The main goal of this study was to assess whether the presence of peripheral arterial disease (PAD) correlates with increased inflammatory cell infiltration. An observational, single-centre, and prospective study was conducted from January 2018 to July 2022. Clinical characteristics and anthropometric measures were registered. Consecutive PAD patients with surgical indications for a common femoral artery approach and patients with varicose veins with an indication for surgical ligation of the saphenofemoral junction were included. In both groups, samples of sartorius skeletal muscle, subcutaneous adipose tissue (SAT), and perivascular adipose tissue (PVAT) were collected from the femoral region. We analysed the characteristics of adipocytes and the presence of haemorrhage and inflammatory cells in the samples of PVAT and SAT via haematoxylin–eosin staining. We found that patients with PAD had significantly more inflammatory cells in PVAT [16 (43.24%) vs. 0 (0%) p = 0.008]. Analysing SAT histology, we observed that patients with PAD had significantly more CD45+ leucocytes upon immunohistochemical staining [32 (72.73%) vs. 3 (27.27%) p = 0.005]. Upon analysing skeletal muscle histology with haematoxylin–eosin staining, we evaluated skeletal fibre preservation, as well as the presence of trauma, haemorrhage, and inflammatory cells. We registered a significantly higher number of inflammatory cells in patients with PAD [well-preserved skeletal fibres: PAD = 26 (63.41%) vs. varicose veins = 3 (37.50%) p = 0.173; trauma: PAD = 4 (9.76%) vs. varicose veins = 2 (25.00%) p = 0.229; haemorrhage: PAD = 6 (14.63%) vs. varicose veins = 0 (0%) p = 0.248; inflammatory cells: PAD = 18 (43.90%) vs. varicose veins = 0 (0%) p = 0.018]. Patients with PAD had a higher number of inflammatory cells in skeletal muscle and adipose tissue (PVAT and SAT) when compared with those with varicose veins, emphasizing the role of inflammation in this group of patients.

Background Peripheral artery disease is characterized by an intense inflammatory process that can be associated with a higher mortality rate, particularly in chronic limb‐threatening ischemia (CLTI). This study aims to compare the evolution of inflammatory markers between patients with claudication with those with CLTI at 3, 6, and 12 months. Methods and Results An observational, single‐center, and prospective study was conducted. A total of 119 patients with peripheral artery disease (65 with claudication and 54 with CLTI) were observed and inflammatory markers collected at admission and 3, 6, and 12 months. At admission, patients with CLTI, when compared with patients with claudication, had significantly higher serum levels of C‐reactive protein and fibrinogen (positive acute‐phase proteins) and lower serum level of albumin, total cholesterol, and high‐density lipoprotein (negative acute‐phase proteins): C‐reactive protein (g/dL), 2.90 (25th–75th percentile, 2.90–4.90) versus 6.80 (25th–75th percentile, 2.90–53.26) ( P =0.000); fibrinogen (mg/dL), 293.00 (25th–75th percentile, 269.25–349.00) versus 415.50 (25th–75th percentile, 312.00–615.75) ( P =0.000); total cholesterol (mg/dL), 161.79±95% [152.74–170.85] versus 146.42%±95% [135.30–157.53] ( P =0.034); high‐density lipoprotein (mg/dL), 50.00 (25th–75th percentile, 41.00–60.00) versus 37.00 (25th–75th percentile, 30.00–45.50) ( P =0.000); albumin (g/dL): 4.00 (25th–75th percentile, 3.70–4.20) versus 3.60 (25th–75th percentile, 3.10–4.00) ( P =0.003). The association between CLTI and total cholesterol was lost after adjusting for confounders. Three months after the resolution of the CLTI, there was an increase in the levels of negative acute‐phase proteins and a decrease in positive acute‐phase proteins. These inflammatory proteins did not register an evolution in patients with claudication. The differences in the inflammatory proteins between groups disappeared at 6 months. Conclusions CLTI has an inflammatory environment that can be partially reverted after resolution of the ischemic process, emphasizing the importance of timely intervention.

