Peripheral arterial disease in relation to glycaemic level in an elderly Caucasian population: the Hoorn Study

Abstract

We investigated the cross-sectional association between peripheral arterial disease and glycaemic level in an age, sex, and glucose tolerance stratified random sample from a 50-74-year-old Caucasian population. Subjects treated with oral hypoglycaemic agents or insulin were classified as having known diabetes mellitus (KDM) (n = 67). Using two oral glucose tolerance tests, and based on World Health Organisation criteria, all other participants were categorized as having a normal (NGT) (n = 288), an impaired (IGT) (n = 170), or a diabetic (NDM) (n = 106) glucose tolerance. Prevalence rates of ankle-brachial pressure index less than 0.90 were 7.0%, 9.5%, 15.1% and 20.9% in NGT, IGT, NDM and KDM subjects, respectively (chi-square test for linear trend: p < 0.01). Prevalence rates of any peripheral arterial disease (ankle-brachial pressure index < 0.90, at least one monophasic or absent Doppler flow curve or vascular surgery) were 18.1%, 22.4%, 29.2% and 41.8% in these categories (chi-square test for linear trend: p < 0.0001). The prevalence of any peripheral arterial disease was higher in KDM and NDM than in NGT (p < 0.03, p < 0.0001, respectively), whereas no statistically significant difference was demonstrated between IGT and NGT. The same applied when using the ankle-brachial pressure index criterion. Logistic regression analyses showed that any arterial disease was significantly associated with HbA1c, fasting and 2-h post-load plasma glucose after correction for cardiovascular risk factors (odds ratios and 95% confidence intervals 1.35; 1.10-1.65 per %, 1.20; 1.06-1.36 and 1.06; 1.01-1.12 per mmol/l, respectively), whereas it was not associated with fasting and 2-h post-load specific insulin. Ankle-brachial pressure indices were not associated with either plasma glucose parameters or insulin in univariate or multivariate analyses. In conclusion, parameters of glucose tolerance are independently associated with any peripheral arterial disease, whereas insulin is not.

Vascular complications in relation to ethnicity in non‐insulin‐dependent diabetes mellitus

“…We therefore compared the clinical characteristics of this study with the confounding risk factors among subjects with known NIDDM in the Hoorn Study [34]. Less frequent attendance for diabetes care of less symptomatic subjects may lead to bias.…”

Rheumatoid arthritis versus diabetes as a risk factor for cardiovascular disease: a cross-sectional study, the CARRÉ Investigation

“…Peripheral arterial disease was defined as peripheral arterial reconstructive surgery, limb amputation or an ankle brachial pressure index (ABPI) <0.50. ABPI was obtained with the use of a hand-held Doppler, measuring the maximum systolic pressure of either the dorsalis pedis artery or posterior tibial artery divided by the maximum systolic blood pressure in the brachial artery after a 5 min resting period in a supine position in the CARRÉ study, and by means of Doppler-assisted systolic blood pressure measurement taken from the brachial and the three crural arteries on both sides in the Hoorn study, as previously described 16. The lowest ABPI of either limb was used for statistical analyses.…”

Forearm Nitric Oxide Balance, Vascular Relaxation, and Glucose Metabolism in NIDDM Patients

“…A complete lifestyle questionnaire was administered to each subject to obtain medical and parental history for cardiovascular disease and information on smoking habits and physical activity. Peripheral vascular disease was ruled out by anklebrachial pressure indices (16), and carotid atherosclerotic involvement by echo-Doppler scanning. Coronary artery disease was excluded on the basis of a resting 12-lead electrocardiogram (Minnesota code) and the World Health Organization Rose questionnaire (17).…”