title: Non-linear association between ankle-brachial pressure index and prevalence of silent cerebral infarction in Japanese patients with type 2 diabetes.
abstract: OBJECTIVE
  Patients with peripheral artery disease (PAD), defined as having low ankle-brachial pressure index (ABI), have increased risk for incident stroke compared with those without PAD. We aimed to reveal whether ABI abnormality, especially high ABI is associated with prevalent silent cerebral infarction (SCI) in type 2 diabetic patients.
  
  
  METHODS
  We studied 538 Japanese type 2 diabetic patients, 227 women and 311 men, with a mean [±SD] age of 64±11 years. All patients underwent cranial magnetic resonance imaging (MRI). Values of ABI were classified as low (<0.9), normal (0.9≤ and <1.3), and high (1.3≤). Logistic regression model was used to calculate odds ratio and 95% confidence interval (95% CI) for prevalent SCI.
  
  
  RESULTS
  The mean ABI among the overall 538 patients was 1.09±0.16. Low and high ABI values were found in 52 (9.7%) and 33 (6.1%) patients, respectively. SCI was detected in 297 (55.2%) patients. The prevalence in patients with low, normal, and high ABI values were 88.5%, 49.7%, and 78.8 (p<0.001), respectively. In the multivariate logistic regression analysis, both patients with high and low ABI were significantly increased risk of prevalent SCI (odds ratio 4.53, 95% CI 1.67-12.34, p=0.003 and odds ratio 3.50, 95% CI 1.50-10.29, p=0.005), independently of other traditional cardiovascular risk factors, than those with normal ABI.
  
  
  CONCLUSIONS
  Both high and low ABI may be strongly associated with prevalent SCI in Japanese patients with type 2 diabetes.
authors.affiliation: Division of Nephrology and Hypertension, Diabetes Center, Tokyo Women's Medical University School of Medicine, 8-1 Kawadacho, Shinjukuku, Tokyo 162-8666, Japan.
authors.forename: Ryotaro
authors.initials: R
authors.lastname: Bouchi
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Babazono
authors.forename: Michino
authors.initials: M
authors.lastname: Takagi
authors.forename: Naoshi
authors.initials: N
authors.lastname: Yoshida
authors.forename: Izumi
authors.initials: I
authors.lastname: Nyumura
authors.forename: Kiwako
authors.initials: K
authors.lastname: Toya
authors.forename: Ko
authors.initials: K
authors.lastname: Hanai
authors.forename: Nobue
authors.initials: N
authors.lastname: Tanaka
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Uchigata
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055109:Ankle Brachial Index; D044466:Asian People / Q000706:statistics & numerical data*; D002544:Cerebral Infarction / Q000175:diagnosis / Q000208:ethnology*; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000208:ethnology*; D003925:Diabetic Angiopathies / Q000175:diagnosis / Q000208:ethnology*; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017711:Nonlinear Dynamics; D016017:Odds Ratio; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000208:ethnology*; D011237:Predictive Value of Tests; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors