article: Chronic aortic dissection: still a challenge.

Giugliano, Giuseppe / Spadera, Lucrezia / De Laurentis, Mario / Brevetti, Gregorio

Acta cardiologica

2009 Volume 64, Issue 5, Page(s) 653–663

Abstract: Chronic aortic dissections are complex lesions with a fairly predictable natural history depending on factors such as baseline aortic diameter, the degree of false lumen thrombosis, the presence of a persistent communication, an underlying connective ... ...

Abstract	Chronic aortic dissections are complex lesions with a fairly predictable natural history depending on factors such as baseline aortic diameter, the degree of false lumen thrombosis, the presence of a persistent communication, an underlying connective tissue disorder, and the control of hypertension. Medical management with antihypertensive therapy including beta-blockers is the treatment of choice for all stable chronic aortic dissections. Repair is indicated in the case of complications: aortic rupture, malperfusion syndromes, symptomatic dissections, asymptomatic dissections becoming significantly aneurysmal or demonstrating a rapid growth rate. In this regard, serial imaging of the aorta is crucial to detect unstable lesions requiring surgery or an endovascular intervention. As endograft technologies improve endovascular approach may become the future standard of care.
MeSH term(s)	Adrenergic beta-Antagonists/therapeutic use ; Aneurysm, Dissecting/diagnosis ; Aneurysm, Dissecting/etiology ; Aneurysm, Dissecting/therapy ; Antihypertensive Agents/therapeutic use ; Aortic Aneurysm/diagnosis ; Aortic Aneurysm/etiology ; Aortic Aneurysm/therapy ; Chronic Disease ; Diagnostic Imaging/methods ; Humans ; Hypertension/complications ; Prognosis ; Vascular Surgical Procedures/methods
Chemical Substances	Adrenergic beta-Antagonists ; Antihypertensive Agents
Language	English
Publishing date	2009-10
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	390197-x
ISSN	0001-5385
ISSN	0001-5385
DOI	10.2143/AC.64.5.2042696
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Article: Carotid artery disease and stroke in patients with peripheral arterial disease. The role of inflammation.

Sirico, Giusy / Spadera, Lucrezia / De Laurentis, Mario / Brevetti, Gregorio

Monaldi archives for chest disease = Archivio Monaldi per le malattie del torace

2009 Volume 72, Issue 1, Page(s) 10–17

Abstract	Although during the last decade there have been great advances in our knowledge of the epidemiology and pathophysiology of multi-district atherosclerotic disease, little is known about the association between peripheral arterial disease and carotid artery disease. This review was conceived to cast some light on this topic, paying special attention to inflammation which plays a pivotal role in atherosclerosis. An aspect of pathophysiologic and clinical relevance is that the coexistence of carotid disease is more frequent in peripheral arterial disease than in coronary artery disease, not only in terms of carotid stenosis, but also with respect to the presence of hypoechoic unstable plaque. These latter plaques present a large infiltration of macrophages and are associated to high levels of inflammatory markers. In particular, the greater prevalence of hypoechoic carotid plaques in peripheral arterial disease compared to patients with carotid artery disease was poorly related to classic risk factors, but showed an independent association with an increased number of leukocyte and neutrophil cells, which are reliable markers of inflammation. The greater prevalence of hypoechoic unstable carotid plaques could explain why peripheral arterial disease portends higher risk of stroke than coronary artery disease.
MeSH term(s)	Atherosclerosis/complications ; Atherosclerosis/diagnostic imaging ; Atherosclerosis/physiopathology ; Carotid Artery Diseases/complications ; Carotid Artery Diseases/diagnostic imaging ; Carotid Artery Diseases/physiopathology ; Humans ; Inflammation/physiopathology ; Peripheral Vascular Diseases/complications ; Peripheral Vascular Diseases/physiopathology ; Stroke/complications ; Stroke/physiopathology ; Ultrasonography
Language	English
Publishing date	2009-03
Publishing country	Italy
Document type	Journal Article ; Review
ZDB-ID	1160940-0
ISSN	1122-0643 ; 1120-0391
ISSN	1122-0643 ; 1120-0391
DOI	10.4081/monaldi.2009.337
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Article: Cellular adhesion molecules and peripheral arterial disease.

