Peripheral Vascular Disease In Type Research Articles

Predictive model and risk analysis for peripheral vascular disease in type 2 diabetes mellitus patients using machine learning and shapley additive explanation.

Peripheral vascular disease (PVD) is a common complication in patients with type 2 diabetes mellitus (T2DM). Early detection or prediction the risk of developing PVD is important for clinical decision-making. This study aims to establish and validate PVD risk prediction models and perform risk factor analysis for PVD in patients with T2DM using machine learning and Shapley Additive Explanation(SHAP) based on electronic health records. We retrospectively analyzed the data from 4,372 inpatients with diabetes in a hospital between January 1, 2021, and March 28, 2023. The data comprised demographic characteristics, discharge diagnoses and biochemical index test results. After data preprocessing and feature selection using Recursive Feature Elimination(RFE), the dataset was split into training and testing sets at a ratio of 8:2, with the Synthetic Minority Over-sampling Technique(SMOTE) employed to balance the training set. Six machine learning(ML) algorithms, including decision tree (DT), logistic regression (LR), random forest (RF), support vector machine(SVM),extreme gradient boosting (XGBoost) and Adaptive Boosting(AdaBoost) were applied to construct PVD prediction models. A grid search with 10-fold cross-validation was conducted to optimize the hyperparameters. Metrics such as accuracy, precision, recall, F1-score, G-mean, and the area under the receiver operating characteristic curve (AUC) assessed the models' effectiveness. The SHAP method interpreted the best-performing model. RFE identified the optimal 12 predictors. The XGBoost model outperformed other five ML models, with an AUC of 0.945, G-mean of 0.843, accuracy of 0.890, precision of 0.930, recall of 0.927, and F1-score of 0.928. The feature importance of ML models and SHAP results indicated that Hemoglobin (Hb), age, total bile acids (TBA) and lipoprotein(a)(LP-a) are the top four important risk factors for PVD in T2DM. The machine learning approach successfully developed a PVD risk prediction model with good performance. The model identified the factors associated with PVD and offered physicians an intuitive understanding on the impact of key features in the model.

The effect of 12 weeks aerobic, resistance and combined trainings on peripheral vascular disease in type 2 diabetes with peripheral neuropathy in men

Type 2 diabetes is caused by more complications. One complication that occurs in some cases is peripheral vascular disease. Early diagnosis is very important to assess peripheral vascular disease. 44 men with type 2 diabetes were randomly divided into four groups of aerobic, resistance, combined and control. Intensity of aerobic exercise was 70–75 percent of maximum heart rate for 25–45 min, Resistance training consists of two to three sets with 8–12 repetitions and combined training consists of both aerobic and resistance training, three times a week for 12 weeks. Ankle brachial index (ABI) measurements and blood samples were analyzed before and after intervention. The collected data were analyzed using ANOVA. The resistance and combined training groups showed a significant increase in the left ABI compared to pretest (P < 0.05) Also, the aerobic and resistance training groups showed a significant increase in the right ABI compared to pretest (P < 0.05). The resistance training group was more effective than aerobic and combined training program in reduction the peripheral vascular disease.

To determine if digital pulse oximetry is an acceptable screening tool for asymptomatic peripheral vascular disease in type 2 diabetes mellitus: An observational study

Methods: The present analytical cross-sectional study was carried out among 80 patients of type 2 Diabetes Mellitus with asymptomatic PVD were included. The diagnostic accuracy of Ankle-Brachial Index (ABI) and pulse oximetry as a screening tool was compared against Color Doppler ultrasonography as the reference standard.

