High prevalence of peripheral arterial disease diagnosed by low ankle–brachial index in Japanese patients with diabetes: The Kyushu Prevention Study for Atherosclerosis

Maeda, Yasutaka; Inoguchi, Toyoshi; Tsubouchi, Hirohito; Sawada, Fumi; Sasaki, Satoshi; Fujii, Masakazu; Saito, Ryoko; Yanase, Toshihiko; Shimabukuro, Michio; Nawata, Hajime; Takayanagi, Ryoichi

doi:10.1016/j.diabres.2008.09.008

Cited by 31 publications

(26 citation statements)

References 20 publications

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“…The very high (baPWV 23.5 m/s) best split for all-cause mortality largely resulted from the fact that subjects with a low ABI (,0.9), who are known to be at severe MR (29,30), were eliminated from analyses because of concern regarding contamination of subjects with erroneous baPWV values due to poor blood flow in the lower extremities. In addition, we previously showed that the prevalence of a low ABI (,0.9), which is considered to increase the risk of development of peripheral arterial disease, was very high in subjects with diabetes (31). Although a substantial number of subjects at risk for mortality had been excluded, this study indicated that severe arterial stiffness contributes to overall death in diabetes.…”

Section: Discussionmentioning

confidence: 93%

Brachial-Ankle Pulse Wave Velocity Predicts All-Cause Mortality and Cardiovascular Events in Patients With Diabetes: The Kyushu Prevention Study of Atherosclerosis

et al. 2014

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OBJECTIVEWhether brachial-ankle pulse wave velocity (baPWV), a noninvasive marker for arterial stiffness, is a useful predictive maker for cardiovascular events in subjects with diabetes is not established. In the present cohort study, we evaluated the benefit of baPWV for the prediction of cardiovascular morbidity and mortality in subjects with diabetes. RESEARCH DESIGN AND METHODSA total of 4,272 outpatients with diabetes were enrolled in the Kyushu Prevention Study of Atherosclerosis. Of these, 3,628 subjects, excluding those with an ankle-brachial index of <0.9, were prospectively followed for 3.2 6 2.2 years. The baPWV at baseline was classified by recursive partitioning (RP) for each end point. We plotted the Kaplan-Meier curves for high-and low-baPWV groups, which were designated based on the cutoff points, and calculated Cox proportional hazards models. RESULTSThe elevation of baPWV quartiles was significantly correlated to the incidence of coronary artery events, cerebrovascular events, and all-cause mortality. RP revealed baPWVs of 14 and 24 m/s as statistically adequate cutoff points for cardiovascular events and mortality, respectively. High-baPWV classes showed significantly low event-free ratios in Kaplan-Meier curves for all end points and remained independent risks for all-cause mortality and cerebrovascular events, but not for coronary artery events after adjustments for age, sex, BMI, hypertension, hyperlipidemia, smoking, and hemoglobin A 1c by Cox proportional hazards models. CONCLUSIONSThis large-scale cohort study provided evidence that high baPWV is a useful independent predictor of mortality and cardiovascular morbidity in subjects with diabetes.

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Section: Discussionmentioning

confidence: 93%

Brachial-Ankle Pulse Wave Velocity Predicts All-Cause Mortality and Cardiovascular Events in Patients With Diabetes: The Kyushu Prevention Study of Atherosclerosis

et al. 2014

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“…While using the ABI as a screening tools, the prevalence has been found to be 26.3% in Germany, [15] 16% in Malaysia, [16] 12.7% in the elderly (> 65 y/o) and 4.0% in younger adults in Japan [17] and 17.7% in a multi-country study in Asia. [18] In Taiwan, Tseng et al, reported the prevalence of PAD to be 10.0%, based on a survey in the diabetic clinic of a teaching hospital in Taipei.…”

Section: Discussionmentioning

confidence: 99%

Pulse pressure and michigan neuropathy screening instrument are independently associated with asymptomatic peripheral arterial disease among type 2 diabetes community residents: A community-based screening program in Taiwan

Fan¹,

Chen²,

Huang³

et al. 2013

Biomed J

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“…Although an ABI of ＞1.4 has been indicated to be abnormally high as a result of poor arterial compressibility due to arterial stiffening and calcificaincluded less than 500 subjects with diabetes 3,[7][8][9][10][11][12] , and some studies have indicated that the association between a low ABI and mortality in Caucasians is weak among subjects with diabetes compared to that observed in those without diabetes 5,8,13) . While ethnic differences profoundly affect the prevalence of PAD 10) , no such prospective studies have been performed in Japanese subjects, who are characterized by a lower prevalence of PAD than Caucasian individuals [14][15][16] . A large-scale study of Japanese individuals including subjects with diabetes is needed to elucidate the association and predictive value of a low ABI with respect to the incidence of CVD.…”

Section: Baseline Examinationsmentioning

confidence: 99%

Relationship between a Low Ankle Brachial Index and All-Cause Death and Cardiovascular Events in Subjects with and without Diabetes

Yokoyama

Sone

Honjo

et al. 2014

JAT

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Aims:The association between a low ankle brachial index (ABI) and mortality and vascular morbidity in Japanese individuals with diabetes and the independence of this association from other risk factors have not yet been examined in the primary care setting among a large number of patients. Methods: An observational prospective cohort study was performed among 3,004 Japanese individuals (2,598 patients with diabetes) to examine all-cause death and cardiovascular disease (CVD) in relation to low ABI (＜0.9) values and other risk factors. Results: Low ABI values were found in 127 subjects (4.2%) and was associated with smoking, diabetes, hypertension, pulse pressure, glycosylated hemoglobin A1C, lipid profiles, glomerular filtration rate, uric acid and prevalent CVD at baseline. Over 13,242 person-years, 93 deaths and 117 cases of CVD occurred. In a multivariate Cox regression analysis, the hazard ratio for low-normal ABI values was 3.97 (95% CI, 2.29 to 6.88) for all-cause death and 2.86 (95% CI, 1.83-4.49) for fatal and nonfatal CVD and all-cause death. Similar hazard ratios were found when the subjects were confined to those with diabetes. All risk analyses indicated that age, a low ABI, diabetes, a history of CVD and smoking remained significantly and independently predictive of CVD and all-cause death. Conclusions: A low ABI exhibits significant cross-sectional associations with conventional risk factors and further more with the glomerular filtration rate, uric acid level and presence of prevalent CVD at baseline, and a low ABI independently predicts subsequent death and cardiovascular events. These findings support the concept that a low ABI is an integrated marker of an excess risk of death and cardiovascular events, independent of conventional risk factors. J Atheroscler Thromb, 2014; 21:574-581.

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High prevalence of peripheral arterial disease diagnosed by low ankle–brachial index in Japanese patients with diabetes: The Kyushu Prevention Study for Atherosclerosis

Cited by 31 publications

References 20 publications

Brachial-Ankle Pulse Wave Velocity Predicts All-Cause Mortality and Cardiovascular Events in Patients With Diabetes: The Kyushu Prevention Study of Atherosclerosis

Brachial-Ankle Pulse Wave Velocity Predicts All-Cause Mortality and Cardiovascular Events in Patients With Diabetes: The Kyushu Prevention Study of Atherosclerosis

Pulse pressure and michigan neuropathy screening instrument are independently associated with asymptomatic peripheral arterial disease among type 2 diabetes community residents: A community-based screening program in Taiwan

Relationship between a Low Ankle Brachial Index and All-Cause Death and Cardiovascular Events in Subjects with and without Diabetes

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