Sub-clinical vascular disease in type 2 diabetic subjects: Relationship with chronic complications of diabetes and the presence of cardiovascular disease risk factors

Abstract 

Background

We evaluated the association between a low ankle-brachial index (ABI), chronic complications of diabetes, and the presence of traditional cardiovascular disease risk factors in subjects with type 2 diabetes but without known cardiovascular disease.

Methods

We included diabetic subjects (n=923; 52% male; age range 50–85 years) without clinical evidence of coronary, cerebrovascular, or peripheral artery disease (PAD). A history of nephropathy, retinopathy, or neuropathy was collected from the medical records. A 12-lead electrocardiogram and ABI measurements were conducted on all study participants.

Results

The mean duration of diabetes was 9.6 years. Prevalence of a low ABI (<0.9) was 26.2%. Multivariate analysis indicated that factors significantly associated with a low ABI were age (OR: 1.06; 95%CI: 1.033–1.084; p<0.001), plasma triglyceride concentration (OR: 1.002; 95%CI: 1.001–1.004; p=0.006), duration of diabetes (OR: 1.029; 95%CI: 1.008–1.051; p=0.007), and smoking habit (OR: 1.755; 95%CI: 1.053–2.925; p=0.03). The presence of nephropathy, neuropathy, retinopathy, left ventricular hypertrophy, left bundle branch block, and atrial fibrillation were all associated with a low ABI, but only renal disease remained significant after adjusting for age, duration of diabetes, and cardiovascular risk factors.

Conclusion

A low ABI is highly prevalent in subjects with diabetes and is related to age, duration of diabetes, smoking habit, and hypertriglyceridemia. Although chronic complications are frequently associated with a low ABI, only renal damage is independently associated with peripheral artery disease.

Keywords: Diabetes mellitus type 2, Peripheral artery disease, Diabetic nephropathy