Ankle pressures in UK South Asians with diabetes mellitus: a case control study

Kain, Kirti; Brockway, M.; Ishfaq, Tasneem; Merrick, Minnie; Mahmood, Hadiyah; Ingoe, Joseph C; Law, Graham; Sohrabi, Soroush; Wheatcroft, Stephen; Scott, D.

doi:10.1136/heartjnl-2012-303217

Cited by 7 publications

(14 citation statements)

References 26 publications

(25 reference statements)

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“…Diabetic South Asians in the U.K. had significantly higher ankle pressures compared to non-diabetic individuals. 112 In the Chennai Urban Population Study, the prevalence of PAD (ankle-brachial index [ABI] < 0.9) in those with normal glucose tolerance, impaired glucose tolerance and diabetes was 2.7, 2.9 and 6.3% and those with known diabetes had a 7.8% PAD prevalence compared to 3.5% in those newly diagnosed with diabetes. 113 South Asians tend to have more distal PAD which may be due to the higher diabetes prevalence and hence the predilection for smaller vessels.…”

Section: Macrovascular Complications Of Diabetes (Table 2)mentioning

confidence: 99%

“…Diabetic South Asians in the U.K. had ankle pressures that are similar to those of diabetic Europeans who were 10 years older. 112 The Northwest Diabetes Foot Study showed that South Asians were less likely to have PAD compared to Europeans (9% vs 24%) and also had a lower risk of amputation. 116 South Asians were also found to have a lower risk of diabetic foot ulcers compared to Europeans – prevalence 5.5% vs 1.8% which was partly attributed to the lower rate of PAD.…”

Section: Macrovascular Complications Of Diabetes (Table 2)mentioning

confidence: 99%

“…Some have hypothesized that due to early mortality from cardiovascular disease, South Asians do not live long enough to develop significant PAD. 112,114,116 Also, different vascular beds may respond differently to diabetes depending on the ethnicity of the patient. 112,114 Finally, less smoking in the South Asian population may partially explain the lower rates of PAD.…”

Section: Macrovascular Complications Of Diabetes (Table 2)mentioning

confidence: 99%

“…112,114,116 Also, different vascular beds may respond differently to diabetes depending on the ethnicity of the patient. 112,114 Finally, less smoking in the South Asian population may partially explain the lower rates of PAD. 116,117 Studies to elucidate the biologic mechanisms behind the lower rates of PAD in diabetic South Asians are warranted.…”

Section: Macrovascular Complications Of Diabetes (Table 2)mentioning

confidence: 99%

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Diabetes and Associated Complications in the South Asian Population

2014

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The increasing prevalence of diabetes in South Asians has significant health and economic implications. South Asians are predisposed to the development of diabetes due to biologic and lifestyle factors. Furthermore, they experience significant morbidity and mortality from complications of diabetes, most notably coronary artery disease, cerebrovascular disease and chronic kidney disease. Therefore, understanding the pathophysiology and genetics of diabetes risk factors and its associated complications in South Asians is paramount to curbing the diabetes epidemic. With this understanding, the appropriate screening, preventative and therapeutic strategies can be implemented and further developed. In this review, we discuss in detail the biologic and lifestyle factors that predispose South Asians to diabetes and review the epidemiology and pathophysiology of microvascular and macrovascular complications of diabetes in South Asians. We also review the ongoing and completed diabetes prevention and management studies in South Asians.

