The peripheral atherosclerotic profile in patients with type 1 diabetes warrants a thorough vascular assessment of asymptomatic patients

被引:17
作者
Nattero-Chavez, Lia [1 ,3 ]
Redondo Lopez, Sandra [2 ]
Alonso Diaz, Sara [1 ]
Garnica Urena, Marta [2 ]
Fernandez-Duran, Elena [3 ]
Escobar-Morreale, Hector F. [1 ,3 ,4 ]
Luque-Ramirez, Manuel [1 ,3 ,4 ]
机构
[1] Hosp Univ Ramon y Cajal, Dept Endocrinol & Nutr, E-28034 Madrid, Spain
[2] Hosp Univ Ramon y Cajal, Dept Vasc Surg, Madrid, Spain
[3] CIBER Diabet & Enfermedades Metab Asociadas CIBER, IRYCIS, Diabet Obes & Human Reprod Res Grp, Madrid, Spain
[4] Univ Alcala, Madrid, Spain
关键词
ankle-brachial index; carotid atherosclerotic disease; peripheral artery disease; prevalence; type 1 diabetes mellitus; ANKLE-BRACHIAL INDEX; ARTERIAL-DISEASE; LOWER-EXTREMITY; TASK-FORCE; CARDIOVASCULAR-DISEASE; SCIENTIFIC STATEMENT; HEART-ASSOCIATION; AMERICAN SOCIETY; GUIDELINES; MANAGEMENT;
D O I
10.1002/dmrr.3088
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims Epidemiological data on subclinical atherosclerotic disease in type 1 diabetes mellitus (DM1) are scarce. We aimed to estimate the subclinical atherosclerosis profile of asymptomatic patients with DM1 and an abnormal ankle-brachial index (ABI). Material and methods In a cross-sectional design ( Identifier: NCT02910271), we estimated ABI in 289 consecutive asymptomatic patients with DM1. An abnormal ABI led to measurements of toe-brachial index (TBI) and peripheral doppler ultrasound (DUS) to diagnose peripheral artery disease (PAD) and/or atherosclerotic carotid plaques (ACP). Results A reduced (<= 0.9) or increased (>1.2) ABI was detected in 17 (6%) and 75 (26%) patients, respectively. PAD was confirmed by TBI and DUS in 9 (53%) patients with a reduced ABI and 28 (37%) patients with an increased ABI, resulting in a 12.8% (9.4-17.2) prevalence of asymptomatic PAD. Fourteen patients with an abnormal ABI also exhibited ACP [4.8% (2.9-7.9)], with 64% of these patients showing bilateral disease. Artery stenosis was mild or moderate in 21% and 29% of patients, respectively. Thus, 46 [16% (12-21)] patients showed asymptomatic PAD, ACP, or both. According to our data, we would have to explore three asymptomatic patients with DM1 and normal pulses to unmask one case of PAD, and seven asymptomatic patients showing abnormal ABI values to detect one carotid disease. Conclusions Peripheral artery disease is often undiagnosed in asymptomatic patients with DM1. However, its presence may change medical management in a substantial percentage of cases, highlighting the potential benefit of a thorough vascular assessment on these patients.
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页数:10
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