Lower Ankle-brachial Pressure Index Research Articles

Echo Intensity of Gastrocnemius Is Independently Associated with 6-Minute Walking Distance in Male Patients with Peripheral Arterial Disease.

Background and Objectives: This study aimed to examine the differences in the thickness and echo intensity (EI) of the gastrocnemius muscle measured via ultrasonography between healthy adults and patients with peripheral arterial disease (PAD) and to determine the associations of gastrocnemius thickness (GT) and EI within a 6 min walking distance (6MD) in patients with PAD. Materials and Methods: This cross-sectional study targeted 35 male patients with PAD (mean age, 73.7 years; mean body mass index [BMI], 23.5 kg/m2) and age- and gender-matched 73 male healthy adults (mean age, 73.2 years; mean BMI, 23.3 kg/m2). The gastrocnemius thickness (GT) and EI were measured using ultrasound. Both legs of patients with PAD were classified based on higher and lower ankle brachial pressure index (ABI), and the GTs and EIs with higher and lower ABI were compared with those of healthy adults. Multiple regression analysis incorporated 6MD as a dependent variable and each GT and EI with higher and lower ABI, age, and BMI as independent variables. Results: This study showed that GT was considerably greater in healthy adults than in both legs with higher and lower ABI (median values, 13.3 vs. 11.3 vs. 10.7, p < 0.01), whereas EI was lower in healthy adults than in the lower ABI leg (72.0 vs. 80.8 vs. 83.6, p < 0.05). The 6MD was shown to be substantially related to EI in both legs with higher and lower ABIs (p < 0.01) but not in the GT. Conclusions: In patients with PAD, the GT was lower, and EI was higher than in healthy adults. In addition, EIs in both legs with higher and lower ABIs were independently associated with 6MD in male PAD patients. This study showed that the EI measured via ultrasonography could become an important indicator for treatments for patients with PAD.

Association of ankle-brachial index with cognitive decline in patients with lacunar infarction.

Atherosclerosis is an important risk factor for cognitive decline. This study aimed to investigate the relationship of ankle-brachial pressure index (ABI) and brachial-ankle pulse wave velocity (baPWV) with cognitive function in patients with lacunar infarction. We included records of consecutive patients with their first-ever acute stroke and a diagnosis of lacunar infarction through magnetic resonance imaging (MRI) from July 1, 2011 to December 31, 2018. We excluded patients diagnosed with dementia, including strategic single-infarct dementia, before or after stroke onset. Moreover, we excluded patients with one or more microbleeds, severe white matter lesions, or severe medial temporal atrophy on MRI. For ABI, we used the lower ankle side and divided the results into ABI < 1.0 and ABI ≥ 1.0. For baPWV, we used the higher ankle side and divided the results into two groups based on the median value of the participants. We analyzed 176 patients with stroke (age 72.5 ± 11.4 years, 67 females). The median score on the Mini-Mental State Examination (MMSE) was 27. The number of patients with ABI < 1.0 was 19 (10.8%). Univariate analysis revealed that the MMSE score was associated with age, body mass index, education, chronic kidney disease, periventricular hyperintensity, and ABI < 1.0 (p < 0.10), but not baPWV. Multivariate analysis revealed that body mass index (p = 0.039) and ABI < 1.0 (p = 0.015) were independently associated with the MMSE score. For patients with lacunar infarction, a lower ABI, but not a higher PWV, was associated with cognitive decline.

Influence of Microalbuminuria on Long-Term Survival and Cardiovascular or Limb Events in Peripheral Arterial Disease.

Objective: This study aimed to examine the relationship between microalbuminuria and long-term life expectancy or limb events in patients with peripheral arterial disease (PAD).Materials and Methods: A prospective cohort study was performed in 714 patients with PAD. The primary outcomes were cardiovascular or cerebrovascular death (CCVD) and all-cause death (AD), and secondary outcomes were major adverse cardiovascular events (MACE) and cardiovascular and/or limb events (CVLE).Results: The 5, 10, and 15 year survival rates were 82.4%, 53.1%, and 33.0%, respectively. The prevalence of patients with increased microalbuminuria was 39.2%. Higher microalbuminuria, age, C-reactive protein (CRP), lower serum albumin, estimated glomerular filtration rate (eGFR), ankle–brachial pressure index (ABI), diabetes, cerebral infarction, and coronary heart disease (CHD) were associated with CCVD; higher microalbuminuria, age, CRP, D-dimer, lower serum albumin, eGFR, and critical limb ischemia were related to AD; higher microalbuminuria, age, CRP, lower serum albumin, ABI, diabetes, and CHD were related to MACE; higher microalbuminuria, age, lower ABI, cerebral infarction, and CHD were related to CVLE in Cox multivariate analyses (p<0.05). Statins reduced CCVD, AD, MACE, and CVLE (p<0.001).Conclusion: Higher microalbuminuria was a significant predictor for CCVD, AD, MACE, and CVLE in PAD patients.

Cohort study examining the relationship between remoteness and requirement for surgery to treat peripheral artery disease at a tertiary hospital in North Queensland

To assess whether outcomes of peripheral artery disease (PAD) were related to remoteness from the treating tertiary vascular centre. Participants with a variety of types of occlusive and aneurysmal diseases were recruited from a tertiary hospital in North Queensland, Australia. Remoteness was assessed by residence outside Townsville and estimated distance to the vascular centre. Cox proportional hazard analyses were used to examine the association of remoteness with outcome. Cohort study. The primary outcome was requirement for surgery to treat PAD. Secondary outcomes were major adverse cardiovascular events (MACE) and all-cause mortality. Of 2487 patients recruited, 1274 (51.2%) had at least one PAD surgery, 720 (29.0%) at least one MACE, and 909 (36.6%) died during a median of 4.2 (inter-quartile range 1.3-7.7) years. Compared to Townsville residents (n=1287), those resident outside Townsville (n=1200) had higher rates of PAD surgery (hazard ratio, HR 1.55, 95% confidence intervals, CI, 1.39, 1.73) but no increased risk of MACE (HR 1.00, 95% CI 0.86, 1.16) or death (HR 1.03, 95% CI 0.90, 1.17). This association was attenuated when adjusting for distance from the vascular centre (HR 1.31, 95% CI 1.14, 1.51). Patients in the highest quartile of distance presented with lower ankle-brachial pressure index, more severe carotid artery disease and larger aortic diameter. People with PAD in North Queensland residing furthest from the tertiary hospital presented with more severe artery disease and had greater rates of PAD surgery.

Peripheral vascular changes in the lower limbs following cocaine abuse

Background: Worldwide, substance use disorder is on the rise, especially amongst the young generation. Although cocaine-induced cardiovascular and cerebrovascular events are well documented, knowledge about the relationship of cocaine use and its effect on arterial perfusion in the lower limbs is scarce.Objective: This study sought to investigate the relationship between cocaine use and peripheral arterial disease.Methods: The study population comprised 30 subjects’ dependent on cocaine, smoking and alcohol [Group A] and another 30 subjects dependent on smoking and alcohol only [Group B]. A comprehensive lower limb vascular assessment was conducted utilizing pulse palpation, Doppler spectral waveform analysis, Ankle brachial pressure index (ABPI) and Toe brachial pressure index (TBPI) to determine the arterial perfusion status in the lower limbs.Results: Group A had lower ABPIs and TBPIs than Group B suggesting poorer vascular perfusion in lower limbs. Furthermore, a larger percentage of Group A had monophasic/continuous waveforms of all three pedal pulses compared to Group B. Conversely there was a higher percentage in Group B with biphasic/triphasic waveforms compared to Group A implying better vascular perfusion.Conclusion: In this study, cocaine use was associated with diminished arterial perfusion of the lower limbs suggesting that cocaine use has the potential to increase the risk of peripheral arterial disease. Regular vascular foot screening is warranted if foot complications are to be avoided.

CT-perfusion in peripheral arterial disease - Correlation with angiographic and hemodynamic parameters.

