Abstract
BackgroundEndothelial dysfunction is an early marker of cardiovascular disease so endothelial and arterial stiffness indexes are good indicators of vascular health. We aimed to assess whether the presence of diabetic foot is associated with arterial stiffness and endothelial function impairment.MethodsWe studied 50 subjects with type 2 diabetes mellitus and diabetic foot syndrome (DFS) compared to 50 diabetic subjects without diabetic foot, and 53 patients without diabetes mellitus, by means of the mini mental state examination (MMSE) administered to evaluate cognitive performance. Carotid-femoral pulse wave velocity (PWV) and augmentation index (Aix) were also evaluated by Applanation tonometry (SphygmoCor version 7.1), and the RH-PAT data were digitally analyzed online by Endo-PAT2000 using reactive hyperemia index (RHI) values.ResultsIn comparison to diabetic subjects without diabetic foot the subjects with diabetic foot had higher mean values of PWV, lower mean values of RHI, and lower mean MMSE. At multinomial logistic regression PWV and RHI were significantly associated with diabetic foot presence, whereas ROC curve analysis had good sensitivity and specificity in arterial PWV and RHI for diabetic foot presence.ConclusionsPulse wave velocity and augmentation index, mean RHI values, and mean MMSE were effective indicators of diabetic foot. Future research could address these issues by means of longitudinal studies to evaluate cardiovascular event incidence in relation to arterial stiffness, endothelial and cognitive markers.
Highlights
Endothelial dysfunction is an early marker of cardiovascular disease so endothelial and arterial stiffness indexes are good indicators of vascular health
We recruited all subjects with type 2 diabetes mellitus and foot ulceration referred to the Diabetic Foot Intervention Clinical Group of Policlinico “P. Giaccone” Hospital of the University of Palermo, Italy from September 2014 to December 2015; we recruited diabetic subjects without diabetic foot admitted from September 2014 to December 2015 for every condition related to diabetic disease in the U.O.C di Medicina Interna con Stroke Care of University Policlinico “P. Giaccone” Hospital of Palermo, and consecutive patients without diabetes mellitus admitted to our wards for causes other than diabetic foot and acute cardiovascular events between 2013 and 2015
Katakami et al [25] recently showed that evaluation of baPWV, in addition to carotid intima-media thickness (IMT) and conventional risk factors, improved the ability to identify the diabetic individuals with high risk for CVE, whereas very recently Gomez-Marcos et al [26] analyzed the relationship between cardio ankle vascular index (CAVI), a new index of the overall stiffness, and target organ damage (TOD), vascular structure and function, and cardiovascular risk factors in Caucasian patients with type 2 diabetes mellitus or metabolic syndrome, suggesting that CAVI is positively associated with IMT, cf-pulse wave velocity (PWV), ba-PWV, CAIx, and PAIx, regardless of cardiovascular risk and the drug treatment used
Summary
Endothelial dysfunction is an early marker of cardiovascular disease so endothelial and arterial stiffness indexes are good indicators of vascular health. Recent studies [3,4,5] have highlighted the association between the occurrence of diabetic foot ulcer and microangiopathy complications, including albuminuria (Alb) and diabetic retinopathy (DR), underlying the pathogenic role of vascular disease in DFS pathogenesis [5,6,7,8,9,10,11]. Endothelial dysfunction is an early marker of vascular diseases, and methods of assessing endothelial function and arterial stiffness are available for clinical research confirming that endothelial function and arterial stiffness markers are surrogate cardiovascular markers [13]
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