title: The combination of the ankle brachial index and brachial ankle pulse wave velocity exhibits a superior association with outcomes in diabetic patients.
abstract: OBJECTIVE
  Patients with type 2 diabetes mellitus (T2DM) and peripheral arterial disease are classified as having very high cardiovascular risks. We therefore sought to determine whether assessments of the ankle brachial index (ABI) and brachial ankle pulse wave velocity (baPWV) together exhibited a superior association with the outcomes of T2DM.
  
  
  METHODS
  A retrospective analysis of patients receiving ABI and baPWV during the period 2005-2007 was performed. Patients A total of 452 subjects were enrolled and followed-up for a mean 5.8 years after being grouped according to the ABI (<0.9 vs. ≥0.9) and baPWV (<1,700 cm/s vs. ≥1,700 cm/s).
  
  
  RESULTS
  The outcomes were all-cause mortality and composite events (all-cause mortality, hospitalization for coronary artery disease, stroke, re-vascularization, amputation and diabetic foot). Inter-group differences in the smoking rate, duration of diabetes, systolic and pulse blood pressure, anti-platelet drugs, estimated glomerular filtration rate, and urine albumin excretion were significant. During the follow-up period, 17 (3.7%) individuals died and composite events were recorded in 64 cases (14.1%). A low ABI plus high baPWV was found be associated with poor outcomes compared with a normal ABI plus low baPWV (p<0.001). Meanwhile, a low ABI plus high baPWV was associated with an increased risk of all-cause mortality [hazard ratio (HR) 17.01, 95% confidence interval (CI) 1.57-183.73, p=0.019] and composite events (HR 8.53, 95% CI 3.31-21.99, p<0.001).
  
  
  CONCLUSIONS
  In this study, the outcomes of patients with a low ABI plus high baPWV were the worst, while the subjects with a low ABI plus low baPWV or normal ABI exhibited similar outcomes. Therefore, the ABI plus baPWV exhibits a better association with the outcomes of T2DM.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital Taoyaun Branch, Taiwan.
authors.forename: Li-Hsin
authors.initials: LH
authors.lastname: Chang
authors.forename: Hong-Da
authors.initials: HD
authors.lastname: Lin
authors.forename: Ching-Fai
authors.initials: CF
authors.lastname: Kwok
authors.forename: Justin G S
authors.initials: JG
authors.lastname: Won
authors.forename: Harn-Shen
authors.initials: HS
authors.lastname: Chen
authors.forename: Chia-Huei
authors.initials: CH
authors.lastname: Chu
authors.forename: Chii-Min
authors.initials: CM
authors.lastname: Hwu
authors.forename: Chin-Sung
authors.initials: CS
authors.lastname: Kuo
authors.forename: Tjin-Shing
authors.initials: TS
authors.lastname: Jap
authors.forename: Kuang-Chung
authors.initials: KC
authors.lastname: Shih
authors.forename: Liang-Yu
authors.initials: LY
authors.lastname: Lin
mesh_terms: D000368:Aged; D055109:Ankle Brachial Index; D003324:Coronary Artery Disease / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000401:mortality / Q000503:physiopathology*; D003925:Diabetic Angiopathies / Q000150:complications* / Q000503:physiopathology; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D058729:Peripheral Arterial Disease / Q000150:complications* / Q000503:physiopathology; D063177:Pulse Wave Analysis; D012189:Retrospective Studies; D020521:Stroke / Q000453:epidemiology