Comparative study of pulse oximetry and ankle-brachial index as a screening test for asymptomatic peripheral vascular disease in type 2 diabetes mellitus against color doppler ultrasonography as reference standard

Background: Currently about 35 million Indians are reported to suffer from diabetes mellitus, a significant proportion of whom are either undiagnosed or diagnosed but undertreated leading to poor glycemic control. This leads to accelerated development of macrovascular complications like Peripheral Vascular Disease (PVD). As most of the patients are asymptomatic, hence, early detection and treatment of PVD in patients with diabetes mellitus carries utmost importance.Methods: The present study was undertaken in SGRDIMSAR, Amritsar on 100 patients of type 2 Diabetes Mellitus with asymptomatic PVD. The diagnostic accuracy of Ankle-Brachial Index (ABI) and pulse oximetry as a screening tool was compared against Color Doppler ultrasonography as the reference standard.Results: The sensitivity, specificity, positive predictive value and negative predicted value of pulse oximetry to diagnose asymptomatic PVD in diabetics was found to be 98.31% (95% CI: 90.91-99.96), 41.46% (95% CI: 26.32- 57.89), 70.73% (95% CI: 65.08-75.81) and 94.44% (95%CI: 70.19-99.19) respectively. The sensitivity, specificity, positive predictive value and negative predicted value of ABI to diagnose asymptomatic PVD in diabetics was found to be 77.97% (95% CI: 65.27-87.71), 97.56% (95% CI: 87.14-99.94), 97.87% (95% CI: 86.85-99.69) and 75.47% (95% CI: 65.51-83.29) respectively.Conclusions: Pulse oximetry is better than ABI for the screening for asymptomatic PVD among diabetics. However, ABI is more accurate as compared to pulse oximetry in diagnosing asymptomatic PVD in diabetics.

Correlation of Ankle Brachial Index with Peripheral Vascular Disease in Type 2 Diabetes Mellitus

Objective : The aim of this study was to correlate ankle brachial index (ABI) with peripheral vascular disease (PVD) in type 2 diabetes mellitus . Material and methods : This was a hospital based interdisciplinary prospective study. A total of 100 patients in the age group of 30 to 80 years having peripheral vascular disease with predefined inclusion criteria were included in the study. Patients with other causes of raised blood sugar or peripheral vascular disease were excluded by relevant investigations. Ankle Brachial Index (ABI) was calculated using sphygmomanometer, and Colour Doppler Ultrasound (CDU) was used to diagnose PVD. Both the ABI method and the CDU method were compared for detecting PVD. Results : In our study, mean age was 60.04 ± 5.03 years, mean body mass index was 27.10 ± 2.67 kg/m2 and mean duration of diabetes was 7.75 ± 1.50 years. Among the 68 diagnosed cases of PVD on CDU, 70.6% cases were detected to have PVD by the ABI method (true positive) whereas 20 (29.4%) cases remained undiagnosed when ABI alone was used for the diagnosis (false negative). Conversely, among 51 diagnosed cases of PVD by ABI method 5.9% cases were found to be normal on CDU (false positive). The ABI method was found to have specificity of 88.5% but the sensitivity was only 70.6%. Conclusion: ABI has a very high specificity but the sensitivity is low compared to colour Doppler ultrasound. Therefore, if ABI is abnormal, the diagnosis of PVD is almost certain but in symptomatic cases with normal ABI; colour Doppler should be performed to exclude the PVD. Keywords : Ankle Brachial Index, peripheral vascular disease, Colour Doppler Ultrasound, type 2 diabetes mellitus. DOI : 10.7176/JMPB/57-02 Publication date : July 31 st 2019

Total Adiponectin and Risk of Symptomatic Lower Extremity Peripheral Vascular Disease in Type 2 Diabetes Mellitus

Total Adiponectin and Risk of Symptomatic Lower Extremity Peripheral Vascular Disease in Type 2 Diabetes Mellitus

A Study on The Prevalence And Risk Factors Associated with Peripheral Vascular Disease In Type2 Diabetes Mellitus

A Study on The Prevalence And Risk Factors Associated with Peripheral Vascular Disease In Type2 Diabetes Mellitus

Comparison of colour Doppler ultrasound and ankle-brachial pressure index measurements in peripheral vascular disease in type 2 diabetic patients with foot infection

Background: Peripheral vascular disease is diagnosed by definitive history of intermittent claudication or if one or more of peripheral pulses are absent in one or both lower limbs. Diagnostic testing for peripheral vascular disease must be accurate, inexpensive, widely accessible, easy to perform and preferably non-invasive. A variety of non-invasive techniques are available to detect the presence of peripheral vascular disease as well as to localize areas of stenosis, assess severity of disease and follow patients for disease progression or response to therapy. In this study we compare the specificity and sensitivity of ankle brachial pressure index with colour Doppler ultrasound for diagnosis of peripheral vascular disease in type 2 diabetes. Methods: This prospective study was carried out in the department of General surgery, GMCH, Udaipur, Rajasthan, India, from September 2014 to February 2016 after taking the permission from institutional ethical committee. A total of 50 patients were selected. The selected patients were evaluated by detailed clinical history, physical examination, local examination, ankle brachial pressure index (ABPI), colour doppler study and other relevant investigations. The ABPI ratio was calculated in every patient and an ABPI less than 0.9 in either foot was defined to have PVD. Colour duplex ultrasound was done in all selected patients. Imaging of peripheral arteries of the lower limbs was done using high resolution colour duplex ultrasound. PVD was diagnosed if the stenosis in the artery was greater than 50% or presence of occlusion. Results: Total 50 patients having type 2 diabetes mellitus with foot infection were included and most of the patients were between 40-60 years of age (68%) with males preponderance. In our study 12 (24%) patients had normal ABPI of 1.0 to 1.29 and 22 (44%) patients were in the range of mild to moderate PVD with ABPI between 0.41 to 0.90. Colour doppler was used as a standard diagnostic test for PVD & out of 50 patients, 36 (72%) showed involvement of arteries and among them both anterior and posterior tibial arteries were involved in 12 (24%) patients. In our study colour doppler ultrasound was used as standard diagnostic method for PVD. The sensitivity, specificity, positive predictive value and negative predictive value of ABPI against colour duplex ultrasound were calculated. Conclusions: In our study it’s concluded that ABPI is a good initial screening tool for peripheral vascular disease, but some patients with significant stenosis or in whom collaterals have developed in lower extremity would be missed, if ABPI measurement alone is used for diagnosis of peripheral vascular disease.

Prevalence of asymptomatic peripheral vascular disease in patients with type 2 diabetes by color Doppler study

Background: A diagnosis of peripheral vascular disease in patients with diabetes mandates a multifaceted treatment approach, involving aggressive risk factor modification, anti-platelet therapy and revascularization procedures. Objective of the study is to study the prevalence of asymptomatic Peripheral vascular disease in patients with type 2 diabetes mellitus by color Doppler study and to correlate it with risk factors and ischemic heart disease. Methods: A total of 40 patients of type 2 diabetes mellitus patients attending outpatient department at Mamata General Hospital, Khammam during the period of August 2008 to August 2009 were selected randomly and a cross sectional analysis was done. The initial history was directed towards obtaining details regarding age/sex of the patient, symptoms/duration of type 2 diabetes, diet/treatment compliance, glycemic control based on HbA1c, presence of hypertension, habit of smoking, family history, symptoms suggestive of limb ischemia, past history of diabetic foot lesions, assessment of physical activity. Results: The prevalence of asymptomatic peripheral vascular disease in type 2 diabetes mellitus was found to be 30%. Age more than 50 years, male sex, smoking, duration of type 2 diabetes mellitus more than 10 years, poor glycemic control (HbA1c > 8%), increased waist hip ratio, overweight and obesity (BMI > 25 kg/m 2 ), increased waist circumference, increased serum cholesterol, increased serum LDL, increased serum Triglycerides, decreased serum HDL, hypertension, abnormal ECG, poor physical activity were found to be risk factors for peripheral vascular disease and they were statistically significant. But the factors like family history of diabetes, diet/treatment compliance were not found to be statistically significant. Conclusions: Age more than 50 years, male sex, smoking, duration of type 2 diabetes mellitus more than 10 years, poor glycemic control (HbA1c > 8%), increased waist hip ratio, overweight and obesity (BMI > 25 kg/m 2 ), increased waist circumference, increased serum cholesterol, increased serum LDL, increased serum Triglycerides, decreased serum HDL, hypertension, abnormal ECG, poor physical activity were found to be risk factors for peripheral vascular disease.

Association of plasma fetuin-A levels and peripheral vascular disease in type 2 diabetic patients

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Peripheral Vascular Disease a Silent Assassin:Rising Trend in State of Punjab

Peripheral vascular disease is a major macrovascular complication of diabetes mellitus. This study was done to determine the prevalence of peripheral arterial disease in type 2 diabetes mellitus using the ankle brachial pressure index. An 12 MHz doppler probe was used in the arms and legs to assess the ankle brachial index (ABI) in 200 type 2 diabetes mellitus patients aged more than 40 years. Thorough history of patients including age, smoking history, history of symptoms of peripheral arterial disease, complete physical examination and routine investigations were collected at the time of enrolment for all subjects. A ratio of the highest blood pressure from the posterior tibial or pedal arteries of each leg to the highest blood pressure from the brachial arteries &amp;lt; 0.9 was considered abnormal. Abnormal ABIs were found in 33% (66/200) patients with type 2 diabetes mellitus. 45.5% patients had ABI 0.80-0.89, 33.3% patients had ABI 0.50-0.79 and 21.2% patients had ABI &amp;lt;0.5 Prevalence of peripheral vascular disease in type 2 diabetes mellitus is on rise in northern India so there is need to educate the patients regarding risk factor modification and importance of early intervention to prevent future progression of peripheral vascular disease.

Blood-soluble Fas Levels are Increased in Type 2 Diabetic Patients with Peripheral Vascular Disease

To investigate the possible utility of plasma sFas (soluble Fas) levels as a marker of peripheral vascular disease (PVD) in type 2 diabetic patients, and the relationship between classical cardiovascular risk factors and sFas levels in these patients. sFas levels were measured in 57 type 2 diabetic patients with and 60 without PVD matched for age and sex. Diagnosis of PVD was established in presence of at least one of the following criteria: leg or foot amputation of vascular cause, lower-extremity arterial angioplasty or surgical by-pass, or ankle-braquial index (ABI) less than 1 in at least one side of the body. ELISA was used to measure sFas levels. None of the risk factors assessed total cholesterol, HDL cholesterol, triglycerides, CRP, ACE, fibrinogen, Lp(a) and homocysteine was significantly different between both groups of patients. However, patients with PVD had higher plasma sFas levels than the group without PVD (10.25+/-3.7 ng/ml VS. 8.86+/-2.6 ng/ml; p=0.02). Levels of sFas were 1.45 ng/ml (95% CI: 0.32-2.58; p=0.013) higher in PVD patients when adjusting by age, total, HDL and LDL cholesterol, triglycerides, homocysteine, CRP, ACE, arterial hypertension and tobacco smoking. Using multiple logistic regression sFas is a predictor of PVD, although not potent. Plasma sFas may be an independent marker of PVD in type 2 diabetes mellitus patients.

Peripheral vascular disease in Type 2 diabetic Chinese patients: associations with metabolic indices, concomitant vascular disease and genetic factors.

Conventional and genetic risk factors have been reported to play a role in the pathogenesis of vascular disease, but do not explain the lower burden of cardiac and peripheral vascular disease (PVD) in Chinese compared with Caucasians. The role of renin-angiotensin system (RAS) gene polymorphisms and conventional vascular risk factors has not been determined. A total of 3097 Chinese diabetic subjects were screened for PVD, which was identified in 194 of the 2967 patients with Type 2 diabetes. Biochemical parameters and the genotype and allele frequencies of three RAS gene polymorphisms, the angiotensin-converting enzyme (ACE) insertion/deletion, angiotensinogen (AGT) M235T and angiotensin II type 1 receptor (AT1R) A1166C polymorphisms were then compared between the PVD patients and 1046 age, gender and diabetes duration-matched patients without PVD. PVD identified in 6.5% was associated with significantly worse glycaemic control, lipid profile and renal function. Smoking was more common, as were the other macro- and microvascular diseases. The prevalence of hypertension was similar between the groups, yet diastolic blood pressure was slightly lower in the PVD group. The ACE D allele was significantly more frequent in patients with PVD compared with the matched diabetic controls (38.1 vs. 29.8%, P = 0.039). No differences in the AT1R or AGT polymorphisms were observed. PVD was associated with a worse metabolic profile and greater concomitant vascular disease than controls. The ACE I/D polymorphism was associated with PVD in these Type 2 diabetic patients.

Fibrinogen is a marker for nephropathy and peripheral vascular disease in type 1 diabetes: studies of plasma fibrinogen and fibrinogen gene polymorphism in the DCCT/EDIC cohort.

We examined whether plasma fibrinogen levels and the beta-fibrinogen gene G(-455)-->A polymorphism were related to microvascular or macrovascular disease in patients (n = 909) with type 1 diabetes enrolled in the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/ EDIC). Univariate regression showed that fibrinogen levels were correlated with BMI (r = 0.15; P < 0.0001), HbA(1c) (r = 0.11; P = 0.0014), total cholesterol (r = 0.17; P < 0.0001), and LDL cholesterol (r = 0.16; P < 0.0001) in all patients. In men, but not women, waist-to-hip ratio (r = 0.20; P < 0.0001) and triglycerides (r = 0.13; P = 0.0047) also became powerful predictors of fibrinogen level; in women, but not men, fibrinogen was correlated with both diastolic (r = 0.16; P = 0.0011) and systolic (r = 0.11; P = 0.0241) blood pressure. Fibrinogen was correlated with urinary albumin excretion rates in men (r = 0.13; P = 0.0033), but not in women. In both sexes, however, the development of proteinuria (albumin excretion >300 mg/24 h) was accompanied by 1.5-fold increment in plasma fibrinogen compared with patients with normal excretion or microalbuminuria. In addition, high fibrinogen levels were associated with a lower average ankle-brachial index in women (r = -0.13; P = 0.0075), but not men. Multiple regression analyses demonstrated that plasma fibrinogen was independently correlated with high albumin excretion rate in men, and with low average ankle-brachial index in women. Fibrinogen was not correlated with the severity of retinopathy. Carotid artery intima-medial thickness was not correlated with fibrinogen, and the G(-455)-->A polymorphism in the 5' promoter region of the beta-fibrinogen gene did not influence circulating fibrinogen levels. However, the presence of the more common G(-455) allele was associated with greater intima-medial thickness in the internal carotid artery (ANCOVA P = 0.045). Last, hyperfibrinogenemia in type 1 diabetes is associated with components of the insulin resistance syndrome trait cluster, and the association is influenced by sex.

Pulse Pressure as a Risk Factor for Peripheral Vascular Disease in Type 2 Diabetic Patients

