Non-occlusive lower limbs arteriopathy in hypertensive type 2 diabetes: Should we get interested?

Abstract

Occlusive peripheral artery disease (OPAD) is a strong marker of cardiovascular events. Screening for PAD is recommended by all guidelines; however, there is no consensus on the benefit for detecting the non-occlusive stage of PAD (NOPAD). Therefore, when screening for OPAD, all patients with NOPAD are usually merged with those having normal arteries. WE aimed to assess the bio-clinical profile and morbidity related to diabetes complications in patients with NOPAD and to compare them to those with OPAD and with normal arteries at ultrasonography (UNA). In a cross-sectional, observational, prospective study with a sub-group analysis, we recruited 327 consecutive newly diagnosed type 2 diabetics, aged from 40 to 70 year from January 2009 to December 2014. We collected clinical, biological data and screened exhaustively for macro and microvascular complications. All patients had an Ankle-Brachial Index measurement and a duplex ultrasonography (DUS). The diagnosis of PAD was done on DUS. We considered as NOPAD the presence of atherosclerosis plaque and/or medial artery calcifications without stenosis. We selected the sub-group of hypertensive diabetics for analysis. Coronary risk was calculated by using the Framingham score. Among 327 newly diagnosed type 2 diabetics, 202 had hypertension, 129 women and 73 men; 12 patients had OPAD (5.9%), 111 had NOPAD (54.9%) and 79 had UNA (39.2%), aged respectively 54.8 ± 8.3, 57.1 ± 7.8 and 50.4 ± 7.9 years ( P < 10 −6 ). Arterial DUS showed both atherosclerosis and medial arterial calcifications in 90% in the PAD groups. We didn’t find significant difference between the three groups on smoking ( P = 0.824), body mass index ( P = 0.962), arterial blood pressure ( P = 0.058), glycemic status ( P = 0.975) and prevalence of metabolic syndrome ( P = 0.431). OPAD and NOPAD patients had higher LDL ( P = 0.005), higher coronary disease risk ( P = 10 −4 ), lower glomerular filtration rate ( P = 0.011) and significantly more chronic kidney disease ( P = 0.0009), coronary artery disease ( P = 0.008), atherothrombotic events ( P = 10 −4 ), peripheral diabetic neuropathy ( P = 0.024) and cognitive impairment ( P = 0.006) than those with UNA. No significant difference has been found while comparing the OPAD and NOPAD groups on all studied parameters except for cardiovascular events that are more prevalent in the OPAD group ( P = 0.009). Non-occlusive as well as occlusive PAD, is associated with a high cardiovascular morbidity when associated with type 2 diabetes and hypertension. A screening of NOPAD could help to risk stratification in hypertensive diabetics allowing them to benefit of an earlier preventive action on cardiovascular events. Clinicaltrials.gov ID: NCT02002091