Coronary artery disease in diabetic and nondiabetic patients with lower extremity arterial disease: A report from the Coronary Artery Surgery Study Registry (original) (raw)
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BMC Cardiovascular Disorders
Background: The risk of peripheral artery disease (PAD) in patients with diabetes mellitus (DM) and coronary artery disease (CAD) is an important and inadequately addressed issue. Our aim is to examine the impact of DM on risk of PAD in patients with different degrees of CAD characterized by coronary angiography (CAG). Methods: Using nationwide registers we identified all patients aged ≥18 years, undergoing first time CAG between 2000 and 2012. Patients were categorized into DM/Non-DM group, and further classified into categories according to the degree of CAD i.e., no-vessel disease, single-vessel disease, double-vessel disease, triple-vessel disease, and diffuse disease. Risk of PAD was estimated by 5-year cumulative-incidence and adjusted multivariable Cox-regression models. Results: We identified 116,491 patients undergoing first-time CAG. Among these, a total of 23.969 (20.58%) had DM. Cumulative-incidence of PAD among DM patients vs. non-DM were 8.8% vs. 4.9% for no-vessel disease, 8.2% vs. 4.8% for single-vessel disease, 10.2% vs. 6.0% for double-vessel disease, 13.0% vs. 8.4% for triple-vessel disease, and 6.8% vs. 6.1% for diffuse disease, respectively. For all patients with DM, the cox-regression analysis yielded significantly higher hazards of PAD compared with non-DM patients with HR 1.70 (no-vessel disease), 1.96 (single-vessel disease), 2.35 (double-vessel disease), 2.87 (triple-vessel disease), and 1.46 (diffuse disease), respectively (interaction-p 0.042). Conclusion: DM appears to be associated with increased risk of PAD in patients with and without established CAD, with increasing risk in more extensive CAD. This observation indicates awareness on PAD risk in patients with DM, especially among patients with advanced CAD.
Journal of the American College of Cardiology, 1999
OBJECTIVES The purpose of this study was to evaluate the prevalence and prognostic importance of lower extremity arterial disease (LEAD) in patients with multivessel coronary artery disease. BACKGROUND The presence of clinically evident LEAD increases the risk of death in patients with known coronary artery disease. Because studies have lacked noninvasive measures of subclinical LEAD, the true prognostic importance of lower extremity atherosclerosis in this population has probably been underestimated. METHODS Ankle blood pressures were measured in 405 consecutive patients with angiographically documented multivessel coronary disease from seven Bypass Angioplasty Revascularization Investigation (BARI) sites and a parallel study site within 3 years of enrollment. Lower extremity arterial disease was defined as an ankle/arm systolic blood pressure ratio of 0.90 or less. RESULTS Among patients studied, 69 (17%) had LEAD. These patients were more likely to be current smokers, treated for diabetes, older and present with unstable angina compared with patients without LEAD. Among patients who underwent coronary arterial bypass grafting, major complications occurred in 2.8% of those without LEAD compared with 20.7% of those with LEAD (p ϭ 0.002). Five-year mortality rates were similar for symptomatic LEAD (14%) and asymptomatic LEAD (14%). Patients without LEAD had a 3% mortality. After adjusting for baseline differences, the relative risk of death was 4.9 times greater for patients with LEAD compared with those without (95% confidence interval [CI]: 1.8, 13.4, p Ͻ 0.01). CONCLUSIONS Patients with LEAD have a significantly higher risk of death than patients without LEAD, regardless of the presence of symptoms. An abnormal ankle/arm index is a strong predictor of mortality and can be used to further stratify risk among patients with multivessel coronary artery disease.
