Prevalence and Major Risk Factors of Reduced Flow Volume in Lower Extremities With Normal Ankle-Brachial Index in Japanese Patients With Type 2 Diabetes

Suzuki, Eiji; Egawa, Katsuya; Nishio, Yoshihiko; Maegawa, Hiroshi; Tsuchiya, Masanobu; Haneda, Masakazu; Yasuda, Hitoshi; Morikawa, Shigehiro; Inubushi, Toshiro; Kashiwagi, Atsunori

doi:10.2337/diacare.26.6.1764

Cited by 20 publications

(14 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Increased stiffness of the arteries in the lower limbs is associated with impaired arterial blood flow (14,30), subclinical hypoxia of the foot (15), and ischemic symptoms of the lower extremities (16). Thus, the decreased PWV in the leg arteries following atorvastatin treatment may have beneficial effects on local blood flow, accounting for the favorable effects on walking performance (6)(7)(8).…”

Section: Discussionmentioning

confidence: 99%

Effect of Atorvastatin on Regional Arterial Stiffness in Patients with Type 2 Diabetes Mellitus

Shinohara

Shoji

Kimoto

et al. 2005

JAT

View full text Add to dashboard Cite

Objective: A statin, a potent lipid-lowering drug, improves pain-free walking distance in patients with peripheral arterial disease (PAD) without increasing the ankle-brachial pressure index (ABI). Arterial stiffness affects the blood flow of peripheral arteries. The purpose of this study was to evaluate the effect of cholesterol-lowering with atorvastatin on regional arterial stiffness in patients with type 2 diabetes mellitus. Methods: The subjects were 22 type 2 diabetic patients with hypercholesterolemia, who received atorvastatin at a daily dose of 10 mg for 6 months. Before and after the treatment with atorvastatin, we measured pulse wave velocity (PWV) in the heartbrachial, heart-carotid, heart-femoral and femoral-ankle segments. Results: Following treatment with atorvastatin, femoral-ankle PWV showed a significant reduction. The PWV of other arterial segments tended to decrease, although the changes were not statistically significant. We found no significant changes in blood pressure, heart rate, ABI, or plasma concentrations of glucose, L-arginine and asymmetric dimethylarginine (

show abstract

Section: Discussionmentioning

confidence: 99%

Effect of Atorvastatin on Regional Arterial Stiffness in Patients with Type 2 Diabetes Mellitus

Shinohara

Shoji

Kimoto

et al. 2005

JAT

View full text Add to dashboard Cite

show abstract

“…An MRI scanner operating at 1.5 Tesla (Signa Horizon-LX; GE Medical Systems, Milwaukee, WI) was used for the following experimental protocols as previously described (15,16). Briefly, after at least 15 min of rest, all patients were evaluated in the supine position in a temperaturecontrolled 25°C room.…”

Section: Magnetic Resonance Studiesmentioning

confidence: 99%

“…Stiffer arteries result in increased vascular resistance and reduced total flow volume in the lower extremities, even in diabetic patients with a normal ABI (15). The prevalence of these patients is comparable with that of patients with intermittent claudication, suggesting that increased vascular resistance may be a major cause of lowerextremity arterial disease (16). However, it is unclear whether quantitatively assessed distensibility measures in the lower-leg arteries can help identify diabetic patients with possible CAD in clinical practice.…”

mentioning

confidence: 99%

Stiffness and Impaired Blood Flow in Lower-Leg Arteries Are Associated With Severity of Coronary Artery Calcification Among Asymptomatic Type 2 Diabetic Patients

et al. 2004

Self Cite

View full text Add to dashboard Cite

OBJECTIVE -To clarify whether stiffness and impaired blood flow in lower-leg arteries are associated with severity of coronary artery calcification among asymptomatic diabetic patients.RESEARCH DESIGN AND METHODS -We enrolled 102 asymptomatic type 2 diabetic patients with no history of cardiovascular complications consecutively admitted to our hospital. Agatston coronary artery calcium (CAC) score, as a marker of coronary artery calcification, was obtained using electron-beam computed tomography. Total flow volume and resistive index, as an index of vascular resistance, at the popliteal artery were evaluated using gated two-dimensional cine-mode phase-contrast magnetic resonance imaging. Brachial-ankle pulsewave velocity (PWV), as an index of distensibility in the lower-extremity arteries, was also measured using an automatic device.RESULTS -When the patients were grouped according to CAC scores of 0 -10 (n ϭ 54), 11-100 (n ϭ 25), and Ͼ100 (n ϭ 23), those with the highest scores, which is considered to show possible coronary artery disease, showed the highest brachial-ankle PWV (P Ͻ 0.001) and resistive index (P Ͻ 0.001) and the lowest total flow volume (P Ͻ 0.001) among the groups. Simple linear regression analyses showed that both brachial-ankle PWV (r ϭ 0.508, P Ͻ 0.001) and resistive index (r ϭ 0.500, P Ͻ 0.001) were positively correlated and total flow volume (r ϭ Ϫ0.528, P Ͻ 0.001) was negatively correlated with the log-transformed CAC score. Receiver operator characteristic curve analyses indicated that 1,800 cm/s for brachial-ankle PWV, 1.03 for resistive index, and 70 ml/min for total flow volume were diagnostic values for identifying patients with the highest scores.CONCLUSIONS -Quantitatively assessed stiffness and impaired blood flow in lower-leg arteries may help identify diabetic patients with possible coronary artery disease. Diabetes Care 27:2409 -2415, 2004A therosclerotic coronary artery disease (CAD) is a major cause of mortality and morbidity among diabetic patients (1). It is desirable to identify subjects with coronary atherosclerosis before the onset of angina pectoris or myocardial infarction. When atherosclerotic plaques are at an advanced stage, calcified deposits in the coronary arteries are found more frequently and in greater amounts (2). A number of studies (3) have documented the usefulness of electron-beam computed tomography (EBCT) for the detection and evaluation of the extent of coronary calcified atherosclerotic lesions in asymptomatic patients before the development of life-threatening cardiac complications. The reliability of EBCT in the detection of calcified deposits in coronary arteries has been confirmed by histomorphometric analysis of dissected coronary vessels from autopsied hearts (4). Moreover, diabetic patients show twofold prevalence of extensive coronary artery calcification compared with nondiabetic subjects as evaluated by EBCT (5). Calcified lesions of arterial walls can be classified as either intimal atherosclerotic calcification or medial arterial calcifica...

