Ankle-brachial index and incident diabetes mellitus: the atherosclerosis risk in communities (ARIC) study

Abstract

BackgroundIndividuals with peripheral artery disease (PAD) often have reduced physical activity, which may increase the future risk of diabetes mellitus. Although diabetes is a risk factor for PAD, whether low ankle-brachial index (ABI) predates diabetes has not been studied.MethodsWe examined the association of ABI with incident diabetes using Cox proportional hazards models in the ARIC Study. ABI was measured in 12,247 black and white participants without prevalent diabetes at baseline (1987–1989). Incident diabetes cases were identified by blood glucose levels at three subsequent visits (1990–92, 1993–95, and 1996–98) or self-reported physician diagnosis or medication use at those visits or during annual phone interview afterward through 2011.ResultsA total of 3305 participants developed diabetes during a median of 21 years of follow-up. Participants with low (≤0.90) and borderline low (0.91–1.00) ABI had 30–40% higher risk of future diabetes as compared to those with ABI of 1.10–1.20 in the demographically adjusted model. The associations were attenuated after further adjustment for other potential confounders but remained significant for ABI 0.91–1.00 (HR = 1.17, 95% CI 1.04–1.31) and marginally significant for ABI ≤ 0.90 (HR = 1.19, 0.99–1.43). Although the association was largely consistent across subgroups, a stronger association was seen in participants without hypertension, those with normal fasting glucose, and those with a history of stroke compared to their counterparts.ConclusionsLow ABI was modestly but independently associated with increased risk of incident diabetes in the general population. Clinical attention should be paid to the glucose trajectory among people with low ABI but without diabetes.Electronic supplementary materialThe online version of this article (doi:10.1186/s12933-016-0476-4) contains supplementary material, which is available to authorized users.

Anthropometric, metabolic and clinical factors associated with diabetes and prediabetes prevalence in women aged 65–74 living in central Poland

“…Significantly higher SBP and pulse pressure in women with overt diabetes together with lower abdominal aorta diameter can be considered as a clinical manifestation of the arterial stiffness in females with DM [20] (we did not perform direct measurements of pulse wave velocity and aortic characteristic impedance). In the Atherosclerosis Risk In Communities (ARIC) study low ABI was modestly but independently associated with diabetes incidence [21]. In our study ABI was not associated with any abnormal pattern of glucose metabolism.…”

Diabetes as a risk factor for incident peripheral arterial disease in women compared to men: a systematic review and meta-analysis

“…4 Multiple-adjusted ratio of women: men relative risks (RRRs) for incident coronary heart disease [8], stroke [9], vascular dementia [10], heart failure [11], and PAD, comparing individuals with diabetes to those without diabetes aggregated across cross-sectional studies, though this finding was not consistent across all included studies. The disadvantage in men may be a spurious finding resulting from the "chicken and egg" problem inherent to cross-sectional design; in addition to diabetes increasing risk for PAD, PAD is known to be a modest but independent risk factor for diabetes [42]. However, assuming the result is non-spurious, a potential explanation for why we see a male disadvantage in the cross-sectional studies, but no sex difference in the prospective studies, may lie in the fact that the crosssectional study participants were, on average, younger than the prospective study participants at follow-up.…”

High-sensitivity cardiac troponin and natriuretic peptide with risk of lower-extremity peripheral artery disease: the Atherosclerosis Risk in Communities (ARIC) Study

“…Of the 14 348 participants who attended Visit 2, we excluded participants with race other than black or white (n = 42), with prevalent PAD (n = 641 defined by ankle-brachial index [ABI] < _0.9, intermittent claudication, or leg revascularization at Visit 1 or any PAD outcomes summarized subsequently between Visits 1 and 2) or with missing data on hs-cTnT or NT-proBNP (n = 885) or covariates (n = 492), leaving a final sample of 12 288 participants. Although details were described elsewhere, 14 ABI was evaluated at Visit 1 based on ankle blood pressure and brachial blood pressure measured by Dinamap Model 1846 SX. The ARIC Study was reviewed and approved by the Institutional Review Board of participating centres, and written informed consent was obtained from all participants.…”