Factor Associated with Abnormal Ankle-Brachial Index Among Diabetic Patients in Songklanagarind Hospital: A Retrospective Cohort Study
Keywords:ankle-brachial index, diabetic patients
Objective: To find the correlation between type 2 diabetic patients who had abnormal ankle-brachial index (ABI) among factors affected diabetes and cardiovascular outcomes including acute coronary syndrome (ACS), myocardial infarction (MI), coronary revascularization stroke, renal replacement therapy, leg revascularization and limb amputation
Material and Methods: Retrospective cohort study collecting the data of 548 diabetic patients examined ABI at Outpatient Departments from 1st January 2009 to 31st December 2015.
Results: From 548 medical records including only normal-ABI group and low-ABI group, we found that hypertension, chronic kidney disease (CKD), smoking, history of previous MI, history of previous stroke and age were the significant associated factor of low-ABI. The survival analyses revealed the significantly higher rate of ACS, MI, and coronary revascularization in low-ABI group (p-value=0.04, <0.01, <0.01 respectively) after exposed to low-ABI around 4 years. However, the study found no significant difference of other outcomes between the 2 groups.
Conclusion: Songklanagarind’s diabetic patients with low-ABI were associated with the significantly higher rate of multiple cardiovascular risk factors including hypertension, CKD, smoking, history of previous MI, history of previous stroke and age and they tend to significantly experience more ACS, MI and coronary revascularization after 4 years exposed to low-ABI.
2. American Diabetes Association. Microvascular complication and foot care. Diabetes Care 2016;39(Suppl 1):S72-9.
3. Aboyans V, Criqui MH, Abraham P, Allison MA, Creager MA, Diehm C, et al. Measurement and interpretation of the ankle brachial index: a scientific statement from the American Heart Association. Circulation 2012;126:2895-909.
4. Dormandy JA, Betteridge DJ, Schernthaner G, Pirags V, Norgren L. Impact of peripheral arterial disease in patients with diabetes results from PROactive (PROactive 11). Atherosclerosis 2009; 202:272–81.
5. Selvin E, Erlinger TP. Prevalence of and risk factors for peripheral arterial disease in the United States: results from the National Health and Nutrition Examination Survey. Circulation 110:2004;738–43.
6. Jessadapattarakun S, Chadchavalpanichaya N. The prevalence of asymptomatic peripheral arterial disease in diabetic patients at Siriraj Hospital. J Thai Rehabil Med 2016;26:54-60.
7. Ix JH, Biggs ML, Kizer JR, Mukamal KJ, Djousse L, Sieman SJ, et al. Association of body mass index with peripheral arterial disease in older adults: the cardiovascular health study. Am J Epidemiol 2011;174:1036-43.
8. Muntner P, Wildman RP, Reynolds K, DeSalvo KB, Chen J, Fonseca V. Relationship between HbA1c level and peripheral arterial disease. Diabetes Care 2005;28:1981-7.
9. Thai Hypertension Society. Thai guidelines on the treatment of hypertension. Bangkok: The Society; 2015.
10. Newman AB, Siscovick DS, Manolio TA, Polak J, Fried LP, Borhani NO, et al. Ankle-arm index as a marker of athero sclerosis in the Cardiovascular Health Study. Cardiovascular Heart Study (CHS) Collaborative Research Group. Circulation 1993;88:837–45.
11. Mostaza JM, Suarez C, Manzano L, Cairols M, Garcia-Iglesias F, Sanchez-Alvarez J, et al. Relationship between ankle brachial index and chronic kidney disease in hypertensive patients with no known cardiovascular disease. J Am Soc Nephrol 2006;17(12 Suppl 3):S201–5.