show abstract

“…The primary composite end point in the present study was any new CVD event, including cerebral infarction, myocardial infarction, coronary revascularization by percutaneous coronary intervention or coronary artery bypass grafting, coronary-related death, development of PAOD, or ischemic foot gangrene assessed by total flow volume at the popliteal artery of Ͻ50.8 ml/min (24).…”

Section: Primary Composite End Pointmentioning

confidence: 99%

Low Blood Flow Estimates in Lower-Leg Arteries Predict Cardiovascular Events in Japanese Patients With Type 2 Diabetes With Normal Ankle-Brachial Indexes

et al. 2006

Self Cite

View full text Add to dashboard Cite

OBJECTIVE -To examine the association of baseline measures in lower-leg arteries and conventional cardiovascular risk factors with the incidence of cardiovascular disease (CVD) events in type 2 diabetic patients with normal ankle-brachial indexes (ABIs) (Ͼ0.9).RESEARCH DESIGN AND METHODS -We studied 129 type 2 diabetic patients and 35 age-matched nondiabetic subjects with no apparent CVD consecutively admitted to our hospital. At baseline, total flow volume and resistive index, as an index of vascular resistance, at the popliteal artery was evaluated using gated two-dimensional cine-mode phase-contrast magnetic resonance imaging. Patients were followed 4.8 Ϯ 1.5 years (range 3.0 -8.2) or until their first event of CVD.RESULTS -On follow-up, 16 patients developed primary CVD events. Patients with CVD had lower blood flow (P Ͻ 0.01) and higher vascular resistance (P Ͻ 0.05) than patients without CVD. When the patients were grouped into tertiles according to their levels of total flow volume (129.6 -85.5, 85.3-63.3, and 62.7-23.8 ml/min), Kaplan-Meier analysis showed a higher probability of developing CVD events in patients in the lowest than in patients in the highest (P ϭ 0.0199, log-rank test) tertile. Multivariate Cox proportional hazards analysis revealed that the lowest tertile for flow volume (hazard ratio [HR] 8.60, 95% CI 1.61-45.97, P ϭ 0.012), hypertension (3.99, 1.12-14.25, P ϭ 0.033), and smoking status (12.01, 1.21-119.28, P ϭ 0.034) were significant independent predictors of CVD events.CONCLUSIONS -We have demonstrated that low blood flow estimates in lower-leg arteries may be predictive for CVD events among Japanese patients with type 2 diabetes even though they have a normal ABI. Diabetes Care 29:1884 -1890, 2006D iabetic patients are likely to develop cardiovascular disease (CVD), including stroke, myocardial infarction, and peripheral artery occlusive disease (PAOD) (1). These manifestations of atherosclerosis frequently coexist in the same individual (2). Therefore, to identify these patients before the onset of CVD, ankle-brachial index (ABI) is generally used as a predictive marker of CVD (3).Furthermore, diabetic patients with chronic hyperglycemia are known to have stiffer arteries (4). Arterial stiffness leads to increased systolic pressure and ventricular mass and hampers coronary filling during diastole; therefore, increased arterial stiffness may play a role in the development of CVD (5). Changes of vessel wall properties, such as nonenzymatic glycosylation of matrix proteins (6), increased intima-media thickness (7,8), and radiographically detectable medial arterial calcification (9,10) may be involved in the pathogenesis of vascular rigidity.When the atherosclerotic plaques are at an advanced stage, calcified deposits in the coronary arteries are found more frequently and in greater amounts (11). Although the detection of coronary calcium deposits by electron-beam computed tomography does not indicate the location or severity of atherosclerotic lesions, this imaging procedure can predi...

show abstract

Prevalence and Major Risk Factors of Reduced Flow Volume in Lower Extremities With Normal Ankle-Brachial Index in Japanese Patients With Type 2 Diabetes

Cited by 20 publications

References 29 publications

Effect of Atorvastatin on Regional Arterial Stiffness in Patients with Type 2 Diabetes Mellitus

Effect of Atorvastatin on Regional Arterial Stiffness in Patients with Type 2 Diabetes Mellitus

Stiffness and Impaired Blood Flow in Lower-Leg Arteries Are Associated With Severity of Coronary Artery Calcification Among Asymptomatic Type 2 Diabetic Patients

Low Blood Flow Estimates in Lower-Leg Arteries Predict Cardiovascular Events in Japanese Patients With Type 2 Diabetes With Normal Ankle-Brachial Indexes

Contact Info

Product

Resources

About