The ankle brachial index in type 2 diabetes


Authors: B. Nussbaumerová 1;  H. Rosolová 1;  J. Ferda 2;  P. Šifalda 1;  I. Šípová 1;  F. Šefrna 1
Authors‘ workplace: Centrum preventivní kardiologie II. interní kliniky Lékařské fakulty UK a FN Plzeň, přednosta prof. MUDr. Jan Filipovský, CSc. 1;  Klinika zobrazovacích metod Lékařské fakulty UK a FN Plzeň, přednosta doc. MUDr. Boris Kreuzberg, CSc. 2
Published in: Vnitř Lék 2011; 57(3): 299-305
Category: 60th birthday of prof. Mudr. Jiřího Vítovce, CSc, FESC

Overview

Introduction:
The ankle brachial index (ABI), i.e. the ratio of systolic blood pressure (SBP) on the ankle and on the arm, is diagnostic for peripheral occlusive artery disease and a marker of cardiovascular (CV) risk. The association between the low ABI < 0.9 and the CV risk in type 2 diabetes (T2DM) subjects was investigated.

Methods:
We examined 253 T2DM subjects (135 males, 118 females, aged 66 ± 9 years). The blood pressures were measured in the supine position with the 2 mm Hg accuracy; Doppler ultrasound was used for the ankle SBP and the mercury sphygnomanometer for the arm SBP. The high CV risk was defined as manifest CV diseases, elevated coronary calcium score (CAC) by Agatston (> 101) or according to the global CV Risk Score ≥ 5% (SCORE).

Statistical method:
Wilcoxon’s unpaired test, χ2 test, multiple logistic regression.

Results:
The ABI < 0.9 was found unilateral in 23 T2DM (8%), bilateral in 24 (9%), in older males (71 ± 8 years) with higher CAC (600 ± 707) (p < 0.01), higher total cholesterol (5.4 ± 1.3 mmol/ L) and total homocystein (17.2 ± 7.1 µmol/L) (p < 0.05) in comparison to those with the ABI ≥ 0.9 (age 66 ± 9 years, CAC 234 ± 458, total cholesterol 5.0 ± 0.9, total homocystein 14.3 ± 7.8). Many CV risk factors correlated positively with the low ABI < 0.9; it was significantly independently associated with age (p < 0.001), smoking (p < 0.01), LDL-cholesterol, total homocystein and CAC (p < 0.05). Low ABI < 0.9 predicted ischemic stroke in subjects with T2DM and manifest CV diseases in the further 3 years. There was no correlation between the ABI and the ultrasensitive C-reactive protein.

Conclusion:
Low ABI < 0.9 was in a strong association with the CV risk. The ABI measurement is a simple, noninvasive, time-nonconsuming and inexpensive method for subclinical atherosclerosis detection; the ABI can supply standard methods for the CV risk prediction.

Key words:
ankle-brachial index – diabetes mellitus – atherosclerosis – cardiovascular risk


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Labels
Diabetology Endocrinology Internal medicine

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