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Section: Macrovascular Complications Of Diabetes (Table 2)mentioning

confidence: 99%

Section: Macrovascular Complications Of Diabetes (Table 2)mentioning

confidence: 99%

Section: Macrovascular Complications Of Diabetes (Table 2)mentioning

confidence: 99%

Section: Macrovascular Complications Of Diabetes (Table 2)mentioning

confidence: 99%

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Diabetes and Associated Complications in the South Asian Population

2014

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“…South Asians are more insulin resistant at younger ages at lower BMIs than Europeans 22 . The ankle blood pressure increase with type 2 diabetes is greater in South Asians compared to Europeans 23 . The primary outcome was to study the differences in the associations between the brachial and ankle SBP with BMI and WHtR.…”

Section: Introductionmentioning

confidence: 84%

Disparity in association of obesity measures with ankle and brachial systolic blood pressures in Europeans and South Asians

Berceanu

Cheng

Viswambharan

et al. 2022

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Obesity causes increases in brachial systolic-blood-pressures (SBP), risks of type 2 diabetes (T2DM) and cardiovascular diseases (CVD). Brachial and ankle SBPs have differential relationship with T2DM and CVD. Our objective was to study the relationship of obesity measures with brachial and ankle SBPs. A population of 1098 adults (South Asians n = 699; 41.70% male and 58.3% female) were recruited over 5 years from primary care practices in England. Their four limbs SBPs were measured using Doppler machine and body-mass-index (BMI) and waist-to-height-ratio (WHtR) calculated. Linear regressions were performed between SBPs and obesity measures, after adjustments for sex, age, ethnicity, T2DM and CVD. The mean age of all participants was 51.3 (SD = 17.2), European was 57.7 (SD 17.2) and South Asian was 47.8 (SD = 16.1). The left posterior tibial [Beta = 1.179, P = 4.559 × 10−15] and the right posterior tibial SBP [Beta = 1.178, P = 1.114 × 10−13] most significantly associated with the BMI. In South Asians, although the left brachial [Beta = 25.775, P = 0.032] and right brachial SBP [Beta = 22.792, P = 0.045] were associated to the WHtR, the left posterior tibial SBP [Beta = 39.894, P = 0.023], association was the strongest. For the first time, we have demonstrated that ankle SBPs had significant association with generalised obesity than brachial systolic blood pressures (SBP), irrespective of ethnicity. However, with respect to visceral obesity, the association with ankle SBP was more significant in South Asians compared to Europeans.

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Differential associations of ankle and brachial blood pressures with diabetes and cardiovascular diseases: cross-sectional study

Viswambharan

Cheng

Kain³

2021

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Increased brachial systolic blood-pressure (BP) predicts diabetes (T2DM) but is not fully effective. Value of absolute ankle systolic BP for T2DM compared to brachial systolic BP is not known. Our objectives were to assess independent relationships of ankle-systolic BP with T2DM and cardiovascular disease in Europeans and south Asians. Cross-sectional studies of anonymised data from registered adults (n = 1087) at inner city deprived primary care practices. Study includes 63.85% ethnic minority. Systolic BP of the left and right-brachial, posterior-tibial and dorsalis-pedis-arteries measured using a Doppler probe. Regression models’ factors were age, sex, ethnicity, body mass index (BMI) and waist height ratio (WHtR). Both brachial and ankle systolic-BP increase with diabetes in Europeans and south Asians. We demonstrated that there was a significant positive independent association of ankle BP with diabetes, regardless of age and sex compared to Brachial. There was stronger negative association of ankle blood pressure with cardiovascular disease, after adjustment for BMI, WHtR and ethnicity. Additionally, we found that ankle BP were significantly associated with cardiovascular disease in south Asians more than the Europeans; right posterior tibial. Ankle systolic BPs are superior to brachial BPs to identify risks of Type 2DM and cardiovascular diseases for enhanced patient care.

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Ankle pressures in UK South Asians with diabetes mellitus: a case control study

Abstract: South Asians with DM had higher ankle pressures versus without and were similar to 10 years older Europeans with DM. Prospective studies on ankle pressures for development of diabetes or cardiovascular disease are warranted in South Asians.

Cited by 7 publications

References 26 publications

Diabetes and Associated Complications in the South Asian Population

Diabetes and Associated Complications in the South Asian Population

Disparity in association of obesity measures with ankle and brachial systolic blood pressures in Europeans and South Asians

Differential associations of ankle and brachial blood pressures with diabetes and cardiovascular diseases: cross-sectional study

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