Analysis of traditional and nontraditional risk factors for peripheral arterial disease in elderly type 2 diabetic patients in Taiwan

Risk associated with estimated glomerular filtration rate and albuminuria for PAD among patients with type 2 diabetes

Chronic kidney disease (CKD) is significantly associated with peripheral arterial disease (PAD) in some studies, but data on the association of the risk of PAD across a broad range of kidney function in patients with type 2 diabetes are limited. Between October 17, 2013 and February 7, 2015, all consecutive outpatients with type 2 diabetes underwent ankle-brachial index (ABI) examination. We investigated the association of estimated glomerular filtration rate (eGFR) and albumin-to-creatinine ratio (ACR) with the risk of PAD. A total of 1254 patients were cross-classified into 12 groups based on ACR category (normoalbuminuria, microalbuminuria and macroalbuminuria) and eGFR stage (≥90, 60-89, 30-59 and <30 mL/min/1.73 m²). Logistic regression analysis was used to investigate the association of eGFR and ACR with PAD. Within each ACR category, a lower eGFR stage was associated with PAD. Similarly, within each eGFR group, a higher ACR category was also associated with PAD. The OR for PAD was highest in patients with eGFR <30 mL/min/1.73 m² and macroalbuminuria (OR 14.42, 95% CI 4.60 to 45.31) when compared with the reference group of subjects with eGFR ≥90 mL/min/1.73 m² and normoalbuminuria. Our study found that cross-classification of eGFR with ACR revealed a more comprehensive association with risk of PAD than eGFR or ACR alone.

Peripheral arterial disease and its correlates in patients with type 2 diabetes mellitus in a teaching hospital in northern Nigeria: a cross-sectional study

BACKGROUND

Peripheral arterial disease (PAD) is a risk factor for diabetic foot ulcer, limb amputation as well as coronary heart disease. It is more common in patients with diabetes mellitus (DM) and co-exists with peripheral neuropathy. Prevalence of PAD in type 2 DM patients in northern Nigeria is largely unknown. We investigated the occurrence and factors associated with PAD among patients with type 2 DM in a tertiary hospital in northern Nigeria.

METHODS

This was a cross- sectional analytic study. We recruited 200 patients with type 2 DM consecutively from the diabetes clinic of the Jos University Teaching Hospital. Ankle brachial index was assessed for each participant. Clinical information, anthropometric indices and blood samples were collected for assay. Data was analysed using CDC Epi-Info and logistic regression analysis was used to determine independent correlates of PAD.

RESULTS

PAD was present in 38.5%(n = 77) of subjects and it was associated with the female sex, age ≥ 50 years, Body mass index (BMI) ≥ 25 kg/m² and low HDL cholesterol levels. However, on multiple logistic regression, a BMI ≥ 25 kg/m² and a low HDL cholesterol level were independent correlates of PAD(adjusted OR = 2.13,95% CI = 1.04-4.36 and adjusted OR = 2.31, 95% CI = 1.04-5.15, respectively).

CONCLUSION

PAD is present in more than a third of patients with type 2 DM in a tertiary hospital in northern Nigeria. A BMI of ≥25 kg/m² and low HDL cholesterol levels were independent correlates of PAD.

Relationships between chronic comorbidities and the atherosclerosis indicators ankle-brachial index and brachial-ankle pulse wave velocity in patients with type 2 diabetes mellitus

This study aimed to determine associations between ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) with different comorbidities in patients with type 2 diabetes mellitus (DM). Records of patients with type 2 DM who received an ABI and baPWV examination between August 2013 and February 2015 were retrospectively reviewed. Associations of ABI and baPWV with chronic kidney disease (CKD), chronic liver disease (CLD), coronary artery disease (CAD) and diabetic nephropathy (DN) were examined by regression analysis. A total of 1232 patients (average age, 65.1±10.0 years) were included in the analysis. CKD and DN were associated with low ABI and increased baPWV (all, P<0.001). No associations were found between CAD and CLD and ABI or baPWV. Thus, regression analysis was performed for CKD and DN. Low ABI was associated with risk of CKD in the crude model (OR 0.724, 95% CI 0.648 to 0.808, P<0.001) and adjusted model (OR 0.872, 95% CI 0.762 to 0.999, P=0.048), whereas baPWV was only significant in the crude model (OR 1.199, 95% CI 1.112 to 1.294, P<0.001). Low ABI was associated with risk of DN in the crude model (OR 0.873, 95% CI 0.780 to 0.977, P=0.018) and adjusted model (OR 0.884, 95% CI 0.782 to 0.999, P=0.048). No association was found for baPWV. In conclusion, low ABI was associated with risk of CKD and DN in patients with type 2 diabetes.

