title: Differences in brain natriuretic peptide and other factors between Japanese peripheral arterial disease patients with critical limb ischemia and intermittent claudication.
abstract: OBJECTIVE
  The goal of this study was to analyze differences in risk factors, including the level of brain natriuretic peptide (BNP) and the distribution of lesions, between cases of critical limb ischemia (CLI) and intermittent claudication (IC) among patients with peripheral arterial disease.
  
  
  METHODS
  Risk factors and clinical characteristics were prospectively investigated in 817 consecutive patients, including 185 patients with CLI and 632 patients with IC.
  
  
  RESULTS
  The patients in the CLI group were older than those in the IC group (p＜0.001). The prevalence of diabetes and cerebral infarction and the proportion of women were higher in the CLI group (p＜0.05). The plasma BNP levels in the CLI group were higher than those observed in the IC group (333±538 vs. 136±354 pg/mL, p＜0.001). In contrast, the levels of homocysteine and fibrinogen were higher and the levels of albumin and the estimated glomerular filtration rate were lower in the CLI group (p＜0.05). According to a multiple logistic analysis, the BNP level, diabetes, female gender, the albumin level, body mass index (BMI) and ankle-brachial pressure index (ABI) were associated with CLI (p＜0.05). Aortoiliac artery lesions were less common, whereas femoropopliteal and below-the-knee (BK) lesions were more common, in the CLI group (p＜0.05). The number of affected BK arteries was also higher in the CLI group (p＜0.001). Correlations were found between the presence of aortoiliac lesions and smoking and a low HDL cholesterol level, while femoropopliteal lesions were found to correlate with age, BMI and hypertension and BK lesions were found to correlate with diabetes, age, female gender and BMI (p＜0.05). The plasma BNP level correlated with the number of affected BK arteries (p＜0.05).
  
  
  CONCLUSIONS
  A high BNP level, diabetes, female gender, a low albumin level, ABI and BMI are risk factors for CLI. In this study, differences in the levels of anatomical lesions and correlated risk factors were found between the CLI and IC groups.
authors.affiliation: Department of Internal Medicine, Cardiovascular Hospital of Central Japan (Kitakanto Cardiovascular Hospital).
authors.forename: Hisao
authors.initials: H
authors.lastname: Kumakura
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Kanai
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Araki
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Hojo
authors.forename: Shu
authors.initials: S
authors.lastname: Kasama
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sumino
authors.forename: Toshiya
authors.initials: T
authors.lastname: Iwasaki
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Takayama
authors.forename: Shuichi
authors.initials: S
authors.lastname: Ichikawa
authors.forename: Kishu
authors.initials: K
authors.lastname: Fujita
authors.forename: Kuniki
authors.initials: K
authors.lastname: Nakashima
authors.forename: Kazutomo
authors.initials: K
authors.lastname: Minami
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000418:Albumins / Q000378:metabolism; D000792:Angiography; D055109:Ankle Brachial Index; D044466:Asian People; D015992:Body Mass Index; D002784:Cholesterol / Q000097:blood; D005260:Female; D005340:Fibrinogen / Q000378:metabolism; D005919:Glomerular Filtration Rate; D006710:Homocysteine / Q000097:blood; D006801:Humans; D007383:Intermittent Claudication / Q000097:blood*; D007511:Ischemia / Q000097:blood*; D007564:Japan; D007866:Leg / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D058729:Peripheral Arterial Disease / Q000097:blood*; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors; D012907:Smoking
chemical_list: D000418:Albumins; D006710:Homocysteine; D020097:Natriuretic Peptide, Brain; D005340:Fibrinogen; D002784:Cholesterol