Prediction of all-cause and cardiovascular mortality using ankle-brachial index and brachial-ankle pulse wave velocity in patients with type 2 diabetes

Abstract

Ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) are used as non-invasive indicators for detecting atherosclerosis and arterial stiffness, two well-known predictors of mortality in patients with type 2 diabetes mellitus (T2DM). ABI and baPWV have independent associations with mortality; however, their joint and interactive effects on mortality have not been assessed in patients with T2DM. This work aims to evaluate the independent, joint, and interactive associations of ABI and baPWV with all-cause and expanded cardiovascular disease (CVD) mortality in patients with T2DM. This observational study included 2160 patients with T2DM enlisted in the Diabetes Care Management Program database of China Medical University Hospital from 2001 to 2016 and then followed their death status until August 2021. Cox proportional hazard models were used to evaluate the independent, joint, and interactive effects of ABI and baPWV on the risk of all-cause and expanded CVD mortality. A total of 474 patient deaths occurred after a mean follow-up of 8.4 years, and 268 of which were attributed to cardiovascular events. Abnormal ABI (≤ 0.9) and highest baPWV quartile were independently associated with increased risks of all-cause [ABI: hazard ratio (HR) 1.67, 95% confidence interval (CI) 1.30–2.11; baPWV: 1.63, 1.16–2.27] and expanded CVD mortality (ABI: 2.21, 1.62–3.02; baPWV: 1.75, 1.09–2.83). The combination of abnormal ABI (≤ 0.9) and highest baPWV quartile was associated with a significantly higher risk of all-cause (4.51, 2.50–8.11) and expanded CVD mortality (9.74, 4.21–22.51) compared with that of the combination of normal ABI and lowest baPWV quartile. Significant interactions were observed between ABI and baPWV in relation to all-cause and expand CVD mortality (both p for interaction < 0.001). Through their independent, joint, and interactive effects, ABI and baPWV are significant parameters that can improve the prediction of all-cause and expanded CVD mortality in patients with T2DM and help identify high-risk patients who may benefit from diabetes care.

Associations of blood biomarkers with arterial stiffness in patients with diabetes mellitus: A population‐based study

“…However, unconventional risk factors directly result from arteriosclerosis, such as chronic inflammation, 16 lipid metabolism, 17 glycemic control, 18 renal disease, 19,20 and thyroid function, 21 are also proposed to contribute to the excess diabetic risk observed in populations with arteriosclerosis by inducing islet beta‐cell inflammation, impairing beta‐cell functions, and enhancing insulin resistance 22 . Considerable evidence suggests that arterial stiffness is a predictor of cardiovascular events and mortality independent of traditional risk factors 23–25 . Furthermore, despite the long‐standing observation between atherosclerosis and diabetes, limited studies have examined the relationship of biomarkers with PWV.…”

“… 22 Considerable evidence suggests that arterial stiffness is a predictor of cardiovascular events and mortality independent of traditional risk factors. 23 , 24 , 25 Furthermore, despite the long‐standing observation between atherosclerosis and diabetes, limited studies have examined the relationship of biomarkers with PWV. Notably, no previous study in type 2 diabetes has evaluated whether afSG was predictive of all‐cause mortality.…”

Ankle-Brachial Index, a New Predictor for All-Cause Mortality

“…A study of 941 patients revealed that ABI calculated using mean blood pressure had a predictive value for overall and CV mortality. 2 Similarly, Lin and colleagues 3 included 2160 diabetic patients ≥30 years and demonstrated that ABI is a predictor of all-cause and CV mortality. Interestingly, Ikura et al 4 studied 102 Japanese diabetic patients, with a mean age of 63 years, and reported that ABI was not a predictor for all-cause mortality in diabetic patients after lower extremity amputation.…”

Fostering diagnostics of cardiovascular disease in diabetics using ABI and baPWV – correspondence

“…A high baPWV is linked to an elevated risk of all-cause and cardiovascular mortality 4 . To determine the baPWV, the distance that separates the brachial and tibial arteries is divided by the amount of time that a pulse wave takes to travel between these two arteries 5 .…”

“…The results of this study disclosed that ABI and baPWV are critical determinants that can assist in predicting all-cause and expanded cardiovascular disease mortality in type 2 DM patients and in identifying high-risk patients who would benefit from diabetes therapy in comparison to ABI or baPWV alone. This practical approach has the potential to be implemented into mainstream clinical practices in order to customize risk assessment and direct clinical decisions 5 .…”