Investigation and analysis of lower extremity arterial disease in hospitalized elderly type 2 diabetic patients

BACKGROUND

The risk of lower extremity arterial disease (LEAD) is increased in diabetic patients. LEAD in diabetic patients occurs earlier and is often more severe and diffuse; however, it is largely underdiagnosed and untreated. The purposes of this study were to investigate and analyze LEAD situation of hospitalized elderly type 2 diabetic patients.

METHODS

The ankle-brachial index (ABI) was used to screen LEAD in hospitalized elderly type 2 diabetic patients. The patients were divided into 5 groups based on the screening results: non-LEAD group and LEAD group; the LEAD group was divided into mild stenosis group, moderate stenosis group, and severe stenosis group.

RESULTS

The percentage of patients who had LEAD was 43%. Significant difference in age, diabetes duration, peak velocity, microalbuminuria, and vibratory sensory neuropathy was observed between patients with and without LEAD; regression analysis showed that urinary albumin and vibratory sensory neuropathy were independent risk factors for LEAD. Significant difference in age, body mass index (BMI), peak velocity, urinary albumin, and high-density lipoprotein cholesterol (HDL-C) was observed between mild stenosis group, moderate stenosis group, and severe stenosis group; regression analysis showed that urinary albumin, BMI, and HDL-C were independent risk factors for accelerating vascular stenosis.

CONCLUSIONS

The incidence of LEAD in hospitalized elderly type 2 diabetic patients is high; age, diabetes duration, peak velocity, BMI, urinary microalbumin, vibratory sensory neuropathy, and HDL-C are the major risk factors for LEAD. Active control of risk factors is helpful to reduce or delay LEAD.

Renal evaluation in patients with type 2 diabetes mellitus and its association with diastolic blood pressure

Background: HbA1c is correlated with the estimated glomerular filtration rate (eGFR) and diastolic blood pressure (DBP). Our main objective was to evaluate the trend of biochemical and clinical variables, in relation to the eGFR in patients with type 2 diabetes mellitus (T2DM). Methods: This was a retrospective, longitudinal, and descriptive study, including patients with T2DM, who were cared for from January 2014 until December 2014, at the Clínica de Diabetes, Hospital Regional “Gral. Ignacio Zaragoza", ISSSTE, Mexico City, Mexico. eGFR was calculated using three formulas: the chronic kidney disease – epidemiology collaboration (CKD-EPI), Cockcroft-Gault, and modification of diet in renal disease (MDRD), during two periods of observation, 3 and 6 months. The results were compared by Student t tests or Wilcoxon-Mann-Whitney test depending on the variable distribution. Pearson correlation was employed to determine the relation between the eGFR determined with each formula and the analyzed variables. Results: The mean age was 56.5±11.3 years in the group of 3 months’ follow-up (n=110) and 57.1±13.8 years in the group of 6 months’ follow-up (n=47). In both groups, the formula with the lowest percentages of cases of CKD was CKD-EPI and the difference of this formula had a basal and final significant positive correlation with the DBP. Conclusion: The CKD-EPI formula showed the lowest percentages of cases of CKD in a short follow-up period, and its difference is consistently associated with the DBP, confirming the importance of controlling the later to mitigate the evolution to CKD.

