Borderline ankle–brachial index is associated with increased prevalence of micro- and macrovascular complications in type 2 diabetes: A cross-sectional analysis of 12,772 patients from the Joint Asia Diabetes Evaluation Program

Yan, Bryan P.; Zhang, Yuying; Kong, Alice Pik Shan; Luk, Andrea; Ozaki, Risa; Yeung, Roseanne O.; Tong, Peter C.Y.; Chan, WM; Tsang, Chiu-Chi; Lau, Kam-Piu; Cheung, Y. Whitney; Wolthers, Troels; Lyubomirsky, Greg; So, Wing‐Yee; Ma, Rong; Chow, Francis C. C.; Chan, Juliana C.N.

doi:10.1177/1479164115590559

Cited by 23 publications

(20 citation statements)

References 37 publications

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“…In addition, a prospective study in African‐Americans with T1DM found that DR severity at baseline was a significant independent risk factor for the incidence of lower extremity arterial disease, defined as present if a patient has had an amputation or angioplasty for poor circulation, or if there is an absence of major arterial pulse in the legs . However, in patients with T2DM, a borderline ABI (0.90‐0.99) has been identified as an independent predictor of DR and other microvascular and macrovascular complications …”

Section: Resultsmentioning

confidence: 99%

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Association between diabetic eye disease and other complications of diabetes: Implications for care. A systematic review

Pearce

Simó

Lövestam-Adrian

et al. 2018

Diabetes Obesity Metabolism

140

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Aims: To evaluate diabetic retinopathy (DR) screening with a portable handheld smartphone-based retinal camera and telemedicine in an urban primary health care setting; to evaluate the learning curve for image acquisition, performed by healthcare personnel without previous experience on retinal imaging. Methods: Prospective study that enrolled patients with type 2 diabetes mellitus (T2DM) followed at a primary healthcare unit in São Paulo, Brazil. After a brief training in image acquisition, there was further continuous feedback during the remote image reading process. Each patient underwent two fundus and one anterior ocular segment images per eye, after mydriasis. Patients were classi ed according need of referral. Results: A total of 627 adult individuals with T2DM underwent retinal evaluation. The population was composed by 63.2% female individuals, age median of 66 years-old, diabetes duration 10.7 ± 8.2 years and A1c 7.7 ± 1.9% (61 + 20.8 mmol/mol). The most prevalent associated comorbidities were arterial hypertension (80.3%) and dyslipidemia (50.2%). Referral decision was possible in 81.2% patients. Most patients had absent or non-referable DR; the main ocular media opacity detected was cataract. After the 7 th day of image acquisition, the daily rate of patients whose images allowed clinical decision was maintained above 80%. A higher A1c was associated with referable DR. Conclusion: A low-cost DR screening strategy with a handheld device and telemedicine is feasible and has the potential to increase coverage of DR screening in underserved areas; the possibility of mobile units is relevant for DR screening in the context of Covid-19 pandemic.

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Section: Resultsmentioning

confidence: 99%

“…93 However, in patients with T2DM, a borderline ABI (0.90-0.99) has been identified as an independent predictor of DR and other microvascular and macrovascular complications. 94…”

Section: Peripheral Complicationsmentioning

confidence: 99%

Association between diabetic eye disease and other complications of diabetes: Implications for care. A systematic review

Pearce

Simó

Lövestam-Adrian

et al. 2018

Diabetes Obesity Metabolism

140

View full text Add to dashboard Cite

show abstract

“…One study showed that IAND could better predict both overall and cardiovascular mortality than IAD in elderly patients [3]. ABI exhibits better association with cardiovascular outcomes than IAD in patients with type 2 diabetes [25]. However, no study has reported the comparison between IAND and IAD in patients with acute ischemic stroke.…”

Section: Discussionmentioning

confidence: 99%

“…In patients undergoing hemodialysis, high PWV and low ABI are significantly associated with mortality [33]. Therefore, ABID and IAND could be more influenced by endothelial dysfunction, systemic atherosclerosis, calcification burden, and arterial stiffness than IAD, which may be related to more frequent PAD in the lower extremities [25,26,28,29].…”

Section: Discussionmentioning

confidence: 99%

Predicting Stroke Outcomes Using Ankle-Brachial Index and Inter-Ankle Blood Pressure Difference

