Abnormal peripheral circulation in type 2 diabetic patients with normal ankle-brachial index associates with coronary atherosclerosis, large artery stiffness, and peripheral vascular resistance

Tsuchiya, Masanobu; Suzuki, Eiji; Egawa, Katsuya; Nishio, Yoshihiko; Maegawa, Hiroshi; Morikawa, Shigehiro; Inubushi, Toshiro; Kashiwagi, Atsunori

doi:10.1016/j.diabres.2005.03.039

Cited by 28 publications

(21 citation statements)

References 39 publications

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“…* p value <0.05 was significant (logistic regression analysis). tions and it could also reflect diffuse atheromatous disease [33]. Meanwhile, McDermott et al [34] reported that even those patients with borderline ABI were more likely to have increased carotid artery intima-media thickness and a coronary artery calcium score of >20 than those with a normal ABI value.…”

Section: Discussionmentioning

confidence: 99%

Early Assessment of the Risk Factors for Diabetic Retinopathy Can Reduce the Risk of Peripheral Arterial and Cardiovascular Diseases in Type 2 Diabetes

Tang

et al. 2017

Ophthalmic Res

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Backgrounds: There is still a lack of consensus about how to assess the risk of peripheral arterial disease (PAD) and cardiovascular disease (CVD) in patients with diabetic retinopathy (DR). Aims: We investigated the risk factors for DR and their association with PAD and CVD in patients with type 2 diabetes (T2D). Methods: A total of 1,421 patients diagnosed with T2D participated in this study. DR stages were classified as non-DR, nonproliferative DR (NPDR), or proliferative DR (PDR). Logistic regression analysis was employed to analyze risk factors associated with DR. Results: NPDR and PDR patients had higher systolic blood pressure (SBP) and higher levels of total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) than the non-DR group (p < 0.05). The prevalence of abnormal ankle-brachial index (ABI) in the non-DR, NPDR, and PDR groups was 7.00, 10.80, and 13.96%, respectively (p < 0.05) and the prevalence of peripheral arterial plaques was 68.48, 81.38, and 80.56%, respectively (p < 0.001). Logistic regression analysis showed that DR (vs. non-DR) was associated with peripheral arterial plaques (OR = 2.07), SBP ≥130 mm Hg (OR = 1.53) and levels of hemoglobin (Hb)A_1c (OR = 2.11) and TC (OR = 1.42). Conclusion: PAD is commonly associated with NPDR and PDR. Hypercholesterolemia is an important risk factor for the development of PAD and CVD in patients with DR. Our results suggest that a routine ABI test, duplex ultrasonography, and obtaining a lipid profile for DR patients may help to reduce the occurrence of PAD and CVD.

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Section: Discussionmentioning

confidence: 99%

Early Assessment of the Risk Factors for Diabetic Retinopathy Can Reduce the Risk of Peripheral Arterial and Cardiovascular Diseases in Type 2 Diabetes

Tang

et al. 2017

Ophthalmic Res

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“…Among diabetic patients, arterial stiffness is reported to be increased in the aorta (4), carotid, brachial, and femoral arteries (26) and lower-limb arteries (27) compared with those in healthy subjects. Abnormal peripheral circulation in type 2 diabetic patients with normal ABI associates with coronary atherosclerosis, large artery stiffness, and peripheral vascular resistance (28). Those parameters were positively correlated with each other, suggesting the parallel development of different aspects of vascular abnormalities in diabetes.…”

Section: Vessel Wall Propertiesmentioning

confidence: 67%

“…Those parameters were positively correlated with each other, suggesting the parallel development of different aspects of vascular abnormalities in diabetes. Although vascular rigidity was not evaluated in the present study, we have previously reported that diabetic patients with normal ABI had a higher brachial-ankle pulse wave velocity, which is used as an indirect index of arterial stiffness, than that in agematched nondiabetic subjects (28). Fur- thermore, total flow volume, brachialankle pulse wave velocity, and resistive index were associated with each other, indicating that higher vascular resistance caused by greater arterial stiffness reduced blood supply in the lower-leg arteries among diabetic patients (28).…”

Section: Vessel Wall Propertiesmentioning

confidence: 99%

“…In the present study, patients with total flow volume Ͻ62.7 ml/ min were at an 8.6-fold increased risk of CVD events compared with patients with total flow volume Ͼ85.5 ml/min. We have reported that reduction of blood flow to the lower limb associates with severity of coronary atherosclerosis, large artery stiffness, and peripheral vascular resistance among diabetic patients with normal ABI (28). Therefore, those patients may have increased risk of CVD events.…”