Risk factors for peripheral artery disease among patients with diabetes in Saudi Arabia

Little is known about the risk factors for peripheral artery disease (PAD) among diabetic patients in Saudi Arabia. We therefore investigated the association of traditional and non-traditional PAD risk factors, as well as clinical markers, with the prevalence of PAD in 598 diabetic patients in Saudi Arabia. PAD was diagnosed as an ankle–brachial index (ABI) <0.9. Information on socio-demographic variables, smoking status, duration of diabetes, and medication were collected by questionnaire. Body weight, height, blood pressure and clinical markers were also measured. The prevalence of PAD in this population was 23.1%. Hypertension (OR (odds ratio) = 2.13, 95% CI: 1.29–3.52), obesity (OR=1.75, 95% CI: 1.13–2.73) and longer duration of diabetes (OR for ≥20 years vs 2–4 years = 3.30, 95% CI: 1.66–6.58) were independently and significantly associated with a higher prevalence of PAD. Participants with the highest quartile of fasting blood glucose and homocysteine levels had a 67% (OR=1.67, 95% CI: 0.89–3.31) and 78% (OR=1.78, 95% CI: 0.87–3.66) higher prevalence of PAD, respectively. Our study identified several important and largely modifiable risk factors for PAD in this Saudi population with diabetes. These findings underscored the importance of reducing cardiovascular risk factors in patients with diabetes.

Relationship between peripheral artery disease and combined albuminuria and low estimated glomerular filtration rate among elderly patients with type 2 diabetes mellitus

This study aimed at investigating the combined effects of albuminuria and reduced estimated glomerular filtration rate (eGFR) on peripheral artery disease (PAD) among elderly patients with diabetes. A total of 236 subjects were cross-classified into four groups according to the presence or absence of albuminuria (urinary albumin creatinine ratio (ACR) ≥ 30 mg/g) and low eGFR (<60 mL/min/1.73 m²). Cardiovascular risk factors and the ankle-brachial index (ABI) were also assessed. After multivariate adjustment using logistic regression analysis, the odds ratios (OR) for prevalent PAD related to albuminuria with preserved eGFR, normoalbuminuria with low eGFR and albuminuria with low eGFR compared to normoalbuminuria with preserved eGFR were 1.10 [95% confidence interval (CI) = 0.43-2.79], 3.14 (95% CI = 1.20-8.22) and 3.87 (95% CI = 1.72-8.72), respectively. In conclusion, in elderly patients with type 2 diabetes, both normoalbuminuria with low eGFR and albuminuria with low eGFR are associated independently with PAD.

Prevalence of Asymptomatic Peripheral Arterial Disease and Related Risk Factors in Younger and Elderly Patients in Taiwan

We determined the prevalence of asymptomatic peripheral arterial disease (PAD) and cardiovascular risk factors in Taiwan. Ambulatory participants (n = 1915) without symptoms of PAD were enrolled (mean age of 61.2 years). The ankle-brachial index (ABI) was used to detect the PAD (ABI < 0.90). The overall prevalence of asymptomatic PAD was 5.4% (2.8% in the younger participants [<65 years of age, n = 1021] and 8.4% in the elderly participants [≥65 years of age, n = 894]). Younger participants with asymptomatic PAD had a significantly higher rate of hypertension (55.2% vs 30%) and obesity (31% vs 13.3%) than those without asymptomatic PAD ( P < .05). Elderly participants with asymptomatic PAD had a significantly higher rate of diabetes mellitus (36% vs 21.2%) and hypertension (69.3% vs 55.4%) than those without asymptomatic PAD ( P < .05). Asymptomatic PAD is prevalent among elderly Taiwanese individuals. Overall, age was the strongest risk factor for the development of asymptomatic PAD.

Ethnicity and peripheral artery disease

Peripheral arterial disease (PAD) is an important healthcare problem and is an indicator of widespread atherosclerosis in other vascular territories, such as the cerebral and coronary circulations. PAD is associated with considerable morbidity and mortality. Most population-based studies investigating PAD prevalence and risk factors for its development and progression have been based on predominantly White ethnic groups. Much less is known about the characteristics of this disease in other ethnic groups. Understanding the epidemiology of PAD amongst ethnic minority groups is relevant, given that the population of minority ethnic groups in countries such as the United Kingdom rose by 53% between 1991 and 2001 and is expected to rise further in the future. This article aims to provide an overview of possible pathophysiological differences between ethnic groups for PAD, focussing predominantly on South Asians (people originating from India, Bangladesh and Pakistan) and Blacks (people of Black Caribbean and Black African descent) as these groups comprise the majority of all ethnic minorities in the United Kingdom.