Skeletal muscle is a highly active endocrine organ that produces several bioactive molecules, myokines, with decisive action in multiple physiologic processes, including inflammation and vascular function.[1] [2] However, the relationship between normal/abnormal skeletal muscle indicators and arterial stiffness is not clear.[3] Thus, this work aimed to evaluate the association between physiological and structural features of skeletal muscle (strength, quantity, histology, myokines) and arterial stiffness.

BACKGROUND:Inflammation is a key element in the initiation and progression of peripheral arterial disease (PAD). Understanding the impact of inflammatory molecules, as cytokines in PAD could help us to improve the prognosis of these patients. The main goal of this study was to compare the serum level of cytokines between patients with claudication to those with chronic limb-threatening ischemia (CLTI). The second objective was to evaluate the relationship between the levels of cytokines and death or amputation rate. METHODS:An observational, single-center, and prospective study was conducted from January 2018 to July 2022. The study was approved by the ethical commission of the Local Hospital (75/2017). Patients with PAD, suggested by the clinical history and objective examination and confirmed with ankle-brachial index, attending vascular surgery consultations of the first author were included. The following exclusion criteria were applied: i) bedridden individuals or subjects who refused to participate in the protocol; ii) diseases responsible for body composition changes or proinflammatory state; iii) recent diet change, iv) active malignancy, v) autoimmune disease, vi) active infection, vii) chronic renal failure (glomerular filtration rate <30 mL/min/1.73 m2), or viii) heart failure in the past 3 months. This cohort was observed at admission, 3, 6, and 12 months. A panel of 27 cytokines was determined with ELISA, at baseline. RESULTS:We included 119 subjects (mean age: 67.58 ± 9.60 years old; 79.80% males), 65 patients with claudication and 54 with CLTI. From the 27 cytokines analyzed, patients with CLTI, when compared to those with claudication, had a higher serum level of 11 cytokines: IL1ra, IL-6, IL-8, IL12 p70, G-CSF, IP-10, MCP-1, MIP-1α, PDGF-β, RANTES, and TNF-α. From the group of patients with CLTI those who underwent a major amputation had a higher serum level of FGF-basic [median = 49.04; interquartile range = 37.03-52.49; versus median = 33.04; interquartile range = 28.60-38.98; P = 0.001]. CONCLUSIONS:Patients with CLTI have higher serum level of inflammatory cytokines, which may have role in the prognosis of these patients.

ABSTRACT Introduction Peripheral arterial disease (PAD) affects over 202 million individuals worldwide, with 1.3% suffering from chronic limb-threatening ischaemia (CLTI). Atherosclerosis, characterized by intense inflammation, is the primary cause of PAD. Inflammation is linked to higher mortality rates, especially in CLTI patients. This study aims to compare the evolution of inflammatory markers between claudication and CLTI patients over three, six, and twelve months. Methods A prospective, single-center observational study was conducted from January 2018 to July 2022. A PAD cohort was observed at admission and at three, six, and twelve months, with data on clinical, analytical, and inflammatory markers collected. The analyzed markers included positive acute phase proteins (C-reactive protein - CRP and fibrinogen) and negative acute phase proteins (albumin, total cholesterol, and high-density lipoprotein - HDL). Results The study involved 119 subjects (mean age: 67.58 ± 9.60 years; 79.80% males), with 65 patients having claudication and 54 with CLTI. At admission, CLTI patients exhibited significantly higher serum levels of CRP and fibrinogen (positive acute phase proteins) and lower levels of albumin, total cholesterol, and HDL (negative acute phase proteins) compared to claudication patients. Three months after CLTI resolution, negative acute phase proteins increased, and positive acute phase proteins decreased. However, no significant changes in inflammatory proteins were observed in patients with claudication over time. Conclusion CLTI patients demonstrate an inflammatory state, which may have deleterious consequences and be partially reversible after the resolution of the ischemic process. Recognizing the potential for reversibility through revascularization/amputation underscores the significance of timely intervention.

