The coexistence of carotid and lower extremity atherosclerosis further increases cardio-cerebrovascular risk in type 2 diabetes - PubMed (original) (raw)

Comparative Study

The coexistence of carotid and lower extremity atherosclerosis further increases cardio-cerebrovascular risk in type 2 diabetes

Mei-Fang Li et al. Cardiovasc Diabetol. 2016.

Abstract

Background: Both carotid and lower limb atherosclerosis are associated with increased cardiovascular and cerebrovascular risks. However, it is still unclear whether the concomitant presence of carotid and lower extremity atherosclerosis further increases the cardiovascular and cerebrovascular risks. Therefore, our aim is to investigate whether the coexistence of carotid and lower extremity atherosclerosis was associated with higher cardiovascular and cerebrovascular risks in patients with type 2 diabetes.

Methods: This cross-sectional study was performed in 2830 hospitalized patients with type 2 diabetes. Based on carotid and lower limb Doppler ultrasound results, the patients were divided into three groups including 711 subjects without atherosclerosis, 999 subjects with either carotid or lower limb atherosclerosis, and 1120 subjects with both carotid and lower limb atherosclerosis. And we compared the clinical characteristics and prevalence of both cardio-cerebrovascular events (CCBVEs) and self-reported cardio- cerebrovascular diseases (CCBVDs) among the three groups.

Results: After adjusting for age, sex, and duration of diabetes, there were significant increases in the prevalence of both CCBVEs (3.8 vs. 11.8 vs. 26.4 %, p < 0.001 for trend) and self-reported CCBVDs (6.9 vs. 19.9 vs. 36.5 %, p < 0.001 for trend) across the three groups (diabetics without atherosclerosis, diabetics with either carotid or lower limb atherosclerosis, and diabetics with both carotid and lower extremity atherosclerosis). A fully adjusted logistic regression analysis also revealed that compared with those without atherosclerosis, those with either carotid or lower limb atherosclerosis had higher risk of CCBVEs (OR 1.724, 95 % CI 1.001-2.966) and self-reported CCBVDs (OR 1.705, 95 % CI 1.115-2.605), and those with concomitant presence of carotid and lower extremity atherosclerosis had the highest risk of CCBVEs (OR 2.869, 95 % CI 1.660-4.960) and self-reported CCBVDs (2.147, 95 % CI 1.388-3.320)(p < 0.001 for trend in CCBVEs and p = 0.002 for trend in CCBVDs, respectively).

Conclusions: Either carotid or lower limb atherosclerosis was obviously related to increased cardio-cerebrovascular risk in type 2 diabetes. The concomitant presence of carotid and lower extremity atherosclerosis further increased cardio-cerebrovascular risk in patients with type 2 diabetes. The combined application of carotid and lower extremity ultrasonography may help identify type 2 diabetics with higher cardio-cerebrovascular risk.

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Figures

Fig. 1

Fig. 1

Characteristics of CCBVEs of the entire subjects a The prevalence of CCBVEs stratified by sex after adjusting on age and DD. The p value for sex comparison was 0.400. b The prevalence of CCBVEs stratified by age after adjusting on sex and DD. The p value for group comparison was <0.001. c The distribution of CCBVEs after adjusting on sex, age and DD. The prevalence of isolated CVEs, isolated CBVEs and combined CVEs and CBVEs was successively 2.1, 12.5 and 0.9 %. The p value for group comparison was <0.001. d The prevalence of CCBVEs stratified by duration of diabetes after adjusting on sex and age. The p value for group comparison was <0.001

Fig. 2

Fig. 2

Characteristics of self-reported CCBVDs of the whole subjects a The prevalence of CCBVDs stratified by sex after adjusting on age and DD. The p value for sex comparison was 0.474. b The prevalence of CCBVDs stratified by age after adjusting on sex and DD. The p value for group comparison was <0.001. c The distribution of CCBVDs after adjusting on sex, age and DD. The prevalence of isolated CVDs, isolated CBVDs and both CVDs and CBVDs was successively 8.4, 11.8 and 3.1 %. The p value for group comparison was <0.001. d The prevalence of CCBVDs stratified by duration of diabetes after adjusting on sex and age. The p value for group comparison was <0.001

Fig. 3

Fig. 3

Comparison of IMT in carotid and femoral among the three groups a Comparison of CIMT among the three groups after adjustment on age, sex and DD. The p value for group comparison was <0.001. b Comparison of FIMT among the three groups after adjustment on age, sex and DD. The p value for group comparison was <0.001

Fig. 4

Fig. 4

Comparison of the prevalence of CCBVEs and self-reported CCBVDs among the three groups a Comparison of the prevalence of CVEs among the three groups after adjustment on age, sex and DD. The p value for group comparison was <0.001. b Comparison of the prevalence of CBVEs among the three groups after adjustment on age, sex and DD. The p value for group comparison was <0.001. c Comparison of the prevalence of CCBVEs among the three groups after adjustment on age and sex. The p value for group comparison was <0.001. d Comparison of the prevalence of CVDs among the three groups after adjustment on age, sex and DD. The p value for group comparison was <0.001. e Comparison of the prevalence of CBVDs among the three groups after adjustment on age, sex and DD. The p value for group comparison was <0.001. f Comparison of the prevalence of CCBVDs among the three groups after adjustment on age, sex and DD. The p value for group comparison was <0.001

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