The Ankle-Brachial Index for assessing the prevalence of peripheral artery disease and cardiovascular risk in patients with type 2 diabetes mellitus

Abstract

Abstract Background. Type 2 diabetes mellitus (T2DM) is an important risk factor for peripheral artery disease (PAD). Measuring the Ankle-Brachial Index (ABI) in patients with diabetes is a simple way to screen for PAD. In the last decade, pathological ABI values (≤ 0.9; ≥1.3) were found associated with a higher cardiovascular (CV) risk and mortality. The role of classic risk factors for PAD in patients with diabetes is still unclear, and there is no specific PAD risk scoring system for these patients. The main goals of this study were to establish the prevalence of PAD in a T2DM population, and assess the relationship between PAD and the CV risk calculated with the CUORE Project score (CPS) (https://www.cuore.iss.it/). The association between the ABI, the main risk factors for PAD and T2DM complications was also investigated. Methods. Two hundred patients attending the Diabetes Clinic run by the ULSS 6 District Health Unit in Padua (north-east Italy) were consecutively enrolled, and their left and right ABI were measured. Twenty-seven patients with a history of CV events were excluded for the purpose of calculating the CPS, which was thus recorded for a total of 173 patients. Results. The prevalence of PAD in this study population was 17%. The CV risk calculated with the CPS tended to be higher (p = 0.0712) in the group with a pathological ABI than in the group with a normal ABI (0.91–1.29). The distribution of patients in the different CV risk classes did not differ significantly (p = 0.2208) between the two groups (pathological vs normal ABI). Glycated hemoglobin (r = -0.1591; p = 0.0244), total cholesterol (r = -0.1958; p = 0.0054), LDL cholesterol (r = -0.1708; p = 0.0156) and systolic blood pressure (r = -0.1523; p = 0.0313) correlated significantly and inversely with the left ABI. The frequency of diabetic retinopathy differed significant (p = 0.0316) between the two groups (pathological vs normal ABI), and was higher in the group with a pathological ABI. Conclusions. The data collected reveal a high prevalence of PAD in patients with T2DM, consistently with studies conducted in other countries. The CPS confirmed that patients with a pathological ABI have tendency to a higher CV risk. Overall, the present results point to the importance of an accurate CV assessment – also measuring individuals’ ABI and calculating their CPS - to better pinpoint those at high risk of PAD, especially among patients with T2DM.