Brevetti, Gregorio / Schiano, Vittorio / Chiariello, Massimo

Vascular medicine (London, England)

2006 Volume 11, Issue 1, Page(s) 39–47

Abstract: Cellular adhesion molecules (CAMs), by mediating the recruitment of circulating leukocytes to the blood vessel wall and their subsequent migration into the subendothelial spaces, play a crucial role in all stages of atherosclerosis. Soluble forms of CAMs, ...

Abstract	Cellular adhesion molecules (CAMs), by mediating the recruitment of circulating leukocytes to the blood vessel wall and their subsequent migration into the subendothelial spaces, play a crucial role in all stages of atherosclerosis. Soluble forms of CAMs, probably derived from proteolytic shedding, are present in the circulation and their blood levels parallel the amount expressed on the cell surface. In patients with peripheral arterial disease (PAD), increased levels of soluble CAMs have been found during exercise-induced claudication, are associated with the presence, the severity and the extent of atherosclerosis in the arteries of the lower limbs, and portend a worse outcome. These findings have provided new insights into the pathophysiology of PAD and its consequences. However, further large population studies are needed to firmly establish whether increased levels of circulating CAMs give additive information to current risk assessment approaches, and to verify whether PAD patients with elevated levels of circulating CAMs would benefit from any specific therapy.
MeSH term(s)	Angioplasty, Balloon ; Animals ; Atherosclerosis/blood ; Atherosclerosis/prevention & control ; Atherosclerosis/therapy ; Biomarkers/blood ; Cell Adhesion Molecules/blood ; Humans ; Immunoglobulins/blood ; Integrins/blood ; Intermittent Claudication/blood ; Intermittent Claudication/prevention & control ; Intermittent Claudication/therapy ; Lower Extremity/blood supply ; Peripheral Vascular Diseases/blood ; Peripheral Vascular Diseases/prevention & control ; Peripheral Vascular Diseases/therapy ; Recurrence ; Risk Factors ; Selectins/blood ; Severity of Illness Index
Chemical Substances	Biomarkers ; Cell Adhesion Molecules ; Immunoglobulins ; Integrins ; Selectins
Language	English
Publishing date	2006-02
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	1311628-9
ISSN	1477-0377 ; 1358-863X
ISSN (online)	1477-0377
ISSN	1358-863X
DOI	10.1191/1358863x06vm645ra
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Article: L'aneurisma dell'aorta addominale sottorenale.

Brevetti, Gregorio / Laurenzano, Eugenio / De Maio, Julieta Isabel / Chiariello, Massimo

Giornale italiano di cardiologia (2006)

2007 Volume 8, Issue 9, Page(s) 543–551

Abstract: The incidence of and mortality from ruptured infrarenal abdominal aortic aneurysm (AAA) are increasing. Therefore, it is important to identify groups at high risk. Tobacco use, hypertension, a family history of AAA, and male sex are clinical risk factors ...

