Open AccessThe ankle brachial index exhibits better association with cardiovascular outcomes than interarm systolic blood pressure difference in patients with type 2 diabetes
Author(s) -
Liang Yu Lin,
Chii Min Hwu,
Chia Huei Chu,
Justin G.S. Won,
Harn Shen Chen,
Lih-Yu Chang
Publication year - 2019
Publication title -
medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.59
H-Index - 148
eISSN - 1536-5964
pISSN - 0025-7974
DOI - 10.1097/md.0000000000015556
Subject(s) - medicine , hazard ratio , cardiology , type 2 diabetes , blood pressure , diabetes mellitus , clinical endpoint , confidence interval , population , proportional hazards model , stroke (engine) , coronary artery disease , randomized controlled trial , endocrinology , mechanical engineering , environmental health , engineering
Increased interarm systolic blood pressure difference (IASBPD) is associated with cardiovascular prognosis in the general population. This study aimed to evaluate whether IASBPD or ankle brachial index (ABI) is strongly associated with cardiovascular outcomes in patients with type 2 diabetes. Total 446 type 2 diabetes followed up for a mean 5.8 years divided by ABI (<0.9 vs ≥0.9) or IASBPD (<10 vs ≥10 mm Hg). The primary outcome was a composite of all-cause mortality, hospitalization for coronary artery disease, nonfatal stroke, carotid, or peripheral revascularization, amputations, and diabetic foot syndrome. The secondary endpoint was all-cause mortality. Sixty-four composite events and 17 deaths were identified. The primary and secondary outcomes were higher than those in the group with ABI < 0.9 vs ABI ≥ 0.9 (32.8% vs 11.6%, P < .005 for primary outcome; 14.0% vs 2.3%, P < .005 for all-cause mortality) but IASBPD cannot exhibit a prognostic value. ABI < 0.9 was also the dominant risk factor of both endpoints demonstrated by multivariate Cox proportional analysis (composite events: adjusted hazard ratio [HR], 2.39; 95% confidence interval [CI], 1.26–4.53; P = .007; all-cause mortality: adjusted HR, 3.27: 95% CI, 1.91–5.60; P < .001). The ABI was more associated with cardiovascular outcomes in patients with diabetes than IASBPD.