The prevalence of obesity has doubled, with a concomitant increase in cardiovascular disease. This study aimed to compare the characteristics of visceral, subcutaneous and peri-aortic adipose tissue determined with computed tomography (CT) scans and to correlate them with cardiovascular risk factors, anthropometric measures and medication. An observational and prospective study was conducted, and 177 subjects were included. Peri-aortic adipose tissue had the highest density, while the subcutaneous adipose tissue had the lowest. The density of subcutaneous adipose tissue differs from the density of visceral (p = 0.00) and peri-aortic adipose tissue (p = 0.00). Smokers/ex-smokers had a lower area (p = 0.00) and density (p = 0.02) of subcutaneous adipose tissue. Multiple linear regression analysis showed that sex was a predictor of subcutaneous adipose tissue area (β = −0.27, t = −3.12, p = 0.00) but smoking habits were not. After controlling for sex, we found that the association between smokers/ex-smokers and area of subcutaneous adipose tissue was lost, but the association with density persisted. Patients with hypertension had a higher visceral adipose tissue area, and this relationship was maintained even after adjusting for gender. Peri-aortic adipose tissue is similar to visceral and distinct from subcutaneous adipose tissue. Cardiovascular risk factors have different influences in distinct adipose compartments.

BACKGROUND:Lower extremity peripheral arterial disease (PAD) is an atherosclerotic disease of the lower extremities. Atherosclerosis, inflammation, and sarcopenia are independently associated and potentiate each other. Inflammation is deeply involved in the formation and progression of atherosclerosis and is also involved in the pathophysiology of sarcopenia. Sarcopenia is defined as low muscle mass, with low muscle strength. This study aims to determine the differences in skeletal muscle characteristics and in inflammatory parameters between patients with claudication and with chronic limb threatening ischemia (CLTI). METHODS:An observational, prospective study in patients with PAD was conducted from January 2018 to December 2020. The clinical characteristics and the cardiovascular risk factors were prospectively registered. The inflammatory parameters determined were: positive acute phase proteins (C-reactive Protein- CRP- and fibrinogen) and negative acute phase proteins albumin, total cholesterol and high-density lipoprotein (HDL). The skeletal muscle area and density were quantified with a computed topography (CT) scan. The strength was determined with a Jamar® hydraulic hand dynamometer. RESULTS:A total of 116 patients (mean age: 67.65 ± 9.53 years-old) 64% with claudication and 46% with CLTI were enrolled in the study. No differences were registered between patients with claudication and CLTI on age, cardiovascular risk factors (hypertension, dyslipidemia, diabetes mellitus, and smoking habits) and medication. There was a higher prevalence of men in the claudication group (88.89% vs. 71.70%, P = 0.019). Analyzing the inflammatory parameters, we noted that patients with CLTI had increased serum levels of positive acute phase proteins: CRP (37.53 ± 46.61 mg/L vs. 9.18 ± 26.12 mg/L, P = 0.000), and fibrinogen (466.18 ± 208.07 mg/dL vs. 317.37 ± 79.42 mg/dL, P = 0.000). CLTI patients had decreased negative acute phase proteins: albumin (3.53 ± 0.85 g/dL vs. 3.91 ± 0.72 g/dL, P = 0.001), total cholesterol (145.41 ± 38.59 mg/dL vs. 161.84 ± 34.94 mg/dL, P = 0.013) and HDL (38.70 ± 12.19 mg/dL vs. 51.31 ± 15.85 mg/dL, P = 0.000). We noted that patients with CLTI had lower skeletal muscle area and mass (14,349.77 ± 3,036.60 mm2 vs. 15,690.56 ± 3,183.97 mm2P = 0.013; 10.11 ± 17.03HU vs. 18.02 ± 13.63HU P = 0.013). After adjusting for the variable sex, the association between skeletal muscle density and CLTI persisted (r (97) = -0.232, P = 0.021). The groups did not differ in strength (patients with claudication: 25.39 ± 8.23 Kgf vs. CLTI: 25.17 ± 11.95 Kgf P = 0.910). CONCLUSIONS:CLTI patients have decreased skeletal muscle mass and a systemic inflammation status. Recognizing the deleterious triad of atherosclerosis, inflammation and loss of skeletal mass patients with CLTI is an opportunity to improve medical therapy and to perform a timely intervention to stop this vicious cycle.