Han

Choi

et al. 2020

JCM

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Background: This study investigated the association of high ankle-brachial index difference (ABID) and systolic inter-ankle blood pressure difference (IAND) with short-and long-term outcomes in acute ischemic stroke patients without peripheral artery disease (PAD). Methods: Consecutive patients with acute ischemic stroke who underwent ankle-brachial index (ABI) measurement were enrolled. ABID was calculated as |right ABI-left ABI|. IAND and systolic inter-arm blood pressure difference (IAD) were calculated as |right systolic blood pressure -left systolic blood pressure|. Poor functional outcome was defined as modified Rankin Scale score ≥3 at 3 months. Major adverse cardiovascular events (MACEs) were defined as stroke recurrence, myocardial infarction, or death. Results: A total of 2901 patients were enrolled and followed up for a median of 3.1 (interquartile range, 1.6-4.7) years. Among them, 2643 (84.9%) patients did not have PAD. In the logistic regression analysis, ABID ≥ 0.15 and IAND ≥ 15 mmHg were independently associated with poor functional outcome (odds ratio (OR), 1.970, 95% confidence interval (CI), 1.175-3.302; OR, 1.665, 95% CI, 1.188-2.334, respectively). In Cox regression analysis, ABID ≥0.15 and IAND ≥ 15 mmHg were independently associated with MACEs (hazard ratio (HR), 1.514, 95% CI, 1.058-2.166; HR, 1.343, 95% CI, 1.051-1.716, respectively) and all-cause mortality (HR, 1.524, 95% CI, 1.039-2.235; HR, 1.516, 95% CI, 1.164-1.973, respectively) in patients without PAD. Conclusion: High ABID and IAND are associated with poor short-term outcomes, long-term MACE occurrence, and all-cause mortality in acute ischemic stroke without PAD.

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“…The multiethnic study of atherosclerosis indicated that lower arterial elasticity predicted faster kidney function decline in subjects with eGFR>60ml/(min·1.73m2). In addition, renal function also declined as ABI decreased [22]. These results revealed the intimate correlations of renal function with various cardiovascular risk factors.…”

Section: Discussionmentioning

confidence: 89%

The Relationships of the Fractional Excretion of Uric Acid with Brachial-Ankle Pulse Wave Velocity and Ankle Brachial Index in Chinese Young Adults

Wang

Chu

et al. 2018

Kidney Blood Press Res

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Background/Aims: Elevated serum uric acid (UA) was intimately correlated with vascular stiffness and abnormal ankle brachial index (ABI) in various populations. These correlations lost significance after adjustment for estimated glomerular filtration rate (eGFR), indicating that the association of UA and brachial-ankle pulse wave velocity (baPWV) or ABI might be driven by kidney function. UA is predominantly eliminated through the kidneys, and metabolic disorders can influence the clearance of UA. In this study, we aimed to explore the putative correlation between FEUA and baPWV or ABI to determine to what extent the associations with UA were affected by renal function. Methods: This cross-sectional study enrolled 2351 participants, who underwent general health screening in Hanzhong people’s hospital from March to June of 2017. BaPWV and ABI were measured using a volume-plethysmographic apparatus (BP-203RPEII; Nihon Colin, Tokyo, Japan). FEUA was divided into quartiles: Q1:FEUA≤3.07; Q2: 3.07 9.19. Results: Lower FEUA predicted a higher prevalence of high baPWV and low ABI (p for trend <0.001). The respective ORs for high baPWV from the first to the third quartiles of FEUA were 1.777(1.323, 2.387); 1.561(1.158, 2.104); and 1.680 (1.250, 2.259). The prevalence of low ABI was greatly elevated with the decrement of FEUA [ORs for the first to third FEUA quartiles were 6.977(2.062, 23.610); 5.123(1.475, 17.790); and 2.685(0.709, 10.171), respectively]. The association of FEUA and ABI was independent of related confounding factors. However, the association between FEUA and baPWV was greatly influenced by corresponding confounders, especially gender. The efficacy of FEUA in the prediction of low ABI was stronger than that of serum UA. However, serum UA was more powerful in the prediction of high baPWV. Conclusion: Kidney function exerted a profound influence on the relationship between UA and baPWV or ABI, revealing complex interactions among cardiovascular risk factors.

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Borderline ankle–brachial index is associated with increased prevalence of micro- and macrovascular complications in type 2 diabetes: A cross-sectional analysis of 12,772 patients from the Joint Asia Diabetes Evaluation Program

Cited by 23 publications

References 37 publications

Association between diabetic eye disease and other complications of diabetes: Implications for care. A systematic review

Association between diabetic eye disease and other complications of diabetes: Implications for care. A systematic review

Predicting Stroke Outcomes Using Ankle-Brachial Index and Inter-Ankle Blood Pressure Difference

The Relationships of the Fractional Excretion of Uric Acid with Brachial-Ankle Pulse Wave Velocity and Ankle Brachial Index in Chinese Young Adults

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