title: Borderline ankle-brachial index is associated with increased prevalence of micro- and macrovascular complications in type 2 diabetes: A cross-sectional analysis of 12,772 patients from the Joint Asia Diabetes Evaluation Program.
abstract: Borderline ankle-brachial index is increasingly recognised as a marker of cardiovascular risk. We evaluated the impact of borderline ankle-brachial index in 12,772 Chinese type 2 diabetes patients from the Joint Asia Diabetes Evaluation Program between 2007 and 2012. Cardiovascular risk factors, complications and health-related quality of life were compared between patients with normal ankle-brachial index (1.0-1.4), borderline ankle-brachial index (0.90-0.99) and peripheral arterial disease (ankle-brachial index < 0.9). The prevalence of peripheral arterial disease and borderline ankle-brachial index was 4.6% and 9.6%, respectively. Borderline ankle-brachial index patients were older, more likely to be smokers and hypertensive, had longer duration of diabetes, poorer kidney function and poorer health-related quality of life than patients with normal ankle-brachial index. After adjustment for traditional cardiovascular risk factors, borderline ankle-brachial index was an independent predictor of diabetes-related micro- and macrovascular complications including retinopathy (odd ratios: 1.19 (95% confidence interval: 1.04-1.37)), macroalbuminuria (1.31 (1.10-1.56)), chronic kidney disease (1.22 (1.00-1.50)) and stroke (1.31 (1.05-1.64)). These findings suggest that patients with diabetes and borderline ankle-brachial index are at increased cardiovascular risk and may benefit from more intensive management.
authors.affiliation: Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China Institute of Vascular Medicine, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia bryan.yan@cuhk.edu.hk.
authors.forename: Bryan P
authors.initials: BP
authors.lastname: Yan
authors.affiliation: Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China Asia Diabetes Foundation, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Yuying
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China Hong Kong Institute of Diabetes and Obesity, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Alice P S
authors.initials: AP
authors.lastname: Kong
authors.affiliation: Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China Asia Diabetes Foundation, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Andrea O Y
authors.initials: AO
authors.lastname: Luk
authors.affiliation: Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Risa
authors.initials: R
authors.lastname: Ozaki
authors.affiliation: Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China Asia Diabetes Foundation, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Roseanne
authors.initials: R
authors.lastname: Yeung
authors.affiliation: Qualigenics Diabetes Centre, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Peter C Y
authors.initials: PC
authors.lastname: Tong
authors.affiliation: Qualigenics Diabetes Centre, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Wing Ban
authors.initials: WB
authors.lastname: Chan
authors.affiliation: Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China.
authors.forename: Chiu-Chi
authors.initials: CC
authors.lastname: Tsang
authors.affiliation: Department of Medicine, Northern District Hospital, Hong Kong, China.
authors.forename: Kam-Piu
authors.initials: KP
authors.lastname: Lau
authors.affiliation: Ma On Shan General Out-Patient Clinic, Hong Kong, China.
authors.forename: Yu
authors.initials: Y
authors.lastname: Cheung
authors.affiliation: Asia Diabetes Foundation, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Troels
authors.initials: T
authors.lastname: Wolthers
authors.affiliation: Asia Diabetes Foundation, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Greg
authors.initials: G
authors.lastname: Lyubomirsky
authors.affiliation: Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Wing-Yee
authors.initials: WY
authors.lastname: So
authors.affiliation: Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China Hong Kong Institute of Diabetes and Obesity, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Ronald C W
authors.initials: RC
authors.lastname: Ma
authors.affiliation: Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Francis C C
authors.initials: FC
authors.lastname: Chow
authors.affiliation: Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China Asia Diabetes Foundation, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China Hong Kong Institute of Diabetes and Obesity, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China Li Ka Shing Institute of Health Sciences, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Juliana C N
authors.initials: JC
authors.lastname: Chan
mesh_terms: D000368:Aged; D055109:Ankle Brachial Index; D001208:Asia; D001794:Blood Pressure / Q000502:physiology; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000453:epidemiology*; D003925:Diabetic Angiopathies / Q000453:epidemiology*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D008297:Male; D055806:Microvessels; D008875:Middle Aged; D015995:Prevalence; D011788:Quality of Life; D012307:Risk Factors
keywords: Ankle–brachial index; Chinese; Joint Asia Diabetes Evaluation Program; micro- and macrovascular complications; peripheral arterial disease; type 2 diabetes