https://www.ijrrjournal.com/IJRR\_Vol.7\_Issue.10\_Oct2020/Abstract\_IJRR0018.html, 2020
Aim & Objective: One of the major microvascular complications that are associated with diabetes is peripheral artery disease which also known as arteriosclerosis obliterans. There are several research papers which already confirm the effect of PAD on vascular complications in patients with type 2 diabetes (T2DM). The main objective of this study is to evaluate risk factors and prevalence associated with peripheral arterial disease in type 2 diabetes mellitus with coronary artery disease. Materials & Methods: 150 randomly selected patients were interviewed with a predesigned questionnaire in addition to a detailed physical examination and case history. CAD in patients was diagnosed by any past history of CAD, medication taken for CAD, ECG changes or any history of angina. Ankle brachial index (ABI) screening was done through Hand held Doppler. Data was collected in Microsoft Excel and analysed. Results: 150 patients were randomly selected from patients who are attending the daily clinics. Demographic details of the participants were listed in table 1. Among participants 90 (60%) patients were male and rest 60 (40%) patients were female. Mean age of participants were 61.08 ± 8.1 years were as this were almost same for both men and women. 78% of participant had family history of diabetes along with 78% patients had family history of hypertension. 56.6% male patients were obese whereas 68% of female patients belongs to obese category. CAD as assessed by history of angina, ECG changes, any past history of CAD or any treatment taken for CAD was present in 60% (men: 54.4% and women: 68.3%). Prevalence of cardiovascular risk factors in the study group were listed in table 2. 22.6% patients were smoker while 61.3% patients having BMI >25kg/m2. Conclusion: PAD was found to be significantly correlated with uncontrolled diabetes and associated CAD. Thus all patients who have high risk factors of cardiovascular disease and metabolic disease should screened with ABI to diagnosed Pad. PAD can alert physic for diabetes patient to prevent underlying CAD.
Doença arterial coronariana subclínica em pacientes com Diabetes Mellitus tipo 1 em hemodiálise
Arquivos Brasileiros De Cardiologia, 2009
In patients with type 1 diabetes mellitus, atherosclerosis occurs earlier in life and coronary artery disease (CAD) constitutes the major cause of death. Evaluate the prevalence and anatomic characteristics of coronary artery disease (CAD) in type 1 diabetic patients with chronic renal failure undergoing hemodialysis. This is a descriptive study of 20 patients with type 1 diabetes mellitus undergoing hemodialysis without known CAD. CAD was assessed by quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS). QCA was performed in all lesions >30%, visually. All proximal 18-mm segments of the coronary arteries were analyzed by IVUS. All other coronary segments with stenosis >30% were also analyzed. Angiography detected 29 lesions >30% in 15 patients (75%). Eleven (55%) of the lesions were >50% and 10 (50%) >70%. Thirteen patients had all 3 major arteries interrogated by IVUS. Atherosclerosis was present in all patients and in all 51 proximal 18-mm seg...
Zagazig University Medical Journal, 2014
Background and Aim:Peripheral arterial disease (PAD) is a common cardiovascular complication in patients with diabetes. The presence of PAD is a potent marker of increased cardiovascular risk.Importantly, PAD is associated with a substantial increase in the risk of fatal and non-fatal cardiovascular and cerebrovascular events, including myocardial infarction (MI) and stroke. We aimed to examine the pattern and risk association of PAD in diabetics ersu nondiabetics in Egyptians scheduled for coronary angiography. Methods:The study included 200 patients with lower extremity arterial stenotic lesions, proved by peripheral angiography, in the cardiac catheterization laboratory of the Faculty of medicine, Zagazig University Hospital, during the period from November 2012 to January 2014. All patients were subjected to all of the following: Complete history taking, full general and local examination, ECG analysis, transthoracic echocardiography, peripheral angiography, calculation of Bollinger score for assessment of the PAD severity and the following laboratory work up: hs-CRP, HbA1C, Albumin in urine, GFR calculation, total cholesterol and total triglycerides. Results:There was no significant difference between both groups regarding age, sex, hypertension, smoking and positive family history (p-value >0.05), There was no significant difference between both groups regarding LVEDD, LVESD and EF (p-value >0.05), There was significant difference between both groups regarding hs-CRP, HbA1c, GFR, Albuminuria, Total cholesterol and Triglycerides (p-value ˂0.05), being higher in group (1), There was no significant difference between both