Title translation	Infrarenal abdominal aortic aneurysms.
Abstract	The incidence of and mortality from ruptured infrarenal abdominal aortic aneurysm (AAA) are increasing. Therefore, it is important to identify groups at high risk. Tobacco use, hypertension, a family history of AAA, and male sex are clinical risk factors for the development of an aneurysm. Chronic inflammation and enzymatic degradation of elastin and collagen constitute the prominent pathogenetic mechanism of infrarenal AAA. Intervals for surveillance depend on the aneurysm diameter, taking into account that AAA >5.5 cm should be referred to a vascular surgeon. Asymptomatic patients with an infrarenal AAA should be medically optimized before repair. Symptomatic aneurysms present with back, abdominal, or leg pain and require urgent surgical attention. Rupture of an AAA involves complete loss of aortic wall integrity and is a surgical emergency requiring immediate repair.
MeSH term(s)	Algorithms ; Aortic Aneurysm, Abdominal/diagnosis ; Aortic Aneurysm, Abdominal/epidemiology ; Aortic Aneurysm, Abdominal/etiology ; Aortic Aneurysm, Abdominal/surgery ; Aortic Rupture/surgery ; Humans ; Hypertension/complications ; Incidence ; Italy/epidemiology ; Risk Factors ; Sex Factors ; Smoking/adverse effects
Language	Italian
Publishing date	2007-09
Publishing country	Italy
Document type	English Abstract ; Journal Article ; Review
ZDB-ID	2272414-X
ISSN	1972-6481 ; 1827-6806
ISSN (online)	1972-6481
ISSN	1827-6806
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Article ; Online: Leukocyte count in peripheral arterial disease: A simple, reliable, inexpensive approach to cardiovascular risk prediction.

Giugliano, Giuseppe / Brevetti, Gregorio / Lanero, Simona / Schiano, Vittorio / Laurenzano, Eugenio / Chiariello, Massimo

Atherosclerosis

2010 Volume 210, Issue 1, Page(s) 288–293

Abstract: Background: An elevated leukocyte count is widely proven to predict cardiovascular risk in healthy subjects and coronary patients, but its prognostic role in peripheral arterial disease (PAD) has received scarce attention.: Objectives: To assess the ... ...

Abstract	Background: An elevated leukocyte count is widely proven to predict cardiovascular risk in healthy subjects and coronary patients, but its prognostic role in peripheral arterial disease (PAD) has received scarce attention. Objectives: To assess the impact of leukocyte count on the incidence of major cardiovascular events in PAD, and verify whether it adds to the prognostic power of the ankle/brachial index (ABI). Methods: The occurrence of myocardial infarction and stroke was prospectively assessed in 259 consecutive PAD patients. Receiver-operating characteristic analysis and the bootstrap approach were used to identify the best cut-offs to predict the outcome, and hazard ratios (HRs) and c-statistics to assess the ability to classify risk. Results: During a median follow-up of 30.0 months, 28 patients had an event. Adjusted Cox analyses performed on total and differential leukocyte counts, showed that only total leukocyte count (TLC) and neutrophil count (NC), considered as continuous variables, were associated with increased cardiovascular risk (HR=1.35, p<0.01 and HR=1.31, p<0.02, respectively). Patients with ABI < or = 0.63 plus TLC>7.7 x10(9)/L or NC>4.6 x 10(9)/L had a higher risk of about 5-fold vs patients with ABI>0.63 plus TLC< or =7.7 x 10(9)/L (p<0.01) or NC < or = 4.6 x 10(9)/L (p<0.01). The c-statistic for ABI was 0.61, similar to those for TLC (0.63) and NC (0.66). However, it significantly increased to 0.70 and 0.69 for the models incorporating ABI and TLC or ABI and NC, respectively (p<0.05 for both vs ABI alone). Conclusions: TLC and NC, which are inexpensive and reliable tests, predict major cardiovascular events in PAD, and add to the prognostic power of ABI, currently the most powerful prognostic indicator in these patients.
MeSH term(s)	Aged ; Ankle Brachial Index ; Cardiovascular Diseases/diagnosis ; Cardiovascular Diseases/etiology ; Female ; Humans ; Leukocyte Count ; Male ; Neutrophils/cytology ; Peripheral Vascular Diseases/blood ; Peripheral Vascular Diseases/complications ; Prognosis ; Proportional Hazards Models ; Prospective Studies
Language	English
Publishing date	2010-05
Publishing country	Ireland
Document type	Journal Article
ZDB-ID	80061-2
ISSN	1879-1484 ; 0021-9150
ISSN (online)	1879-1484
ISSN	0021-9150
DOI	10.1016/j.atherosclerosis.2009.11.009
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