ObjectiveThe purpose of this study was the assessment of volumetric CT-perfusion (CTP) of the lower leg musculature in patients with symptomatic peripheral arterial disease (PAD) of the lower extremities, comparing it with established angiographic and hemodynamic parameters.Materials and methodsThirty-five consecutive patients with symptomatic PAD of the lower extremities requiring interventional revascularization were assessed prospectively. All patients underwent a CTP scan of the lower leg, and hemodynamic and angiographic assessment. Hemodynamic parameters, specifically ankle-brachial pressure index (ABI), ankle blood pressure (ABP), peak systolic velocity (PSV), and segmental pulse oscillography (SPO) level, were determined. Lesion length and degree of collateralization were assessed by interventional angiography. CTP parameters were calculated with a perfusion software, acting on a no outflow assumption. A sequential two-compartment model was used. Differences in CTP parameters and correlations between CTP, hemodynamic and angiographic parameters were assessed with non-parametric tests.ResultsThe cohort consisted of 27 subjects with an occlusion, and eight with a high-grade stenosis. The mean blood flow (BF) was 7.71 ± 2.96 ml/100ml*min-1, mean blood volume (BV) 0.71 ± 0.33 ml/100ml, and mean mean transit time (MTT) 7.22 ± 2.66 s. BF and BV were higher in subjects with longer lesions, and BV was higher in subjects with lower ABI. Significant correlations were found between lesion length and BV (r = 0.65) and BF (r = 0.52). Significant inverse correlations were found between BV and ABI and between BV and ABP (r = -0.56, for both correlations).ConclusionsIn our study, we have shown the feasibility of CTP for the assessment of PAD. In the future, this quantitative method might serve as a non-invasive method, possibly complementing the diagnostic workup of patients with peripheral arterial disease.

Comparison of non-traditional biomarkers, and combinations of biomarkers, for vascular risk prediction in people with type 2 diabetes: The Edinburgh Type 2 Diabetes Study

Background and aimsWe aimed at comparing the impact of multiple non-traditional biomarkers (ankle brachial pressure index (ABI), N-terminal pro-brain natriuretic peptide (NT-proBNP), high sensitivity cardiac troponin (hs-cTnT), gamma-glutamyl transpeptidase (GGT) and four markers of systemic inflammation), both individually and in combination, on cardiovascular risk prediction, over and above traditional risk factors incorporated in the QRISK2 score, in older people with type 2 diabetes. MethodsWe conducted a prospective study of 1066 men and women aged 60–75 years with type 2 diabetes mellitus, living in Lothian, Scotland. ResultsAfter 8 years, 205 cardiovascular events occurred. Higher levels of hs-cTNT and NT-proBNP and lower ABI at baseline were associated with increased risk of CV events, independently of traditional risk factors (basic model). The C statistic of 0.722 (95% CI 0.681, 0.763) for the basic model increased on addition of individual biomarkers, most markedly for hs-cTnT (0.732; 0.690, 0.774)). Models including different combinations of biomarkers had even greater C statistics, with the highest for ABI, hs-cTnT and GGT combined (0.740; 0.699, 0.781). ConclusionsIndividually, hs-cTnT appeared to be the most promising biomarker in terms of improving vascular risk prediction in people with type 2 diabetes, over and above traditional risk factors incorporated in the QRISK2 score. Combining several non-traditional biomarkers added further predictive value, and this approach merits further investigation when developing cost effective risk prediction tools for use in clinical practice.

Adiposity Indices and Ankle Brachial Index as Cardiovascular Risk Prediction Tool in Acute Myocardial Infarction

Obesity associated lipid peroxidation is thought to play a crucial role in the generation of atherosclerotic lesions of acute myocardial infarction (AMI). The ankle-brachial pressure index (ABI), an easily accessible, inexpensive bedside test can be a significant tool to assess the vascular risk in symptomatic and asymptomatic cardiovascular patients. The study assessed the anthropometric indices of obesity and the oxidative stress profile in acute myocardial infarction patients and compared the finding with control subjects. In this cross-sectional study, 200 subjects (AMI:120; Controls: 80) were included. The lipid profile and all other routine laboratory investigations including the cardiac biomarkers were performed. Obesity indices such as body mass index (BMI), waist to hip ratio (WHR), atherogenic index (AI), and conicity index (CI) were recorded using appropriate formulae. Antioxidant status was determined by measuring the serum levels of glutathione peroxidase (GPx), catalase and superoxide dismutase (SOD), and the total antioxidant capacity (TAC). Estimation of malondialdehyde (MDA), a marker of lipid peroxidation was used as a surrogate marker of free radical activity. Atherosclerotic changes were assessed by the ankle brachial index (ABI). The antioxidant enzymes GPx, catalase and SOD were significantly decreased (p < 0.05) and MDA levels were found to be significantly increased in AMI patients compared to controls. The obesity indices showed a negative correlation with the antioxidant enzymes and a positive correlation with the MDA levels, with WHR and AI showing a significantly strong correlation. The frequency of patients with lower ABI (≤ 0.9) was significantly higher in the AMI group as compared to the controls. In conclusion, obesity reflected by increased obesity indices, in particular waist to hip ratio, is an aggravating factor that disrupts the oxidant-antioxidant balance leading to enhanced oxidative stress. ABI calculation would be able to identify more patients at high risk, and as such, it should be considered routine investigation for cardiovascular risk prediction.

Association between estimated glomerular filtration rate and peripheral arterial disease

BackgroundChronic kidney disease (CKD) is an evolving paradigm for the risk assessment of cardiovascular diseases. We hypothesized that an advanced stage of CKD may predict the presence of peripheral arterial disease (PAD). MethodsScreening for PAD by an ankle-brachial pressure index (ABI) ≤0.9 was conducted in a consecutive series of 583 subjects (mean age 68.1±12.9 years, 411 men). Levels of estimated glomerular filtration rate (eGFR) and factors associated with the presence of PAD were examined. ResultsSixty patients (10.3%) had PAD and 192 patients (32.9%) had eGFR <60mL/min/1.73m2 among all subjects. In patients with an advanced stage of CKD (stage ≥3, equivalent to eGFR <60mL/min/1.73m2), high prevalence of PAD (17.2%) and lower ABI levels (1.04±0.18) were observed. Univariate analyses revealed that PAD was associated with an advanced stage of CKD [odds ratio (OR) 1.850, 95% confidence interval (CI) 1.322–2.588, p<0.001], as well as age, male gender, systolic blood pressure, and hemoglobin A1c. Multivariate logistic regression analyses revealed that PAD was independently predicted by the CKD stages (OR 1.498, 95% CI 1.011–2.220, p=0.044, adjusted for covariates). ConclusionsAn advanced stage of CKD is independently and significantly associated with the presence of PAD. Targeted screening with ABI measurement can be beneficial in patients with CKD.

Metabolic Syndrome, Wall Motion Score and Infarct Size after AMI

The infarct size is an important marker for early and late mortality after acute myocardial infarction [1,2]. The metabolic syndrome (MetS) is interrelated atherosclerotic risk factors including insulin resistance, hypertension, a low level of high-density lipoprotein (HDL) cholesterol, a high triglyceride level, a high plasma glucose concentration, central obesity, and the increased number of components of the metabolic syndrome is associated with a higher mean carotid intima media thickness, lower ankle brachial pressure index in patients with coronary heart disease, peripheral arterial disease, or abdominal aortic aneurysm [3-5].

A longitudinal study of ankle brachial pressure indices in a cohort of patients with systemic sclerosis.

Digital ischaemia, often progressing beyond RP to digital ulceration and sometimes even gangrene, is the most common vascular manifestation of SSc. Both microvascular and macrovascular disease can contribute and coexistence of microvascular and macrovascular (proximal vessel) disease in patients with SSc is potentially limb threatening. The aims of this study were to examine the change over time in the ankle brachial pressure index (ABPI) in a cohort of patients with SSc and to examine whether age, gender, smoking status, disease duration, disease subtype and ACA are associated with ABPI. The clinical and laboratory data of 217 patients attending the SSc clinic at a tertiary referral centre and who had their ABPIs checked between 1996 and 2011 were reviewed retrospectively. Data were analysed to see how the ABPI changed with time and linear mixed effects modelling was used to determine which factors were associated with ABPI. In most patients with SSc, the ABPI remained constant over time [median rate of change 0 units/year, interquartile range (IQR) -0.01-0.01]. There was a significant association between lower ABPI and increasing age (P = 0.04), the limited cutaneous subtype of SSc (P = 0.01) and ACA positivity (P = 0.03). Additionally there was an association between ABPI and smoking status of borderline statistical significance (P = 0.08). This study provides further evidence for associations between the severity of vascular disease in patients with SSc and increasing age, smoking, limited cutaneous disease and positive ACA. Reassuringly, in most patients ABPI remains stable over time.

Ankle-Brachial Pressure Index and Pulse Wave Velocity as Markers of White Matter Hyperintensities and Cognitive Impairment

Vascular disease is associated with cognitive impairment. White matter hyperintensities (WMHs), as detected by brain magnetic resonance imaging (MRI), are associated with cognitive impairment and considered to be a marker of cerebral microvascular abnormality. Ankle-brachial pressure index (ABI) and pulse wave velocity (PWV) are noninvasive methods to assess blockage and stiffness in peripheral arteries, respectively. We investigated the associations of ABI and PWV with WMHs and cognition. We included 242 subjects representing 56 controls, 75 patients with mild cognitive impairment, and 111 patients with Alzheimer’s disease. We assessed brachial-ankle PWV (baPWV), ABI, general cognitive status with the Korean Mini-Mental State Examination (K-MMSE), and WMHs with brain MRI. The mean age of subjects correlated with values of baPWV (r=0.432, p<0.001) and ABI (r=-0.192, p=0.002). Among vascular risk factors, baPWV was positively associated with the presence of intracerebral artery stenosis (r=0.102, p=0.028) and ABI was negatively correlated with the presence of hypertension (r=-0.150, p=0.017) and smoking (r=-0.176, p=0.005), independent of age. After adjusting for age and vascular risk factors, baPWV was associated with WMHs (r=0.192, p=0.002), and ABI was associated with the K-MMSE score (r=0.14, p=0.028). There was no association of ABI with WMHs and of baPWV with K-MMSE. An increased baPWV was associated with the severity of WMHs, and a lower ABI was associated with cognitive impairment. Management of peripheral vascular disease may help prevent the progression of WMHs or cognitive decline.

Peripheral arterial disease in patients with systemic lupus erythematosus: a prospective controlled study.

The aim of our study was to: (i) map out the presence of peripheral vascular disease in a sample of systemic lupus erythematosus (SLE) patients; and (ii) correlate our findings with disease characteristics, activity indices, traditional risk factors of atherosclerosis and thrombotic variables. The study population comprised 120 SLE patients and 100 controls. Clinical data were collected for patients and controls with stress on clinical issues of SLE patients, including British Isles Lupus Assessment Group index score, anti-double stranded DNA titer C3 and C4 levels, and treatment taken, mainly steroids. Measurements of thrombotic variables were performed. Non-invasive arterial assessment was performed, including carotid duplex scanning and measurement of carotid artery intima-media thickness (IMT) and peripheral arterial assessment and measurement of ankle-brachial pressure index (ABPI). The mean age of SLE patients was 32years and mean disease duration was 8years. There were no statistically significant differences in the traditional vascular risk factors measured between SLE patients and controls. There were significantly higher plasma levels of thrombotic variables in SLE patients. The average IMT was statistically significantly greater in SLE patients compared to controls. Thirty SLE patients (25%) had an ABPI <1.0 compared with six controls (6%), which was statistically significant. This study showed an increased prevalence of peripheral arterial disease in SLE patients as shown by the higher carotid artery IMT and lower ABPI in such patients compared with controls. Multiple risk factors are likely to be involved in such findings.

Measurment of Ankle-Brachial Pressure Index, Homocystein Level, and Evaluation of Coronary Artery Disease Association with Other Macrovascular Diseases in Patients with Myocardial Infarction

We aimed to measure ankle-brachial pressure index (ABPI) and homocysteine levels, and to evaluate frequency of cerebrovascular disease (CVD) and/or peripheral arterial disease (PAD) combination of patients with myocardial infarction (MI). 39 patients (26 males, 13 females) with acute or subacute MI and 36 control cases (9 male, 27 female) were included in the study. ABPI and homocysteine levels were measured, and bilateral carotid-vertebral and bilateral lower extremity arterial Doppler ultrasonography, and coronary angiography were examined. Homocysteine was significantly higher in patient group than control group (p=0.0001). The ABPI was not significantly different in two groups (p=0.428). However the frequency of patients with lower ABPI (≤0.9) was significantly higher compared to the frequency of control patients with lower ABPI (25.6% and 3%, respectively; p=0.02). The combination of the atherosclerotic findings in the carotid artery and coronary artery disease (CAD) were found significantly higher compared to that of the bilateral lower extremity (59%, 25.6%). Screening of CVD should be done in patients with MI history. Determining carotid arterial lesions may be useful for the early diagnosis and treatment of any possible CVD in cases with CAD. Studies with larger numbers of cases are needed.

