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

Abstract

Background The 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. Methods Ankle-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. Results Seventy-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 HbA1c, 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. Conclusions Increased CIMT and aortic stiffness are associated with greater risks of developing/progressing PAD, beyond traditional risk factors, in type 2 diabetes.

Prevalence and related factors of peripheral arterial disease in diabetes mellitus inpatients: a cross-sectional study in China

“…Multivariate logistic regression analysis indicated that LDL-C level was also an independent factor associated with PAD in diabetic patients (OR = 1.510, 95% CI = 1.152 to 1.980, p = 0.003). This fining is consistent with Cardoso et al's report that LDL-cholesterol was associated with PAD development/progression in patients with type 2 diabetes [12]. It is known that low levels of low-density lipoprotein cholesterol can effectively reduce the risk of vascular events [29].…”

“…The independent factors associated with PAD in type 2 diabetic patients have been investigated. Cardoso et al have reported that increased carotid intima-media thickness and aortic stiffness were independent factors associated with PAD in type 2 diabetic patients [12]. Bertrand et al demonstrate that HDL-cholesterol, ApoA-I, total cholesterol/HDL-cholesterol ratio or non-HDL-cholesterol were independent factors associated with PAD in patients with type 2 diabetes [13].…”

Prognostic impact of liver fibrosis and steatosis by transient elastography for cardiovascular and mortality outcomes in individuals with nonalcoholic fatty liver disease and type 2 diabetes: the Rio de Janeiro Cohort Study

“…All participants gave written informed consent, and the local Ethics Committee had previously approved the study protocol. The characteristics of the participants of the whole Rio-T2D cohort, as well as of the individuals with NAFLD, its baseline procedures and diagnostic definitions, all have been detailed previously [ 21 – 26 ]. All participants with NAFLD had at least a previous abdominal ultrasound demonstrating any grade of liver steatosis and none of them had any other cause of liver steatosis except NAFLD.…”

“…The primary outcomes were the occurrence of any cardiovascular event (CVE) and all-cause mortality. Total CVEs included the following: fatal or non-fatal myocardial infarctions (MIs), sudden cardiac deaths, new-onset heart failure, death from progressive heart failure, any myocardial revascularization procedure, fatal or non-fatal strokes, any aortic or lower limb revascularization procedure, any amputation above the ankle, and deaths from aortic or peripheral arterial disease [ 24 – 26 ]. Primary outcomes were ascertained from medical records, death certificates and interviews with attending physicians and patient families, by a standard questionnaire reviewed by two independent observers [ 24 – 26 ].…”

“…Total CVEs included the following: fatal or non-fatal myocardial infarctions (MIs), sudden cardiac deaths, new-onset heart failure, death from progressive heart failure, any myocardial revascularization procedure, fatal or non-fatal strokes, any aortic or lower limb revascularization procedure, any amputation above the ankle, and deaths from aortic or peripheral arterial disease [ 24 – 26 ]. Primary outcomes were ascertained from medical records, death certificates and interviews with attending physicians and patient families, by a standard questionnaire reviewed by two independent observers [ 24 – 26 ]. Secondary outcomes were the classic 3-point major adverse cardiovascular events (MACEs: non-fatal MIs and strokes plus all cardiovascular deaths), and cardiovascular and non-cardiovascular mortalities.…”