Document Detail

Amputation and Cardiac Comorbidity: Analysis of Severity of Cardiac Risk.
MedLine Citation:
PMID:  22698850     Owner:  NLM     Status:  Publisher    
OBJECTIVE: Despite very high cardiovascular mortality in amputees, indices of preclinical risk in these persons are poorly characterized. The purpose of this study is to evaluate population-based cardiovascular risk scores and coronary artery calcification scores (CACS) in amputees. DESIGN: A retrospective cohort study of 1300 veterans in a cardiac computed tomography database. SETTING: 1B Veterans Administration medical center. PARTICIPANTS: A total of 76 amputees and similar number of age-, sex-, and Framingham Risk Scores (FRS)-matched control subjects. METHODS: The amputee population was identified and compared for CACS and traditional cardiac risk factors. Two control groups were used: control group 1, with known risk factors including diabetes mellitus, and control group 2, with all risk factors without diabetes mellitus. MAIN OUTCOME MEASURES: Statistical associations between amputee and control group FRS scores, CACS, and other cardiac risk factors were assessed. RESULTS: The study included 57 nontraumatic and 19 traumatic amputees with an average age of 62.4 years. Sixty-six amputees were in the low-to-intermediate cardiac risk groups according to FRS. Despite this classification, the mean CACS were significantly higher in amputees (1285 ± 18) than in either of the control groups: control group 1 (540 ± 84) and control group 2 (481 ± 11), P < .001. CACS also were significantly higher in the nontraumatic subject group (1595 ± 12) compared with the traumatic group (356 ± 57; P < .001). Upon categorization of CACS based on probability of coronary artery disease (CAD), 76% of amputees had a CACS >100 and 38% of amputees had a CACS >1000. Interestingly, CACS were almost the same in finger/toe amputations compared with an above-knee amputation, indicating an already ongoing CAD process irrespective of level of amputation. The predominant clinical significant cardiac risk factors in amputees are hypertension (89.5%), P < .005; chronic kidney disease (31.6%), P < .001; dyslipidemia (72.4%), P < .04; and insulin resistance. Total cholesterol, low-density lipoprotein, and high-density lipoprotein levels were nonsignificantly low in all amputees. Triglycerides were particularly higher in traumatic patients compared with nontraumatic patients, with the triglycerides/high-density lipoprotein ratio >7. CONCLUSION: This study demonstrates that amputees have a much greater burden of underlying atherosclerotic disease as detected by CACS than do control subjects matched by Framingham risk stratification. Early screening for CAD and aggressive targeted interventions may be an important part of management to reduce early mortality after amputation.
Mallikarjuna Nallegowda; Esther Lee; Murray Brandstater; Alloysius B Kartono; Guresh Kumar; Gary P Foster
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-6-12
Journal Detail:
Title:  PM & R : the journal of injury, function, and rehabilitation     Volume:  -     ISSN:  1934-1563     ISO Abbreviation:  -     Publication Date:  2012 Jun 
Date Detail:
Created Date:  2012-6-15     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101491319     Medline TA:  PM R     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.
Department of Physical Medicine & Rehabilitation, Loma Linda University Medical Center, Room 516, 11406 Loma Linda Dr, Loma Linda, CA 92354.
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