Traditional and non-traditional risk factors for peripheral artery disease development/progression in patients with type 2 diabetes: the Rio de Janeiro type 2 diabetes cohort study

被引:22
作者
Cardoso, Claudia R. L. [1 ]
Melo, Juliana V. [2 ]
Santos, Thaina R. M. [2 ]
Leite, Nathalie C. [1 ]
Salles, Gil F. [1 ]
机构
[1] Univ Fed Rio de Janeiro, Sch Med, Univ Hosp Clementino Fraga Filho, Dept Internal Med, Rua Croton 72, BR-22750240 Rio De Janeiro, RJ, Brazil
[2] Univ Fed Rio de Janeiro, Sch Med, Univ Hosp Clementino Fraga Filho, Dept Occupat Therapy, Rio De Janeiro, Brazil
关键词
Aortic stiffness; Carotid intima-media thickness; Peripheral artery disease; Risk factors; Type; 2; diabetes;
D O I
10.1186/s12933-021-01249-y
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BackgroundThe prognostic importance of non-traditional risk factors for peripheral artery disease (PAD) development/progression is scarcely studied in diabetes. We investigated if carotid intima-media thickness (CIMT) and carotid-femoral pulse wave velocity (cf-PWV) added prognostic information beyond traditional cardiovascular risk markers for PAD outcomes.MethodsAnkle-brachial index (ABI) was measured at baseline and after a median of 91 months of follow-up in 681 individuals with type 2 diabetes. Multivariate Cox regressions examined the associations between the candidate variables and the outcome. PAD development/progression was defined by a reduction in ABI >= 0.15 (to a level<0.9) or limb revascularization procedures, lower-extremity amputations or death due to PAD. The improvement in risk discrimination was assessed by increases in C-statistics of the models.ResultsSeventy-seven patients developed/progressed PAD: 50 reduced ABI to<0.9, seven had lower-limb revascularizations, and 20 had amputations or death. Age, male sex, diabetes duration, presence of microvascular complications (peripheral neuropathy and diabetic kidney disease), baseline HbA(1c), 24-h systolic BP (SBP) and mean cumulative office SBP and LDL-cholesterol were associated with PAD development/progression in several models. CIMT and cf-PWV were additionally associated with PAD outcomes, and their inclusion further improved risk discrimination (with C-statistic increases between 0.025 and 0.030). The inclusion of ambulatory 24-h SBP, instead of office SBP, also improved PAD risk discrimination.ConclusionsIncreased CIMT and aortic stiffness are associated with greater risks of developing/progressing PAD, beyond traditional risk factors, in type 2 diabetes.
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页数:10
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