Obesity is a risk factor for coronary atherosclerosis. However, the influence of adipose tissue in carotid atherosclerosis is not completely understood. No systematic review/meta-analysis was previously performed to understand if obesity is a risk factor for carotid atherosclerosis. This paper aims to provide an opportunistic review of the association between obesity and carotid atherosclerosis and define the role of the different adipose tissue depots in the characteristics of carotid stenosis. The databases PubMed and Cochrane Library were searched on 15–27 April and 19 May 2021. A total of 1750 articles published between 1985 and 2019 were identified, 64 were preselected, and 38 papers (35,339 subjects) were included in the final review. The most frequent methods used to determine obesity were anthropometric measures. Carotid plaque was mostly characterized by ultrasound. Overall obesity and visceral fat were not associated with the presence of carotid plaque when evaluated separately. Waist-hip ratio, however, was a significant anthropometric measure associated with the prevalence of carotid plaques. As it reflected the ratio of visceral and subcutaneous adipose tissue, the balance between these depots could impact the prevalence of carotid plaques.

Background: Determine the influence of sarcopenia on the prognosis of peripheral arterial disease (PAD). Methods: A systematic search of the PubMed and Cochrane Library databases was performed with the keywords and medical subject heading (MesH): "muscle, skeletal", "sarcopenia", "prognosis", "duration of stay", "death", "mortality", "patient readmission", "length of stay", "peripheral arterial disease", "intermittent claudication" and "critical limb ischemia". Papers published from January 2010 to October 2020 in English, French, Spanish and Portuguese were eligible for inclusion. The primary outcome was overall survival. Secondary outcomes included postoperative complications, amputation, length of hospital stay and hospital readmission. Results: Of 1071 papers, 8 articles and 1511 patients were included (68.96% male, mean age 71.83 years). Five papers found an inverse relationship between SM area and mortality. Matsubara (2015) found that the 5-year overall survival rates were lower for patients with sarcopenia (23.5% +/- 0.18% vs 77.5% +/- 0.09% P = 0.001). Matsubara (2016) registered 3-year cardiovascular event-free survival rates of 43.1% and 91.2% for patients with and without sarcopenia (P < 0.01). Juszczak (2018) found that survival was lower in patients with reduced total psoas area. Taniguchi (2019) found that 3-year overall survival rate was 60% for patients with sarcopenia and 87% for patients without sarcopenia (P < 0.05). Shimazoe (2019) concluded sarcopenia was a significant predictor of overall survival. Distinctly, Nyers (2017) concluded that higher ratio bilateral psoas area to L4 vertebral body was associated with an increased risk of death. Two other studies analyzed other characteristics of the SM (density and strength). McDermott (2012) and found that lower calf muscle density and strength were associated with an increase in mortality. Sugai (2019) concluded that patients with major cardiovascular and limb events had a lower SM density. Conclusions: Lower SM area and mass seem to be associated with a higher mortality in PAD patients.

BACKGROUND:Sarcopenia is defined as low muscle mass, with low muscle strength or low physical performance. The skeletal muscle mass (or density) and strength are inversely associated with cardiovascular risk factors. We aim to determine the relationship between skeletal muscle characteristics (strength, mass, area), and cardiovascular risk factors in a population with lower extremity artery disease (LEAD). METHODS:An observational, prospective study including patients with LEAD was conducted from January 2018 to December 2020. The cardiovascular risk factors and anthropometric measurements were prospectively registered. The skeletal muscle characteristics (area, density/mass and strength) were analysed. The skeletal muscle area and density were quantified with a CT scan. The strength was determined with a Jamar® hydraulic hand dynamometer. RESULTS:A total of 96 patients with LEAD with 67.70 ± 10.11 years-old were enrolled in the study. The most prevalent cardiovascular risk factor was hypertension, followed by dyslipidemia and diabetes. Patients with diabetes had a lower handgrip strength and skeletal muscle density, when compared with patients without diabetes (strength: 19.67 ± 9.98 kgf vs. 26.79 ± 11.80 kgf, P = 0.002 and skeletal muscle density: 10.58 ± 17.61 HU vs. 18.17 ± 15.33 HU, P = 0.032). There was a trend for the association between the presence of cardiovascular risk factors (hypertension and dyslipidemia) and a decrease in skeletal muscle density and strength (density: hypertension: 13.46 ± 16.74 HU vs. 20.38 ± 11.63 HU P=0.055; dyslipidemia: 13.57 ± 17.16 HU vs. 17.74 ± 13.00 HU P= 0.315; strength- hypertension: 22.55 ± 10.08 kgf vs. 27.58 ± 15.11 P= 0.073; dyslipidemia: 22.80 ± 10.52 kgf vs. 25.28 ± 13.14 kgf P= 0.315). Interestingly, we found that smokers had a favorable skeletal muscle characteristic, which could be explained by the higher prevalence of diabetes in nonsmokers. CONCLUSIONS:The indicators of skeletal muscle dysfunction (strength and density) are associated to the presence of diabetes in patients with LEAD. Therapeutic strategies to improve the skeletal muscle characteristics could have a role in improving LEAD risk factors, particularly diabetes.

Background: Carotid Arterial Disease (CAD) and peripheral arterial disease (PAD) are atherosclerotic diseases. Adipose tissue (AT) and skeletal muscle (SM) are endocrine organs producing polypeptides with vascular effects. The main objective of this study is to characterize the AT and SM in PAD and CAD. It is also an aim to determine their role in central hemodynamics. Methods: A prospective, observational, case–control study is being conducted. The study group includes patients with PAD/CAD, with and without surgical indication. The control group includes subjects without PAD/CAD, with indication for elective non-vascular surgery, in order to allow access to samples of AT and SM. The quantity, histology and endocrine function of AT and SM are being determined. Results: From December 2018 to August 2019, 47 PAD were studied: 33 with Intermittent Claudication (IC) - (28 male; age: 67.24 ± 9.97 years) and 14 Critical Limb Ischemia (CLI) - (seven male; age: 69.21 ± 8.33 years). CLI patients have a lower quantity of SM and higher quantity of visceral and subcutaneous AT, determined on the CT scan, but these differences were not statistically significant. CLI had significant lower SM strength and density [muscle strength right hand: 22.62 ± 8.20 kgf IC vs. 16.38 ± 7.84 kgf CLI, p = 0,02; SM strength left hand: 21.98 ± 8.98 kgf IC vs. 16.37 ± 8.35 kgf CLI, p = 0.04; SM density: 20.44 ± 11.73 Hounsfield Units (HU) IC vs. 9.04 ± 2.47 HU CLI, p = 0.01]. Conclusion: This preliminary data suggests that CLI patients could have a SM dysfunction, inferred from hand grip strength and SM density. These results would be corroborated with the project development. The novelty of this research is the possibility to study the histology features and endocrine markers of AT and SM and to find an association with artery function, arteriosclerosis an atherosclerosis, in human.

Purpose/Background Sarcopenia (decrease of muscle mass and function) has been linked with atherosclerosis [ 1 ]. The EWGSOP2 updated consensus, uses low muscle strength as the primary indicator of sarcopenia [ 2 ]. It is acknowledged that strength is better than mass for predicting adverse outcomes [ 2 ]. Handgrip strength (HGS) is a simple assessment to estimate overall muscular strength [ 3 ]. and is associated with cardiovascular mortality [ 4 ]. Objective Analyze the relationship between HGS and atherosclerotic disease (carotid artery disease + lower extremity artery disease). Methods Prospective observation study was conducted from January to December 2019. The clinical and demographic data was recorded. Isometric HGS was measured with an adjustable handheld dynamometer (Jamar The higher value of each arm was used to classify the patient as sarcopenic or non-sarcopenic. Definition of sarcopenia: HGS <30 kgf in men and <20 kgf in women [ 5 ]. Results 94 patients (aged 44–86 years) were analyzed: 64 sarcopenic and 30 non sarcopenic. Groups differed in the prevalence of diabetes and smoking status ( Table 1 ). No differences were found in the carotid parameters analyzed ( Table 1 ). There was, a difference in the prevalence of chronic limb-threatening ischemia (CLTI) in sarcopenic versus non-sarcopenic group (23.44% versus 6.67% p = 0.046). Importantly, binary logistic regression showed that diabetes ( p = 0.014), and HGS ( p = 0.027) have a significant effect on CLTI ( Table 2 ). Conclusions No relationship was found between sarcopenia (measured by HGS) and carotid atherosclerosis, differing from other authors [ 1 , 6 ]. In this study, sarcopenic had a higher incident of diabetes and CLTI. Sarcopenia and diabetes are reciprocally related and may share a similar pathogenetic pathway [ 7 , 8 , 9 ]. Table 1 Sarcopenia ( n = 64) No Sarcopenia ( n = 30) p Age (years) 69.81 ± 8.79 62.6 ± 8.61 p = 0.889 Male 47 (73.44%) 27 (90.00%) p = 0.067 Hypertension 51 (79.69%) 21 (70.00%) p = 0.301 Dyslipidemia 47 (73.43%) 18 (60.00%) p = 0.189 Smoking load (UMA) 24.42 ± 33.14 37.76 ± 31.8 p = 0.748 Smoker/Ex-smoker 33 (51.56%) 24 (80.00%) p = 0.013 * Diabetes 28 (43.75%) 7 (23.33%) p = 0.049 * Coronary disease 11 (17.19%) 4 (13.33%) p = 0.613 History of stroke 11 (17.19%) 3 (10.00%) p = 0.347 Total cholesterol (mg/dL) 158.16 ± 39.82 159.6 ± 30.72 p = 0.22 LEAD 43 (67.19%) 17 (56.67%) p = 0.275 Claudicants 28 (43.75%) 15 (50.00%) p = 0.615 CLTI 15 (23.44%) 2 (6.67%) p = 0.046 * ABI right 0.83 ± 0.24 0.78 ± 0.29 p = 0.287 ABI left 0.81 ± 0.28 0.77 ± 0.23 p = 0.671 Right carotid artery stenosis 50–70 4 (6.25%) 2 (6.67%) p = 0.952 >70% 58 (90.63%) 27 (90.00%) p = 0.702 Light carotid artery stenosis 50–70 3 (4.79%) 1 (3.33%) p = 0.787 >70% 4 (6.25%) 2 (6.67%) p = 0.903 Area right carotid plaque (mm 2 ) 21.22 ± 19.81 20.01 ± 17.04 p = 0.622 Average IMT- right (mm) 0.96 ± 0.41 0.88 ± 0.24 p = 0.159 Area left carotid plaque (mm 2 ) 21.46 ± 18.73 21.47 ± 22.06 p = 0.948 Average IMT- left (mm) 0.93 ± 0.25 0.88 ± 0.29 p = 0.861 Table 2 Independent variables Categories a 95% CI p CLTI Diabetes 1.488 1.34–14.60 0.014 Higher HGS −0.888 0.846–0.990 0.027

