Effectiveness of combined therapy with angiotensin-converting enzyme inhibitors and statins in reducing mortality in diabetic patients with critical limb ischemia: An observational study

Faglia, Ezio; Clerici, Giacomo; Scatena, Alessia; Caminiti, Maurizio; Curci, Vincenzo; Morabito, Alberto; Prisco, Vincenzo; Greco, Rosaria; Edmonds, M E

doi:10.1016/j.diabres.2013.12.060

Cited by 26 publications

(21 citation statements)

References 23 publications

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“…A total of twelve observational cohort studies and two randomised trials reporting 19,368 patients (10,023 in the statin group and 9345 in the no statin group) met the inclusion criteria and were included in the meta-analysis [17][18][19][20][21][22][23][24][25][26][27][28][29][30]. No unpublished data were obtained.…”

Section: Literature Search Resultsmentioning

confidence: 99%

“…All-cause mortality All-cause mortality was reported in twelve studies (reporting a total of 11,956 patients) [17][18][19][20][21][22][23][24][26][27][28][29]. Patients receiving statins had a lower incidence of all-cause mortality (17%) compared with those not being on a statin (25%) (odds ratio 0.60, 95% confidence interval 0.46-0.78, p = 0.0002) (Fig.…”

Section: Outcome Synthesismentioning

confidence: 88%

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Statin therapy in lower limb peripheral arterial disease: Systematic review and meta-analysis

Antoniou

Fisher

Georgiadis

et al. 2014

Vascular Pharmacology

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Section: Literature Search Resultsmentioning

confidence: 99%

Section: Outcome Synthesismentioning

confidence: 88%

Statin therapy in lower limb peripheral arterial disease: Systematic review and meta-analysis

Antoniou

Fisher

Georgiadis

et al. 2014

Vascular Pharmacology

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“… 14 Especially in combination with angiotensin-converting enzyme inhibitors, statins may have even reduced mortality in diabetic CLI patients during a 2-year follow-up. 15 The beneficial findings of statins in CLI patients were further underlined in large databases, like the REACH Registry. 16 A recent publication on symptomatic PAOD patients revealed that among them, statin use was associated with an 18% lower rate of adverse limb outcomes, including worsening of symptoms, peripheral revascularization, and ischemic amputations.…”

Section: Discussionmentioning

confidence: 99%

Graz Critical Limb Ischemia Score

et al. 2015

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Critical limb ischemia (CLI), a frequently encountered disorder, is associated with a high rate of limb amputation and mortality. To identify patients at high risk for CLI, we developed a simple risk score for peripheral arterial occlusive disease (PAOD).In our cross-sectional study, we first evaluated 1000 consecutive PAOD patients treated at our institution from 2005 to 2007, documenting clinical symptoms, comorbidities, and concomitant medication. We calculated odds ratios (OR) in a binary logistic regression model to find possible risk factors for CLI. We then verified the score in a second step that included the 1124 PAOD patients we treated between 2007 and 2011.In the first patient group, the greatest risk factors for CLI were age ≥75 years (OR 2.0), type 2 diabetes (OR 3.1), prior myocardial infarction (OR 2.5), and therapy with low molecular weight heparins (2.8). We scored 1 point for each of those conditions. One point was given for age between 65 and 75 years (OR 1.6) as well as for therapy with cardiac glycosides (OR 1.9) or loop diuretic therapy (OR 1.5). As statin therapy was protective for CLI with an OR of 0.5, we subtracted 1 point for those patients.In the second group, we could prove that frequency of CLI was significantly higher in patients with a high CLI score. The score correlated well with inflammatory parameters (c-reactive protein and fibrinogen). We were also able to define 3 different risk groups for low (score −1 to 1), intermediate (score 2–4), and high CLI risk (score >4).We developed a simple risk stratification scheme that is based on conditions that can be easily assessed from the medical history, without any laboratory parameters. This score should help to identify PAOD patients at high risk for CLI.

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“…Such changes leave the body weight concentrated in certain sites of the foot; these sites experience force overload, which further causes change in the foot bearing point, which preclude foot ulcer formation . Other causes include vasculopathy and ischemia . Many studies have shown that peripheral vascular disease in the lower limbs has an important role in diabetic foot ulcer formation …”

mentioning

confidence: 99%

“…11,12 Other causes include vasculopathy and ischemia. [13][14][15] Many studies have shown that peripheral vascular disease in the lower limbs has an important role in diabetic foot ulcer formation. 16 Diabetic patients with retinopathy or neuropathy bear significantly increased risks of lower limb ulcers, suggesting that these patients suffer a wide range of microcirculatory disturbances that may lead to plantar calluses in sites under elevated force due to decreased sweating and dry skin.…”

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confidence: 99%

Variation of plantar pressure in Chinese diabetes mellitus

Yang

Xiao

Wang

et al. 2015

Wound Repair Regeneration

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To investigate dynamic changes in plantar pressure in Chinese diabetes mellitus patients and to provide a basis for further preventing diabetic foot. This is a cross-sectional investigation including 649 Chinese diabetes mellitus patients (diabetes group) and 808 "normal" Chinese persons (nondiabetes group) with normal blood glucose levels. All the subjects provided a complete medical history and underwent a physical examination and a 75-g oral glucose tolerance test. All subjects walked barefoot with their usual gait, and their dynamic plantar forces were measured using the one-step method with a plantar pressure measurement instrument; 5 measurements were performed for each foot. No significant differences were found in age, height, body weight, or body mass index between the two groups. The fasting blood glucose levels, plantar contact time, maximum force, pressure-time integrals and force-time integrals in the diabetes group were significantly higher than those in the nondiabetes group (p < 0.05). However, the maximum pressure was significantly higher in the nondiabetes group than in the diabetes group (p < 0.05). No difference was found in the contact areas between the two groups (p > 0.05). The maximum plantar force distributions were essentially the same, with the highest force found for the medial heel, followed by the medial forefoot and the first toe. The peak plantar pressure was located at the medial forefoot for the nondiabetes group and at the hallucis for the diabetes group. In the diabetes group, the momentum in each plantar region was higher than that in the nondiabetes group; this difference was especially apparent in the heel, the lateral forefoot and the hallucis. The dynamic plantar pressures in diabetic patients differ from those in nondiabetic people with increased maximum force and pressure, a different distribution pattern and significantly increased momentum, which may lead to the formation of foot ulcers.

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Effectiveness of combined therapy with angiotensin-converting enzyme inhibitors and statins in reducing mortality in diabetic patients with critical limb ischemia: An observational study

Cited by 26 publications

References 23 publications

Statin therapy in lower limb peripheral arterial disease: Systematic review and meta-analysis

Statin therapy in lower limb peripheral arterial disease: Systematic review and meta-analysis

Graz Critical Limb Ischemia Score

Variation of plantar pressure in Chinese diabetes mellitus

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