title: Sub-clinical vascular disease in type 2 diabetic subjects: relationship with chronic complications of diabetes and the presence of cardiovascular disease risk factors.
abstract: 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.
authors.affiliation: Atherosclerosis Unit, Hospital Carlos III, Madrid, Spain. jmostaza.hciii@salud.madrid.org
authors.forename: Jose Ma
authors.initials: JM
authors.lastname: Mostaza
authors.forename: Carmen
authors.initials: C
authors.lastname: Suarez
authors.forename: Luis
authors.initials: L
authors.lastname: Manzano
authors.forename: Marc
authors.initials: M
authors.lastname: Cairols
authors.forename: Fernando
authors.initials: F
authors.lastname: López-Fernández
authors.forename: Isabel
authors.initials: I
authors.lastname: Aguilar
authors.forename: Fernando
authors.initials: F
authors.lastname: Diz Lois
authors.forename: Juan L
authors.initials: JL
authors.lastname: Sampedro
authors.forename: Herminia
authors.initials: H
authors.lastname: Sánchez-Huelva
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Sanchez-Zamorano
mesh_terms: 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