Introduction: Peripheral arterial disease (PAD) is a manifestations of atherosclerotic disease. Adipose tissue (AT) and skeletal muscle (SM) are endocrine organs producing polypeptides with vascular effects (adipokines and myokines). The objective of this study is to compare the quantity and function of AT and SM between two groups: intermittent claudication (IC) and critical limb ischemia (CLI). Methods: The quantity of AT and SM will be determined with anthropometric measurements (height, weight, body mass index, waist circumference, hip circumference, waist-to-hip ratio and skinfolds) and with CT scan. A transverse CT image obtained at lower border the third lumbar vertebra (in the lower border) will be used to quantify the SM, visceral and subcutaneous AT. The SM area will be calculated adding the areas of the following muscle at the third lumbar vertebra: psoas, erector spinae, quadratus lumborum, transversus abdominis, external and internal oblique abdominal muscle and rectus abdominis. The area of subcutaneous compartment will be determined as the area of tissue between the visceral cavity and the body contour. Visceral fat area will be the area of the tissue within the contour of the visceral cavity. The skeletal muscle function will be inferred with the determination of hand strength using a Jamar® hydraulic hand dynamometer. The t-test will be applied to analyse the continuous variables. Results: In this poster the preliminary results will be showed. From december 2018 to March 2019 28 PAD patients were studied: 18 IC (14 male; age:68,89± 9,33years) and 10 CLI (6 male; age: 70,88± 9,61years). Analyzing the anthropometric measures, there is no statistic meaningful differences between the two groups, however the CLI patients have less muscle strength and larger subscapular and suprailiac skinfolds (weight: 74,45± 11,7Kg IC versus 73,45± 12,64Kg CLI p=0,13; body mass index: 27,80± 3,33Kg/m2 IC versus 27,59± 3,30Kg/m2 CLI p=0,18; waist circumference: 101,86± 9,97cm IC versus 101,76± 10,62cm CLI p=0,38; ; hip circumference: 100,43± 7,38cm IC versus 101,04± 7,44cm CLI p=0,39; subscapular skinfold: 10,44± 4,11mm IC versus 13,30± 4,71mm CLI p=0,43; suprailiac skinfold: 11,08± 4,81mm IC versus 14,43± 4,43mm CLI p=0,26; skeletal muscle strength right hand skinfold: 10,37± 7,75Kgf IC versus 17,33± 6,92Kgf CLI p=0,24; skeletal muscle strength left hand skinfold: 18,50± 8,34Kgf IC versus 16,88± 6,93Kgf CLI p=0,10. We also found on CT scan that the quantity SM is lower in CLI than in IC (subcutaneous AT area: 16607,02± 7323,67cm2 IC versus 17572,4± 8682,3cm2 CLI p=0,17; visceral AT area 20194,74± 10629,62cm2 IC versus 22112,07± 10561,9cm2 CLI p=0,93; Total AT area 42056,79± 29932,1cm2 IC versus 49815,74± 36672,21cm2 CLI p=1,13; SM area 14119,4± 4802,87cm2 IC versus 13694± 4528,51cm2 CLI p=0,27). Conclusion: CLI tend to have smaller SM and larger AT areas, as determined with the CT scan. The AT has a direct effect on the reduction of the quantity of SM. There is an association between the SM area and the muscle function, strength (determined by handgrip strength), which seems to be also true in this small sample. Loss of muscle strength is associated with arterial stiffness, inflammation, endothelial dysfunction and all-cause mortality. Disclosure: Nothing to disclose

The role of visceral obesity in atherosclerosis is well recognized by the medical community. On the contrary, the importance of skeletal muscle is almost unknown. Muscle is nowadays understood as an endocrine organ producing myokines with direct action in several physiological and pathological pathways, including atherosclerosis. The myokines reduce the formation of neointima, expression of inflammatory mediators, the recruitment of inflammatory cells and the formation of foam cells. Epidemiological studies are demonstrating the association between reduced muscle mass and cardiovascular atherosclerotic disease. Low muscle mass is associated with an increased prevalence of coronary heart disease, aortic calcification, carotid atherosclerosis, carotid intima-media thickness, intracranial artery stenosis and endothelial dysfunction. In this way resistance training, which increases the muscle size and strength may have a key role in atherosclerosis while endurance training alone might not. The time and type of protein intake by older adults may be critical to the maintenance of muscle mass and to the increase survival. The objective of this paper was to perform a review about the published literature in the last 13 years about the role of skeletal muscle in atherosclerosis.

Background: Peripheral arterial disease (PAD) is a manifestation of atherosclerosis. Adipose tissue (AT) and skeletal muscle (SM) are endocrine organs with vascular effects. The objective is to compare the quantity and function of AT and SM between two groups: intermittent claudication (IC) and critical limb ischemia (CLI). Methods: A prospective observational study is being performed. A transverse CT image at lower border the third lumbar vertebra was used to quantify the SM, visceral and subcutaneous AT. The SM function was inferred with the determination of hand strength using a Jamar® hydraulic hand dynamometer. Results: From December 2018 to May 2019, 44 PAD were studied: 31 with IC (24 male; age: 67 10, 29 years) and 13 CLI (7 male; age: 70, 62 6, 74 years). CLI have a lower quantity of subcutaneous AT and higher quantity of visceral and total AT, determined on the CT scan (subcutaneous AT: 16564,75 7600,00 cm2 IC versus 16067,42 10187,33 cm2 CLI p = 0.03; visceral AT: 17212,20 10096, 30 cm2 IC versus 18904,85 10189,04 cm2 CLI p = 0,03; Total AT: 33222,08 15459,33 cm2 IC versus 57320,00 52538,78 cm2 CLI p = 0.03). CLI had lower SM strength and density (muscle strength right hand: 22,62 8,20 Kgf IC versus 16,38 7,84 Kgf CLI p = 0,02; SM strength left hand: 21,98 8,98 Kgf IC versus 16,37 8,35 Kgf CLI p = 0,04; SM density: 20,44 11,73 HU IC versus 9,04 28,47 HU CLI p = 0,01) No differences were found in the SM quantity (15120,87 3199,35 cm2 IC versus 15322,57 5315,31 cm2 CLI p = 0.44). Conclusion: CLI have a higher quantity of visceral, total AT and lower quantity of subcutaneous AT, SM function and density.

Background: By contrast with other southern European people, north Portuguese population registers an especially high prevalence of hypertension and stroke incidence. We designed a cohort study to identify individuals presenting accelerated and premature arterial aging in the Portuguese population. Method: Pulse wave velocity (PWV) was measured in randomly sampled population dwellers aged 18–96 years from northern Portugal, and used as a marker of early vascular aging (EVA). Of the 3038 individuals enrolled, 2542 completed the evaluation. Results: Mean PWV value for the entire population was 8.4 m/s (men: 8.6 m/s; women: 8.2 m/s; P < 0.02). The individuals were classified with EVA if their PWV was at least 97.5th percentile of z-score for mean PWV values adjusted for age (using normal European reference values as comparators). The overall prevalence of EVA was 12.5%; 26.1% of individuals below 30 years presented this feature and 40.2% of individuals in that same age strata were placed above the 90th percentile of PWV; and 18.7% of the population exhibited PWV values above 10 m/s, with male predominance (17.2% of men aged 40–49 years had PWV > 10 m/s). Logistic regression models indicated gender differences concerning the risk of developing large artery damage, with women having the same odds of PWV above 10 m/s 10 years later than men. Conclusion: The population PWV values were higher than expected in a low cardiovascular risk area (Portugal). High prevalence rates of EVA and noteworthy large artery damage in young ages were found.

Background: Cardiovascular disease and dementia are growing medical and social problems in aging societies. Appropriate knowledge of cardiovascular disease and cognitive decline risk factors (RFs) are critical for global CVR health preventive intervention. Many epidemiological studies use case definition based on data collected/measured in a single visit, a fact that can overestimate prevalence rates and distant from clinical practice demanding criteria. Portugal displays an elevated stroke mortality rate. However, population's global CV risk characterization is limited, namely, considering traditional/nontraditional RF and new intermediate phenotypes of CV and renal disease. Association of hemodynamic variables (pulse wave velocity and central blood pressure) with global CVR stratification, cognitive performance, and kidney disease are practically inexistent at a dwelling population level.Study Design and Methods: After reviewing published data, we designed a population-based cohort study to analyze the prevalence of these cardiovascular RFs and intermediate phenotypes, using random sampling of adult dwellers living in 2 adjacent cities. Strict definition of phenotypes was planned: subjects were observed twice, and several hemodynamic and other biological variables measured at least 3 months apart.Results: Three thousand thirty-eight subjects were enrolled, and extensive data collection (including central and peripheral blood pressure, pulse wave velocity), sample processing, and biobank edification were carried out. One thousand forty-seven cognitive evaluations were performed.Conclusions: Seeking for CV risk reclassification, early identification of subjects at risk, and evidence of early vascular aging and cognitive and renal function decline, using the strict daily clinical practice criteria, will lead to better resource allocation in preventive measures at a population level.