Section: Association With Cvd Eventsmentioning

confidence: 99%

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Low Blood Flow Estimates in Lower-Leg Arteries Predict Cardiovascular Events in Japanese Patients With Type 2 Diabetes With Normal Ankle-Brachial Indexes

et al. 2006

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OBJECTIVE -To examine the association of baseline measures in lower-leg arteries and conventional cardiovascular risk factors with the incidence of cardiovascular disease (CVD) events in type 2 diabetic patients with normal ankle-brachial indexes (ABIs) (Ͼ0.9).RESEARCH DESIGN AND METHODS -We studied 129 type 2 diabetic patients and 35 age-matched nondiabetic subjects with no apparent CVD consecutively admitted to our hospital. At baseline, total flow volume and resistive index, as an index of vascular resistance, at the popliteal artery was evaluated using gated two-dimensional cine-mode phase-contrast magnetic resonance imaging. Patients were followed 4.8 Ϯ 1.5 years (range 3.0 -8.2) or until their first event of CVD.RESULTS -On follow-up, 16 patients developed primary CVD events. Patients with CVD had lower blood flow (P Ͻ 0.01) and higher vascular resistance (P Ͻ 0.05) than patients without CVD. When the patients were grouped into tertiles according to their levels of total flow volume (129.6 -85.5, 85.3-63.3, and 62.7-23.8 ml/min), Kaplan-Meier analysis showed a higher probability of developing CVD events in patients in the lowest than in patients in the highest (P ϭ 0.0199, log-rank test) tertile. Multivariate Cox proportional hazards analysis revealed that the lowest tertile for flow volume (hazard ratio [HR] 8.60, 95% CI 1.61-45.97, P ϭ 0.012), hypertension (3.99, 1.12-14.25, P ϭ 0.033), and smoking status (12.01, 1.21-119.28, P ϭ 0.034) were significant independent predictors of CVD events.CONCLUSIONS -We have demonstrated that low blood flow estimates in lower-leg arteries may be predictive for CVD events among Japanese patients with type 2 diabetes even though they have a normal ABI. Diabetes Care 29:1884 -1890, 2006D iabetic patients are likely to develop cardiovascular disease (CVD), including stroke, myocardial infarction, and peripheral artery occlusive disease (PAOD) (1). These manifestations of atherosclerosis frequently coexist in the same individual (2). Therefore, to identify these patients before the onset of CVD, ankle-brachial index (ABI) is generally used as a predictive marker of CVD (3).Furthermore, diabetic patients with chronic hyperglycemia are known to have stiffer arteries (4). Arterial stiffness leads to increased systolic pressure and ventricular mass and hampers coronary filling during diastole; therefore, increased arterial stiffness may play a role in the development of CVD (5). Changes of vessel wall properties, such as nonenzymatic glycosylation of matrix proteins (6), increased intima-media thickness (7,8), and radiographically detectable medial arterial calcification (9,10) may be involved in the pathogenesis of vascular rigidity.When the atherosclerotic plaques are at an advanced stage, calcified deposits in the coronary arteries are found more frequently and in greater amounts (11). Although the detection of coronary calcium deposits by electron-beam computed tomography does not indicate the location or severity of atherosclerotic lesions, this imaging procedure can predi...

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“…17 Furthermore, it also led to clinical manifestation of PAD and increased risk of amputation, proposing that elevation of this index could reflect diffuse atheromatous disease. 19,20 Since the manifestations or prognosis of high ABI (>1.4) is equivalent with those of low ABI (<0.9), subjects with elevated ABI are thus included in the PAD group for current analysis.…”

Section: Discussionmentioning

confidence: 99%

Relationship between peripheral artery disease and combined albuminuria and low estimated glomerular filtration rate among elderly patients with type 2 diabetes mellitus

Yap

Chuang

Chien

et al. 2013

Diabetes and Vascular Disease Research

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This study aimed at investigating the combined effects of albuminuria and reduced estimated glomerular filtration rate (eGFR) on peripheral artery disease (PAD) among elderly patients with diabetes. A total of 236 subjects were crossclassified into four groups according to the presence or absence of albuminuria (urinary albumin creatinine ratio (ACR) ≥ 30 mg/g) and low eGFR (<60 mL/min/1.73 m 2 ). Cardiovascular risk factors and the ankle-brachial index (ABI) were also assessed. After multivariate adjustment using logistic regression analysis, the odds ratios (OR) for prevalent PAD related to albuminuria with preserved eGFR, normoalbuminuria with low eGFR and albuminuria with low eGFR compared to normoalbuminuria with preserved eGFR were 1.10 [95% confidence interval (CI) = 0.43-2.79], 3.14 (95% CI = 1.20-8.22) and 3.87 (95% CI = 1.72-8.72), respectively. In conclusion, in elderly patients with type 2 diabetes, both normoalbuminuria with low eGFR and albuminuria with low eGFR are associated independently with PAD.

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Abnormal peripheral circulation in type 2 diabetic patients with normal ankle-brachial index associates with coronary atherosclerosis, large artery stiffness, and peripheral vascular resistance

Cited by 28 publications

References 39 publications

Early Assessment of the Risk Factors for Diabetic Retinopathy Can Reduce the Risk of Peripheral Arterial and Cardiovascular Diseases in Type 2 Diabetes

Early Assessment of the Risk Factors for Diabetic Retinopathy Can Reduce the Risk of Peripheral Arterial and Cardiovascular Diseases in Type 2 Diabetes

Low Blood Flow Estimates in Lower-Leg Arteries Predict Cardiovascular Events in Japanese Patients With Type 2 Diabetes With Normal Ankle-Brachial Indexes

Relationship between peripheral artery disease and combined albuminuria and low estimated glomerular filtration rate among elderly patients with type 2 diabetes mellitus

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