Risk factors for lower extremity amputation in diabetic foot disease categorized by Wagner classification

AimsTo elucidate the risk factors for lower extremity amputation (LEA) in patients of diabetic foot disease with different Wagner gradings. MethodsThis study was conducted in a multidisciplinary diabetic foot care center. Demographic characteristics, laboratory data, disease history, ankle brachial pressure index (ABI) and Wagner classification were considered as independent variables to predict the therapeutic outcome (major LEA, minor LEA, and non-amputation). Risk factors for LEA in different Wagner grades were further analyzed. Multivariate stepwise ordinal logistic regression was performed. ResultsOf 789 study subjects, 19.9% received major LEA and 22.9% received minor LEA. Higher Wagner grade, lower ABI, serum albumin and hemoglobin, and elevated white blood cell (WBC) count were significantly associated with an increased risk of LEA. When stratified by Wagner classification, most of the above predictors and estimated glomerular filtration (eGFR) were detected only in grade 3. While in grades 2 and 4, WBC count was identified as primary predictor positively associated with an increased risk of LEA. ConclusionsWagner classification remarkably influenced the potential risk factors for LEA, showing different predictors in different grades. The traditionally recognized predictors for diabetic foot amputation such as lower ABI, albumin or eGFR were almost exclusively found in patients with Wagner grade 3.

Ankle brachial pressure index as a marker of apathy in a community-dwelling population

Apathy is defined as a lack of interest or emotion. Several studies have shown the relationship between apathy and atherosclerotic change in poststroke patients. Although apathy is confused with depression, it might be a specific neuropsychiatric syndrome separate from depression. To clarify the relationship between atherosclerotic change and apathy in a community-dwelling population, which does not include the psychologic factors associated with stroke events. The ankle brachial pressure index (ABI) was measured using a volume-plethymographic apparatus in 860 volunteers (315 males and 545 females) who participated in the Iwaki Health Promotion Project 2008. Starkstein's apathy score and the Center for Epidemiologic Studies Depression Scale (CES-D) were used to assess the psychologic status. The association between the ABI and apathy was assessed by a multiple linear regression analysis. Gender and low-density lipoprotein (LDL)-cholesterol were independently and significantly associated with the CES-D score. We did not find any association between CES-D score and the ABI. In addition, the extent of education and the ABI were independently and significantly associated with the apathy scale (AS). In a community-dwelling population, a lower ABI score was an independent risk factor for a higher AS score, but not for a higher CES-D score. Apathy and depression may have different etiologies in vascular factors.

Smoking-Related Changes in Cerebral Perfusion in a Population of Elderly Men

Aim: Smoking and hypertension are known causes of stroke and dementia. This study was designed to test the longitudinal effect of lifestyle factors and hypertension on cerebral blood flow (CBF) in old age. Method: A study of an unselected population cohort of 703 men, born in 1914, has been in progress since 1968 and the last clinical examination occurred at age 69. CBF was examined in 129 survivors who reached 82 years, using SPECT. Results: At the age of 69, the study subjects consisted of 36 smokers, 37 nonsmokers and 56 former smokers who had quit. Fourteen years later, there were no differences in CBF among them. The cohort was stratified into 69 hypertensive and 60 normotensive men. CBF in normotensives was lowest in smokers and highest in nonsmokers. No CBF differences were observed in hypertensive men regarding smoking, but their CBF was as low as in normotensive smokers. Hypertensives had a higher BMI, and higher blood glucose and triglyceride levels, but lower alcohol consumption at 69 and a lower ankle-brachial pressure index at 82 years. Alcohol consumption was highest in normotensive smokers. Conclusion: Smoking and high alcohol consumption in normotensive men are correlated to low CBF in senescence. Low CBF in hypertensive men regardless of smoking may be due to a high vascular risk profile.

Key role of insulin resistance in vascular injury among hemodialysis patients

Insulin resistance prevails not only among diabetic patients but also among hypertensive and obese patients. The relationship between insulin resistance and cardiovascular diseases was investigated in hemodialysis (HD) patients. Eighty-one maintenance HD patients were enrolled. The homeostasis model assessment of insulin resistance (HOMA-IR) method was used to assess insulin resistance. The relationship of HOMA-IR with cardiovascular and all-cause events was assessed. Compared with nondiabetic patients (n = 55), diabetic patients (n = 26) showed higher HOMA-IR (2.5 ± 0.3 vs 1.4 ± 0.2, P < .05), lower ankle-brachial pressure index (ABI, 0.85 ± 0.09 vs 1.12 ± 0.02, P < .01), and shorter HD duration (3 ± 1 vs 9 ± 1 years, P < .01), although their body mass index was similar (22.3 ± 0.5 vs 21.5 ± 0.4 kg/m 2). Nondiabetic patients taking angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (n = 36) had lower HOMA-IR (1.2 ± 0.2 vs 1.8 ± 0.4, P < .05) and higher ABI (1.18 ± 0.02 vs 1.02 ± 0.05, P < .01) than those without (n = 17). Cardiovascular events were less common in HD patients with normal HOMA-IR ( P < .05) or ABI ( P < .01). Our data indicate that 69% of diabetic and 27% of nondiabetic patients have HOMA-IR greater than 1.6, implying reduced insulin sensitivity in HD patients. The present results provide evidence that angiotensin inhibition improves insulin resistance, possibly preventing vascular injury in HD patients. Finally, our findings suggest that insulin resistance is prognostic of cardiovascular events in HD patients.

Metabolic syndrome increases the risk of significant coronary artery involvement in patients with peripheral artery disease

Peripheral artery disease is a common condition, mainly associated with clinical cardiovascular risk factors. Patients with peripheral artery disease suffer from coronary artery disease-related complications. On the other hand, metabolic syndrome, as a constellation of specific risk factors, represents a risk factor for cardiovascular mortality. Metabolic syndrome might increase the risk of significant coronary artery disease in patients with peripheral artery disease. We aimed to examine the association of metabolic syndrome with the angiographically shown coronary artery involvement in patients with peripheral artery disease. Two hundred and forty-seven patients with peripheral artery disease (mean age 60+/-9.5 years, 223 men/24 women), who were referred to coronary angiography, were evaluated. The resting ankle-brachial pressure index was measured with the patient in supine position. Patients with >70% diameter stenosis were considered to have significant coronary artery disease. In all, there were 223 male/24 female patients with mean ankle-brachial pressure index of 0.7+/-0.2, and mean age of 60+/-9.5 years. Metabolic syndrome was present in 53% (n=131) of all patients. Significant coronary artery disease was more frequently encountered in patients with peripheral artery disease and metabolic syndrome than in those without metabolic syndrome (73.3 vs. 40.5%, P<0.001). The presence of metabolic syndrome increased the risk of having significant coronary artery disease in patients with peripheral artery disease by 4.027 fold. Lower ankle-brachial pressure index (P=0.038, B=2.567), older age (P<0.001, B=1.075), presence of metabolic syndrome (P=0.015, B=2.247), and presence of diabetes mellitus (P<0.001, B=1.293) were found to be independent predictors of significant coronary artery disease in patients with peripheral artery disease in multivariable regression. Metabolic syndrome seems to increase the risk of significant coronary artery disease in patients with peripheral artery disease.

Ankle brachial pressure index and carotid intima-media thickness as atherosclerosis markers in Japanese diabetics

The aim of this study was to assess the clinical significance of ankle brachial pressure index (ABI) and carotid intima-media thickness (IMT) in Japanese patients with type 2 diabetes. ABI and ultrasonographic carotid IMT measurements were made in 1311 patients and the relationships between ABI, IMT, and cardiovascular diseases were examined. Patients were assigned to one of three groups depending on their ABI index: (i) ABI ≥ 1.0; (ii) ABI from ≥0.9 to <1.0; and (iii) ABI < 0.9. The odds ratios (ORs) for groups (ii) and (iii) compared with (i) for the prevalence of coronary heart disease (CHD), cerebrovascular disorder (CVD), and carotid atherosclerosis (mean carotid IMT ≥ 1.1 mm) demonstrated that these conditions were inversely related to ABI. As the combined ABI/carotid IMT score increased, each OR for the prevalence of CHD and CVD increased significantly. This suggests that a lower ABI is associated with generalized atherosclerosis. Measurements of the ABI and carotid IMT might provide a good prognostic indicator, and both should be assessed during screening for atherosclerosis in Japanese patients with type 2 diabetes.