title: Onychomycosis is associated with subclinical atherosclerosis in patients with diabetes.
abstract: BACKGROUND
  We aimed to investigate the association of toenail onychomycosis with subclinical atherosclerosis in patients with diabetes mellitus.
  
  
  METHODS
  Consecutive diabetic patients who were seen at our outpatient clinic were enrolled. The carotid intima-media thickness (CIMT) was assessed and toenail onychomycosis was diagnosed with microscopic evaluation.
  
  
  RESULTS
  We investigated 127 patients with diabetes melltus type 2. Overall, the prevalence of toenail onychomycosis was 37.8 % (48 of 127). Of the 127 patients, 60 (47.2 %) had subclinical atherosclerosis (CIMT ≥ 1 mm). Prevalence of male gender (43.3 % vs. 22.4 %, p = 0.012) and onychomycosis (53.3 % vs. 23.9 %, p = 0.001) was significantly higher in patients with subclinical atherosclerosis. Among biochemical parameters, low-density lipoprotein (122 ± 38 mg/dL vs. 108 ± 36 mg/dL, p = 0.039) and glycosylated hemoglobin levels (median 8.4 %, IQR: 2.1 % vs. median 7.5 %, IQR: 1.6 %, p = 0.002) were significantly higher in patients with subclinical atherosclerosis. Study groups were similar with respect to all other demographic, clinical, and laboratory parameters. After adjustment for all potential confounders, the presence of onychomycosis was independently associated with subclinical atherosclerosis (OR 2.77, 95 % CI 1.16 to 6.30) in multivariate logistic regression analysis.
  
  
  CONCLUSIONS
  Presence of onychomycosis in patients with diabetes is associated with subclinical atherosclerosis. Onychomycosis may be a marker of atherosclerotic arterial involvement.
authors.affiliation: Karabuk University Faculty of Medicine, Turkey.
authors.forename: Orhan
authors.initials: O
authors.lastname: Onalan
authors.affiliation: Karabuk University Faculty of Medicine, Turkey.
authors.forename: Adem
authors.initials: A
authors.lastname: Adar
authors.affiliation: Karabuk University Faculty of Medicine, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Keles
authors.affiliation: Karabuk University Faculty of Medicine, Turkey.
authors.forename: Goksen
authors.initials: G
authors.lastname: Ertugrul
authors.affiliation: Karabuk University Faculty of Medicine, Turkey.
authors.forename: Nurhayat
authors.initials: N
authors.lastname: Ozkan
authors.affiliation: Karabuk University Faculty of Medicine, Turkey.
authors.forename: Habibullah
authors.initials: H
authors.lastname: Aktas
authors.affiliation: Karabuk University Faculty of Medicine, Turkey.
authors.forename: Ekrem
authors.initials: E
authors.lastname: Karakaya
mesh_terms: D000368:Aged; D050197:Atherosclerosis / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D003925:Diabetic Angiopathies / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009262:Nails; D014009:Onychomycosis / Q000453:epidemiology*; D015995:Prevalence
keywords: Onychomycosis; carotid intima-media thickness; subclinical atherosclerosis