Use of the ankle-brachial index combined with the percentage of mean arterial pressure at the ankle to improve prediction of all-cause mortality in type 2 diabetes mellitus: an observational study

Li, Yu-Hsuan; Sheu, Wayne Huey‐Herng; Lee, I-Te

doi:10.1186/s12933-020-01149-7

Cited by 12 publications

(11 citation statements)

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“…ROC results revealed that the combination of ABI and baPWV may improve risk classification in predicting all-cause and expanded CVD mortality in patients with T2DM. ABI and baPWV are simple, non-invasive, economical, and realistic measures that have become increasingly important in predicting mortality [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] . Most studies exploring the associations of ABI and/or baPWV with mortality in T2DM population [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] only considered ABI alone [28][29][30][31][32][33][34][35][36][37]…”

Section: Discussionmentioning

confidence: 99%

“…Only two works considered baPWV alone 43,44 , and another two simultaneously considered ABI and baPWV 45,46 . As a consequence, the findings on the association between ABI and mortality were inconsistent [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] . Significant associations were observed in some studies [28][29][30][31][32][33][34][35][36][37][38][39][40] but not in others 41,42 .…”

Section: Discussionmentioning

confidence: 99%

“…As a consequence, the findings on the association between ABI and mortality were inconsistent [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] . Significant associations were observed in some studies [28][29][30][31][32][33][34][35][36][37][38][39][40] but not in others 41,42 . Two prior studies conducted in patients with DM did not detect the predictive capacity of abnormal ABI for mortality, and these non-significant findings can be explained by their small sample sizes 41,42 .…”

Section: Discussionmentioning

confidence: 99%

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Prediction of all-cause and cardiovascular mortality using ankle-brachial index and brachial-ankle pulse wave velocity in patients with type 2 diabetes

Lin

Liu

et al. 2022

Sci Rep

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Ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) are used as non-invasive indicators for detecting atherosclerosis and arterial stiffness, two well-known predictors of mortality in patients with type 2 diabetes mellitus (T2DM). ABI and baPWV have independent associations with mortality; however, their joint and interactive effects on mortality have not been assessed in patients with T2DM. This work aims to evaluate the independent, joint, and interactive associations of ABI and baPWV with all-cause and expanded cardiovascular disease (CVD) mortality in patients with T2DM. This observational study included 2160 patients with T2DM enlisted in the Diabetes Care Management Program database of China Medical University Hospital from 2001 to 2016 and then followed their death status until August 2021. Cox proportional hazard models were used to evaluate the independent, joint, and interactive effects of ABI and baPWV on the risk of all-cause and expanded CVD mortality. A total of 474 patient deaths occurred after a mean follow-up of 8.4 years, and 268 of which were attributed to cardiovascular events. Abnormal ABI (≤ 0.9) and highest baPWV quartile were independently associated with increased risks of all-cause [ABI: hazard ratio (HR) 1.67, 95% confidence interval (CI) 1.30–2.11; baPWV: 1.63, 1.16–2.27] and expanded CVD mortality (ABI: 2.21, 1.62–3.02; baPWV: 1.75, 1.09–2.83). The combination of abnormal ABI (≤ 0.9) and highest baPWV quartile was associated with a significantly higher risk of all-cause (4.51, 2.50–8.11) and expanded CVD mortality (9.74, 4.21–22.51) compared with that of the combination of normal ABI and lowest baPWV quartile. Significant interactions were observed between ABI and baPWV in relation to all-cause and expand CVD mortality (both p for interaction < 0.001). Through their independent, joint, and interactive effects, ABI and baPWV are significant parameters that can improve the prediction of all-cause and expanded CVD mortality in patients with T2DM and help identify high-risk patients who may benefit from diabetes care.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Prediction of all-cause and cardiovascular mortality using ankle-brachial index and brachial-ankle pulse wave velocity in patients with type 2 diabetes

Lin

Liu

et al. 2022

Sci Rep

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“…Diabetic retinopathy was reported to be associated with eGFR variability and predictive of all-cause mortality in patients with type 2 DM [40,41]. Peripheral artery disease (PAD) was also reported to be associated with CKD [42], and a high-risk PAD is predictive of all-cause mortality in patients with type 2 DM [43]. Moreover, Zhang et al [44] verified that CKD was associated with a reduction in left ventricular function and strain based on cardiac magnetic resonance imaging in patients with type 2 DM.…”

Section: Discussionmentioning

confidence: 99%

A synergistic effect of variability in estimated glomerular filtration rate with chronic kidney disease on all-cause mortality prediction in patients with type 2 diabetes: a retrospective cohort study

