title: Non-compressible arterial disease and the risk of coronary calcification in type-2 diabetes.
abstract: OBJECTIVE
  Ankle-brachial index (ABI) screening is recommended for the detection of asymptomatic peripheral arterial disease (PAD) in at-risk populations, including diabetics. A low ABI identifies obstructive lower extremity vascular disease and predicts CVD events and increased mortality. A high ABI represents non-compressible arterial disease (NCAD), and is also associated with increased mortality and vascular events. Our objective is to investigate whether low and high ABI have distinct patterns of association with cardiovascular disease (CVD) risk factors and subclinical atherosclerosis in individuals with type-II diabetes mellitus.
  
  
  METHODS
  The Penn Diabetes Heart Study (PDHS) is a prospective observational cohort of diabetic individuals without clinically evident CVD. Multivariate logistic and Tobit linear regression were used to compare CVD risk factors and coronary artery (CAC) among 1863 subjects with PAD (ABI ≤ 0.9), NCAD (ABI ≥ 1.4 or non-compressible) or normal ABI (0.91-1.39).
  
  
  RESULTS
  Compared to those with normal ABI, PAD was associated with smoking, obesity, and lower HDL-c; while diabetes duration and reduced renal function were associated with NCAD. Both PAD and NCAD were independently associated with increased CAC compared to those with normal ABI, and these relationships were not attenuated in multiply adjusted models.
  
  
  CONCLUSIONS
  NCAD bears a distinct relationship to traditional CVD risk factors among diabetics, though like PAD is independently associated with increased CAC. These findings support the recognition of NCAD as a high-risk phenotype and provide additional relevance to ABI screening in diabetics.
authors: Division of Cardiovascular Medicine, Section of Interventional Cardiology, The Ohio State University, Columbus, 43210, USA. Scott.Lilly@uphs.upenn.edu
authors: Scott M
authors: SM
authors: Lilly
authors: Atif N
authors: AN
authors: Qasim
authors: Claire K
authors: CK
authors: Mulvey
authors: Timothy W
authors: TW
authors: Churchill
authors: Muredach P
authors: MP
authors: Reilly
authors: Luis H
authors: LH
authors: Eraso
mesh_terms: D000328:Adult; D000368:Aged; D055109:Ankle Brachial Index; D050197:Atherosclerosis / Q000097:blood; D002114:Calcinosis / Q000150:complications / Q000503:physiopathology*; D002318:Cardiovascular Diseases / Q000150:complications / Q000503:physiopathology*; D008076:Cholesterol, HDL / Q000097:blood; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009765:Obesity; D058729:Peripheral Arterial Disease / Q000150:complications / Q000503:physiopathology*; D010641:Phenotype; D012044:Regression Analysis; D012307:Risk Factors; D012907:Smoking
chemical_list: D008076:Cholesterol, HDL
keywords: ABI; Ankle–brachial index; CAC; CVD; Cardiovascular disease; HDL-c; LDL-c; Medial artery calcification; NCAD; PAD; PDHS; Penn Diabetes Health Study; Subclinical atherosclerosis; Vascular stiffness; ankle–brachial index; cIMT; cardiovascular disease; carotid intima–media thickness; coronary artery calcium; eGFR; estimated glomerular filtration rate; high-density lipoprotein cholesterol; low-density lipoprotein cholesterol; non-compressible arterial disease; peripheral arterial disease