medigraphic.com
ISSN 0016-3813 (Print)

2011, Number 2

<< Back Next >>

Gac Med Mex 2011; 147 (2)

Relationship between the ankle-arm index determined by Doppler ultrasonography and cardiovascular outcomes and amputations, in a group of patients with type 2 diabetes mellitus from the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zu

Miranda GLM, Bermúdez RR, Gómez PFJ, Aguilar SCA

Language: Spanish
References: 26
Page: 111-116
PDF size: 88.66 Kb.


ABSTRACT

Background: An ankle/arm index ‹ 0.90 and ≥ 1.41 is considered as abnormal. This study was aimed to investigate the prevalence of peripheral arterial disease through the identification of the ankle/arm index using Doppler ultrasound, and the possible association between pathological ankle/arm index and the micro- and macrovascular complications of diabetes and amputation. Methods: The ankle/arm index was determined in outpatient type 2 diabetic subjects. There were the following variables: age and cardiovascular outcomes. To find if the ankle/arm index is related to the cardiovascular outcomes or with the presence of micro- or macrovascular complications we determined the index of correlation of Pearson and also used logistic regression methods to analyze the association between ankle/arm index with the categorical variables. Results: We calculated the ankle/arm index in 242 patients. The prevalence of ischemic ankle/arm index (‹ 0.90) was 13.6%. The Pearson correlation coefficient for ankle/arm index pathological and cardiovascular outcomes was 0.180 (p = 0.005), amputation 0.130 (p ‹ 0.05), retinopathy 0.132 (p ‹ 0.05), and nephropathy 0.158 (p = 0.01). In logistic regression analysis, the factors associated with pathological ankle/arm index were age › 51 years, cardiovascular outcomes, and amputation. With the Mann Whitney U test we found that a relationship exists between pathological and amputation iliotibial band (p ‹ 0.05). Conclusions: Diabetic patients have a high prevalence of pathological ankle/arm index.


REFERENCES

  1. Fowkes FG. Epidemiological research on peripheral vascular disease. J Clin Epidemiol. 2001;54:863-8.

  2. Shinozaki T, Hasegawa T, Yano E. Ankle-arm index as an indicator of atherosclerosis: its application as a screening method. J Clin Epidemiol. 1998;51:1263-9.

  3. Stoffers HE, Kester AD, Kaiser V, et al. The diagnostic value of the measurement of the ankle-brachial systolic pressure index in primary health care. J Clin Epidemiol. 1996;49:1401-5.

  4. Greenland P, Abrams J, Aurigemma GP, et al. Writing Group III. Prevention Conference V: Beyond secondary prevention: identifying the highrisk patient for primary prevention: noninvasive test of atherosclerotic burden. Circulation. 2000;101:E16-22.

  5. Criqui MH, Langer RD, Fronek A, et al. Mortality over a period of 10 years in patients with peripheral arterial disease. N Engl J Med. 1992;326:381-6.

  6. Baker JD, Dix DE. Variability of Doppler ankle pressures with arterial occlusive disease: an evaluation of ankle index and brachial-ankle pressure gradient. Surgery. 1981;89:134-7.

  7. Atsma F, Bartelink ML, Grobbee DE, Van der Schouw YT. Best reproducibility of ankle-arm index was calculated using Doppler and dividing highest pressure by highest arm pressure. J Clin Epidemiol. 2005;58:1282-8.

  8. Vicente I, Lahoz C, Taboada M, et al. Prevalencia de un índice tobillobrazopatológico según el riesgo cardiovascular calculado mediante la función de Framingham. Med Clin (Barc). 2005;124:641-4.

  9. Lahoz C, Vicente I, Taboada M, et al. Índice tobillo-brazo y riesgo cardiovascular estimado mediante la función de SCORE en sujetos no diabéticos en prevención primaria. Clin Invest Arterioscl. 2006;18:35-9.

  10. Hirsch AT, Criqui MH, Treat-Jacobson D, et al. Peripheral arterial disease detection, awareness, and treatment in primary care. JAMA. 2002;286:1317-24.

  11. Vicente I, Lahoz C, Taboada M, et al. Índice tobillo-brazo en pacientes con diabetes mellitus: prevalencia y factores de riesgo. Rev Clin Esp. 2006;206:225-9.

  12. American Diabetes Association. Peripheral arterial disease in people with diabetes. Diabetes Care. 2003;26:3333-41.

  13. Remuzzi G, Schieppati A, Ruggenenti P. Nephropathy in patients with Type 2 diabetes. N Engl J Med. 2002;346:1145-51.

  14. Leese GP, Reid V, Mcalpine R, et al. Stratification of foot ulcer risk in patients with diabetes: a population-based study. J Clin Pract. 2006;60:541-5.

  15. White C. Intermitent Claudication. N Engl J Med. 2007;356:1241-50.

  16. Ogren M, Hedblad B, Engstrom G, Janzon L. Prevalence and prognostic significance of asymptomatic peripheral arterial disease in 68-year-old men with diabetes. Results from the population study «Men born in 1914» from Malmo, Sweden. Eur J Vasc Endovasc Surg. 2005;29:182-9.

  17. Kallio M, Forsblom C, Groop PH, Groop L, Lepantalo M. Development of new peripheral arterial occlusive disease in patients with type 2 diabetes during a mean follow-up of 11 years. Diabetes Care. 2003;26: 1241-5.

  18. Murabito JM, Evans JC, Nieto K, et al. Prevalence and clinical correlates of peripheral arterial disease in the Framingham Offspring Study. Am Heart J. 2002;143:961-5.

  19. Curb JD, Masaki K, Rodríguez BL, et al. Peripheral artery disease and cardiovascular risk factors in the elderly. The Honolulu Heart Program. Arterioscler Thromb Vasc Biol. 1996;16:1495-500.

  20. Wackers FJ, Young LH, Inzucchi SE, Chyun DA, Davey JA, Barrett EJ. Detection of silent myocardial ischemia in asymptomatic diabetic subjects: the DIAD study. Diabetes Care. 2004;27:1954-61.

  21. Rajagopalan N, Miller TD, Hodge DO, Frye RL, Gibbons RJ. Identifying high-risk asymptomatic diabetic patients who are candidates for screening stress single-photon emission computed tomography imaging. J Am Coll Cardiol. 2005;45:43-9.

  22. Consensus development conference on the diagnosis of coronary Herat disease in people with diabetes: 10-11 February 1998, Miami, Florida. American Diabetes Association. Diabetes Care. 1998;21: 1551-9.

  23. Di Carli MF, Hachamovitch R. Should we screen for occult coronary artery disease among asymptomatic patients with diabetes? J Am Coll Cardiol. 2005;45:50-3.

  24. Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med. 1998;339:229-34.

  25. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001;285:2486-97.

  26. Evans JM, Wang J, Morris AD. Comparison of cardiovascular risk between patients with type 2 diabetes and those who had had a myocardial infarction: cross sectional and cohort studies. BMJ. 2002; 324:939-42.




2020     |     www.medigraphic.com