This study examined whether pulse pressure (PP) could be an independent predictor and associated with severity of peripheral vascular disease (PVD) in 396 type 2 diabetic patients (143 men and 253 women, aged 64.1 ± 11.2 years). Peripheral vascular disease was diagnosed by an ankle‐brachial index (ABI) < 0.90 and as severe PVD if ABI < 0.80. Association was evaluated before and after adjustment for age, sex, diabetes duration, hypertension, smoking, fasting plasma glucose (FPG), total cholesterol (TC), usage of insulin, and usage of angiotensin‐converting enzyme inhibitors (ACEI) or angiotensin receptor blockers (ARB); and for systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP), respectively. Results showed that PP increased from no (n = 348) to mild (n = 25) and severe (n = 23) PVD (one‐way ANOVA, p < 0.001; multiple comparisons, p < 0.05 for any two groups). The PP increase from no to mild PVD was due to SBP increase; while further increase to severe PVD was due to both DBP drop and an even higher SBP. Adjusted odds ratio (AOR) for PVD for every 1‐mmHg PP increment was 1.035 (1.012–1.058). When PP was categorized as tertiles (<50, 50–59 and ≥60 mmHg), respective AOR for PVD for second and third vs. first tertile was 2.605 (1.008–6.729) and 2.835 (1.123–7.156). Pulse pressure was also predictive for ABI independent of the effects of the confounders and the other parameters of blood pressure. In conclusion, PP was an independent predictor and correlated with severity of PVD in type 2 diabetic patients.

UKPDS 59: hyperglycemia and other potentially modifiable risk factors for peripheral vascular disease in type 2 diabetes.

To determine the role of hyperglycemia in prospective analyses of peripheral vascular disease (PVD) in type 2 diabetes, taking into account other potential risk factors. Potential risk factors for the development of PVD were examined in 3,834 of 5,102 individuals enrolled in the U.K. Prospective Diabetes Study (UKPDS) without PVD at diagnosis of diabetes, followed for 6 years, and for whom relevant data were available. PVD was defined as two of the following: ankle-arm blood pressure index < 0.8, absence of both dorsalis pedis and posterior tibial pulses to palpation in one or both legs, and intermittent claudication. Logistic regression was used to estimate the association between potential risk factors measured 3-4 months after diagnosis of diabetes and incident PVD. The prevalence of PVD at 3-year intervals to 18 years was determined. Hyperglycemia, assessed as HbA(1c), was associated with an increased risk for incident PVD, independent of other risk factors including age, increased systolic blood pressure, reduced HDL cholesterol, smoking, prior cardiovascular disease, peripheral sensory neuropathy, and retinopathy. Each 1% increase in HbA(1c) was associated with a 28% increased risk of PVD (95% CI 12-46), and each 10-mmHg increase in systolic blood pressure with a 25% increase in risk (95% CI 10-43). Hyperglycemia, as well as smoking, dyslipidemia, and blood pressure are potentially modifiable risk factors for the development of PVD.

Lack of association between angiotensin-converting enzyme gene polymorphism and peripheral vascular disease in type 2 diabetic patients in Taiwan.

A total of 361 Chinese patients with type 2 diabetes were studied for the association between peripheral vascular disease (PVD) and the insertion/deletion polymorphism involving a 287-bp alu repeat sequence at intron 16 of the angiotensin-converting enzyme (ACE) gene. The patients were divided into PVD (+) (n=45) and PVD (-) (n=316) based on an ankle-brachial index <0.9 and > or =0.9, respectively. Polymerase chain reaction was used to identify gene polymorphism. Results showed that D allele frequency in the patients without and with PVD was 31.8% and 33.3%, respectively (p=NS). The prevalence rates of II, ID and DD genotypes in the PVD (-) group were 45.6%, 45.3% and 9.2%, respectively; and the respective values for the PVD (+) group were 44.4%, 44.4% and 11.1% (p=NS). Prevalence rates of PVD in genotypes II, ID, and DD were 12.2%, 12.3% and 14.7%, respectively (p=NS). In logistic regression analyses, the unadjusted and adjusted odds ratios for DD vs II and ID vs II genotypes for PVD were not statistically significant. The respective adjusted odds ratios were 1.88 (0.56-6.29) and 1.33 (0.63-2.80). In conclusion, there was not a significant association between the ACE genotype and PVD in Chinese type 2 diabetic patients. However, a type 2 error can not be ruled out.

Validez de los métodos diagnósticos para la detección de vasculopatía periférica en diabéticos tipo-2

Background: the diabetes is one of the main causes of peripheral vascular disease (PVD), its precocious diagnosis allows to restore a fast processing and a greater control of the risk factors associate. Objective: to analyze the validity of the different diagnostic methods for the detection of PVD in type 2 diabetics (DM2) in relation to the ankle/arm index (AAI) obtained by echo-doppler (AAI-D). Design: a descriptive crossover study. Setting: Valls - Tarragona, Urban Health Center. Patients: random sample of 130 DM2 patients (260 lower extremities). Measurements: anamness, physical examination (by mean of only before trained explorer) and the existence of pedal and posterior tibial pulses was explored by palpation and echo-doppler, oscillometry and AAI's calculated. Considering 3 PA 's categories: severe (AAI 1). Main results: the prevalence of PVD by means of AAI recorded was 33.1% (IC 95%: 5. 7%), 23. 8% (IC 95%: 5.2%) moderate; 2.7% (IC 95%: 1.9%) severe; 6.5% (IC 95%: 3.0%) artheriosclerotic. The PVD 's global prevalence in DM2 detected by means of AAI-D (33. 1%) was significantly high (p<0.05) to the detected by means of other explorations: 22.3% posterior tibial pulse by palpation; 23.1% oscillometry, 4. 6% pedal pulse by palpation, 4.2% pedal pulse by echo-doppler and 6.54% posterior tibial pulse by echo-doppler. For an AAI <0.9 (moderate PVD) we estimated bigger sensitivity in the oscillometry and bigger specificity and positive predictive value in the tibial pulse by echo-doppler (98.3 and 76.9% respectively). Conclusions: the tests that are in the habit of realizing routine in our health center for detection of PVD (palpation of pedal pulse and oscillometry), present a low sensitivity for the detection of this pathology and it wold be necessary to have a portable echo-doppler (trustworthier for the detection of PVD).

Femoral artery wall thickness and stiffness in evaluation of peripheral vascular disease in type 2 diabetes mellitus

Stiffening and thickening of arterial wall are two important components of atherosclerosis. The purpose of this study was to evaluate the effects of femoral artery wall stiffness on clinical manifestation of peripheral vascular disease (PVD) in type 2 diabetes mellitus. The subjects were 315 patients with type 2 diabetes. Presence of intermittent claudication and/or leg pain at rest and reduced ankle-brachial blood pressure index (ABI<0.9) were used as a subjective and an objective index of PVD, respectively. Femoral artery intima-media thickness (FA-IMT) and stiffness parameter β (FA-stiffness β) were measured by ultrasound methods. Symptomatic patients ( N=58) showed greater values for both FA-IMT and FA-stiffness β than those without symptom ( N=257). Similarly, patients with reduced ABI ( N=56) had greater FA-IMT and FA-stiffness β than those without ( N=259). However, correlation between FA-IMT and FA-stiffness β was not impressive, especially in the symptomatic patients. To evaluate the effect of FA-stiffness β on PVD symptoms, the subjects were divided into three subgroups according to FA-IMT, and then FA-stiffness β was compared between those with and without PVD symptoms in each subgroup. The symptomatic patients had greater FA-stiffness β values than the asymptomatic subjects in all the three subgroups. Multiple logistic regression analysis indicated that the presence of PVD symptoms was associated more closely with increased FA-stiffness β than with increased FA-IMT, whereas reduced ABI was associated more closely with FA-IMT than with FA-stiffness β. These data suggest that stiffening of arterial wall has a significant impact on PVD manifestations, particularly on the leg symptoms, in patients with type 2 diabetes.

Comparison of Ankle/Brachial Index with duplex colour doppler scanning in evaluation of peripheral vascular disease in type 2 diabetic patients

Comparison of Ankle/Brachial Index with duplex colour doppler scanning in evaluation of peripheral vascular disease in type 2 diabetic patients