Chang

Lee

2021

Cardiovasc Diabetol

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Background The combination of diabetes mellitus (DM) and chronic kidney disease (CKD) is associated with a high risk of mortality. Annual assessment of the estimated glomerular filtration rate (eGFR) is recommended for patients with DM. We investigated the effect of variability in annual eGFR values on all-cause mortality in patients with type 2 DM. Methods In this retrospective cohort study, we enrolled patients with eGFR data between 01 Aug 2017 and 31 July 2018. We defined the index eGFR as the first available eGFR value within the enrollment year and collected additional annual eGFR data from the previous three years. A total of 3592 patients with type 2 DM were enrolled, including 959 patients with CKD (index eGFR < 60 mL/min/1.73 m2) and 2633 patients without CKD. We assessed eGFR variability by using the standard deviation (SD) of the three annual eGFR and index eGFR values. We divided patients into subgroups according to the median SD of their annual eGFR (7.62 mL/min/1.73 m2). The primary endpoint was all-cause mortality after the index eGFR was assessed. Results During a median follow-up of 19 months (interquartile range: 18‒20 months), 127 (3.5%) deaths occurred among all 3592 enrolled patients. The highest mortality risk was observed in the high SD with CKD group, with a hazard ratio (HR) of 2.382 [95% confidence interval (CI) 1.346‒4.215] in comparison to the low SD without CKD group after adjusting for the associated factors. In patients without CKD, a high SD was an independent risk factor for mortality (HR = 2.105, 95% CI 1.256‒3.528). According to the C-index, the mortality prediction ability was better for the index eGFR + SD model than for the index eGFR alone model (0.671 vs. 0.629, P < 0.001). Conclusion There was a synergistic effect of eGFR variability with single-measured eGFR for the prediction of mortality in patients with type 2 DM. The SD of the annual eGFR values was also an independent predictor of mortality in patients with an eGFR > 60 mL/min/1.73 m2.

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“… 29 There is a lack of investigation to assess the relationship between %MAP and glucose variability. Since a combination of low ABI and high %MAP carries a high mortality risk in patients with DM, 30 we hypothesized that glucose variability is associated with ABI and %MAP in patients with DM. Therefore, this screening study investigated whether glucose variability, as estimated by the standard deviation (SD) of annual fasting plasma glucose, is significantly associated with PAD, reflected by either high %MAP or low ABI, in patients with DM.…”

Section: Introductionmentioning

confidence: 99%

Variability in Annual Fasting Glucose and the Risk of Peripheral Artery Disease in Patients with Diabetes Mellitus

Chang

Lee

2021

DMSO

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Purpose High glucose concentrations and swings are associated with endothelial dysfunction. We examined the effects of variability in fasting plasma glucose on peripheral artery disease (PAD) in patients with diabetes mellitus (DM). Patients and Methods In this screening study for the risk factors of PAD, we retrospectively collected data on the ankle-brachial index (ABI) and the percentage of mean arterial pressure (%MAP) at the ankle between August 01, 2016 and July 31, 2017. We defined low ABI ≤0.90, high %MAP ≥45%, or both as high-risk PAD and others as low-risk PAD. We compared the standard deviation (SD) of the first fasting plasma glucose data available each year after January 01, 2007. Results In 2577 patients, a higher SD of annual fasting glucose was observed in those with an ABI ≤0.90 than in patients with an ABI >0.90 (2.6 ± 2.1 vs 2.2 ± 2.3, P = 0.009), and in patients with %MAP ≥45% than in those with %MAP <45% (2.4 ± 2.1 vs 2.2 ± 2.3, P = 0.034). A high-risk PAD was significantly associated with the SD (P = 0.032) but not with the mean (P = 0.338) of annual fasting glucose. The former was an independent risk factor for high-risk PAD (odds ratio = 1.424; 95% CI = 1.118‒1.814; P = 0.004). Conclusion Variability but not mean of annual fasting plasma glucose was significantly associated with a high risk of PAD in patients with DM.

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Use of the ankle-brachial index combined with the percentage of mean arterial pressure at the ankle to improve prediction of all-cause mortality in type 2 diabetes mellitus: an observational study

Cited by 12 publications

References 60 publications

Prediction of all-cause and cardiovascular mortality using ankle-brachial index and brachial-ankle pulse wave velocity in patients with type 2 diabetes

Prediction of all-cause and cardiovascular mortality using ankle-brachial index and brachial-ankle pulse wave velocity in patients with type 2 diabetes

A synergistic effect of variability in estimated glomerular filtration rate with chronic kidney disease on all-cause mortality prediction in patients with type 2 diabetes: a retrospective cohort study

Variability in Annual Fasting Glucose and the Risk of Peripheral Artery Disease in Patients with Diabetes Mellitus

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