groups regarding mean Bollinger score of the aorta, common iliac, external iliac, internal iliac, superficial femoral and profundafemoris arteries while there was highly significant difference between both groups regarding mean total Bollinger score, mean Bollinger score of popliteal, anterior tibial, peroneal artery and posterioirtibial arteries (below the knee arteries); being higher in group (1).There was significant positive correlation between total Bollinger score and hs-CRP, total Cholesterol and triglycerides in both groups, (p<0.05), while in group (1) there was significant positive correlation between total Bollinger score and each of HbA1C and Albuminuria (p<0.05), and significant negative correlation between total Bollinger score and GFR (p<0.05). Conclusions: The current study showed that peripheral arterial disease differs in diabetic patients compared to nondiabetics in severity (being more severe in diabetics), distribution (tends to more distal affection among diabetic patients), associated risk factors and predictors of severity (as in diabetics it depends more on HbA1C, GFR, dyslipidemia, hs-CRP and albuminuria while in non-diabetic patients it depends only on hs-CRP and dyslipidemia)
International Journal of Advances in Medicine, 2016
Background: Diabetes mellitus is one of the commonest disease worldwide ranking next to cardiovascular disorder. The estimated prevalence of diabetes among adults is expected to rise about 100% in future. Cardiac involvement in diabetes commonly manifests as CAD and less commonly as dilated (diabetic) cardiomyopathy and autonomic cardiovascular neuropathy. The risk of CAD among diabetic patients is directly related to the levels of blood pressure, cigarette smoking and total cholesterol. Methods: The present study was undertaken at Chandulal Chandrakar memorial hospital, Bhilai, Chhattisgarh (India) between the periods of September 2010-2012 (2 years). 120 cases of CAD were studied, out of which 60 cases are diabetic CAD and 60 cases are non-diabetic CAD. Sample is drawn by simple random technique. Ethical approval was obtained from institutional ethical committee. Total Cases-120, Diabetic CAD [group-1]-60 and Non-diabetic CAD [group-2]-60. On recruiting the subjects into Group 1 and Group 2 following protocol is followed-history, clinical examination, pt. stabilization, anthropometric measurement, routine investigations, specific investigations including echocardiography. Procedures, definitions and criteria were used in the study as per standard protocol. In the present study values are expressed as mean ±1 SD. Demographic characteristics of patient with or without diabetes and other unpaired variables were compared. Results: Mean age in diabetic group was (55.7 ± 9.5) years while in non-diabetic group (55.6 ± 9.32) years. Diabetic group consists of 42 males and 18 females. Non Diabetic Group consists of 38 males and 22 females. Most of the patients in diabetic group presented with chest pain with sweating and with symptoms of sympathetic stimulation (vomiting/ apprehension 83.33%). A small fraction of diabetic patients presented with breathlessness-20%, syncope (3.33%) and palpitation (8.3%). In diabetic group 55% of patients were hypertensive, pre-HTN was seen in 18.33% and 26.66% had optimal blood pressure. Non-diabetics have higher ideal body weight 58.33% than diabetic (36.66%). Among the diabetic group and non-diabetic group maximum number of cases belonged to low risk category with total cholesterol, triglycerides and LDL cholesterol, but with borderline risk with HDL cholesterol. Diabetics are more vulnerable to mortality than non-diabetics (p<0.05). Conclusions: Diabetics had considerably higher percent of typical and atypical presentation. Hence, CAD should be considered as one of the differential diagnoses in diabetics who have presented with chest pain, however less severe it may be.
Journal of International Medical Research, 2004
We evaluated the sensitivity and specificity of a diagnosis of peripheral arterial occlusive disease (PAOD) as a predictor of the severity of coronary artery disease (CAD) in patients with and without diabetes. A total of 302 patients were assigned to groups according to the angiographic severity of their CAD and their diabetes status. Both PAOD and severe PAOD were diagnosed by measuring the ankle-brachial index (ABI) and toe-brachial index (TBI). A diagnosis of PAOD had a low sensitivity (34.3%) but a high specificity (87.0%) for detecting patients with severe CAD. Sensitivity was higher in patients with diabetes (52.4%) than without (19.5%), whereas specificity was higher in patients without diabetes (95.4%) than those with diabetes (69.8%). A diagnosis of severe PAOD had a higher specificity (96.0%), but a very low sensitivity (16.4%). We conclude that a diagnosis of PAOD among patients with CAD had a low sensitivity but a high specificity for detecting those with severe CAD, pa...