Sub-clinical vascular disease in type 2 diabetic subjects: relationship with chronic complications of diabetes and the presence of cardiovascular disease risk factors.
BACKGROUND
We evaluated the association between a low ankle-brachial index (ABI), chronic complications of diabetes, and the presence of traditional cardiovascular disease risk factors in subjects with type 2 diabetes but without known cardiovascular disease.


METHODS
We included diabetic subjects (n=923; 52% male; age range 50-85 years) without clinical evidence of coronary, cerebrovascular, or peripheral artery disease (PAD). A history of nephropathy, retinopathy, or neuropathy was collected from the medical records. A 12-lead electrocardiogram and ABI measurements were conducted on all study participants.


RESULTS
The mean duration of diabetes was 9.6 years. Prevalence of a low ABI (<0.9) was 26.2%. Multivariate analysis indicated that factors significantly associated with a low ABI were age (OR: 1.06; 95%CI: 1.033-1.084; p<0.001), plasma triglyceride concentration (OR: 1.002; 95%CI: 1.001-1.004; p=0.006), duration of diabetes (OR: 1.029; 95%CI: 1.008-1.051; p=0.007), and smoking habit (OR: 1.755; 95%CI: 1.053-2.925; p=0.03). The presence of nephropathy, neuropathy, retinopathy, left ventricular hypertrophy, left bundle branch block, and atrial fibrillation were all associated with a low ABI, but only renal disease remained significant after adjusting for age, duration of diabetes, and cardiovascular risk factors.


CONCLUSIONS
A low ABI is highly prevalent in subjects with diabetes and is related to age, duration of diabetes, smoking habit, and hypertriglyceridemia. Although chronic complications are frequently associated with a low ABI, only renal damage is independently associated with peripheral artery disease.
Mostaza
Jose Ma
JM
Atherosclerosis Unit, Hospital Carlos III, Madrid, Spain. jmostaza.hciii@salud.madrid.org
Suarez
Carmen
C
Manzano
Luis
L
Cairols
Marc
M
López-Fernández
Fernando
F
Aguilar
Isabel
I
Diz Lois
Fernando
F
Sampedro
Juan L
JL
Sánchez-Huelva
Herminia
H
Sanchez-Zamorano
Miguel A
MA
D000368:Aged; D000369:Aged, 80 and over; D000842:Ankle; D001916:Brachial Artery / Q000000981:diagnostic imaging*; D002318:Cardiovascular Diseases / Q000150:complications* / Q000175:diagnosis*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003925:Diabetic Angiopathies / Q000175:diagnosis*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014463:Ultrasonography