title: Cardiovascular risk factor management is poorer in diabetic patients with undiagnosed peripheral arterial disease than in those with known coronary heart disease or cerebrovascular disease. Results of a nationwide study in tertiary diabetes centres.
abstract: OBJECTIVE
  To assess whether patients with Type 2 diabetes mellitus and unrecognized peripheral arterial disease (PAD), detected by the ankle-brachial index (ABI), have poorer cardiovascular risk factor management (CVRFs) and receive fewer medications than patients previously diagnosed with coronary heart disease (CHD) or cerebrovascular disease (CVD).
  
  
  METHODS
  In 31 diabetes centres throughout Spain, 1303 patients with Type 2 diabetes mellitus were screened for PAD using the ABI. Patient history of CHD and CVD and treatment and control of CVRFs were recorded.
  
  
  RESULTS
  Forty-one patients had an ABI > 1.30 and were excluded, leaving 1262 patients (age 65.3 +/- 7.7 years) for the study. Of those screened, 790 patients had a normal ABI (ABI > 0.9) and no known history of CHD or CVD (no CHD/CVD/PAD group), 194 had unrecognized PAD (ABI < or = 0.9) with no known history of CHD or CVD (undiagnosed PAD group) and 278 had a known history of CHD and/or CVD (CHD/CVD group). The undiagnosed PAD group had higher low-density lipoprotein (LDL) cholesterol (2.9 +/- 0.83 vs. 2.4 +/- 0.84 mmol/l; P < 0.001) and systolic blood pressure (150 +/- 20 vs. 145 +/- 21 mmHg; P < 0.001) compared with the CHD/CVD group. They were less likely to take statins (56.9 vs. 71.6%; P < 0.001), anti-hypertensive agents (75.9 vs. 90.1%, P = 0.001), and anti-platelet agents (aspirin, 28.7 vs. 57.2%; P < 0.001; clopidogrel, 5.6 vs. 20.9%; P < 0.001) and more likely to smoke (21.0 vs. 9.2%; P < 0.001). Higher LDL in the undiagnosed PAD group was associated with the underutilization of statins.
  
  
  CONCLUSIONS
  Measurement of ABI detected a significant number of patients with PAD, who did not have CHD or CVD, but whose CVRFs were under treated and poorly controlled compared with subjects with CHD and/or CVD.
authors.affiliation: Hospital of Sabadell, Sabadell, Spain. gonclem@yahoo.es
authors.forename: J-M
authors.initials: JM
authors.lastname: González-Clemente
authors.forename: J A
authors.initials: JA
authors.lastname: Piniés
authors.forename: A
authors.initials: A
authors.lastname: Calle-Pascual
authors.forename: A
authors.initials: A
authors.lastname: Saavedra
authors.forename: C
authors.initials: C
authors.lastname: Sánchez
authors.forename: D
authors.initials: D
authors.lastname: Bellido
authors.forename: T
authors.initials: T
authors.lastname: Martín-Folgueras
authors.forename: I
authors.initials: I
authors.lastname: Moraga
authors.forename: A
authors.initials: A
authors.lastname: Recasens
authors.forename: J
authors.initials: J
authors.lastname: Girbés
authors.forename: M-A
authors.initials: MA
authors.lastname: Sánchez-Zamorano
authors.forename: D
authors.initials: D
authors.lastname: Mauricio
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000842:Ankle / Q000098:blood supply; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001916:Brachial Artery / Q000502:physiology; D002561:Cerebrovascular Disorders / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000517:prevention & control*; D003925:Diabetic Angiopathies / Q000175:diagnosis / Q000517:prevention & control*; D005260:Female; D006297:Health Services Accessibility / Q000592:standards*; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006973:Hypertension / Q000188:drug therapy; D008297:Male; D016491:Peripheral Vascular Diseases / Q000175:diagnosis / Q000517:prevention & control*; D011320:Primary Health Care / Q000592:standards; D011787:Quality of Health Care; D013030:Spain
chemical_list: D000959:Antihypertensive Agents; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors