Toe brachial index predicts major acute cardiovascular events in patients with type 2 diabetes independently of arterial stiffness. (March 2020)

• Record Type: Journal Article
• Authors: Chisalita, Simona I.; Wijkman, Magnus; Davidson, Lee Ti; Spångeus, Anna; Nyström, Fredrik; Östgren, Carl Johan
• Is Part Of: Diabetes research and clinical practice. Volume 161(2020)
• Publication Date: 2020-03
• Subjects: Type 2 diabetes -- Toe pressure -- Toe brachial index -- Cardiovascular events; ABI arterial brachial index -- AH Antihypertensive drugs -- ACE-I Angiotensin Converting Enzyme Inhibitor -- ARB Angiotensin Receptor Blockers -- BMI Body Mass Index (weight/height2) -- BP Blood Pressure (mmHg) -- CABG Coronary Artery Bypass Grafting -- CARDIPP Cardiovascular Risk Factors in Patients with Diabetes – a Prospective Study in Primary Care -- GFR Glomerular Filtration Rate -- IMT Intima Media Thickness -- MACE Major Acute Cardiovascular Events -- OAD Oral Anti-Diabetes Drugs -- PCI Percutaneous Coronary Intervention -- PWV Pulse Wave Velocity -- TBI Toe Brachial Index (TP/Brachial SBP; Diabetes -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462
• DOI: 10.1016/j.diabres.2020.108040
• Languages: English
• ISSNs: 0168-8227

Abstract

Abstract: Objective: Our aim was to analyze the predictive value of toe brachial index (TBI) as a risk marker for future major adverse cardiovascular events (MACE) and all-cause mortality in patients with type 2 diabetes (T2D). Methods: TBI was measured in 741 patients with T2D in 2005–2008. Conventional risk factors for vascular disease as well as non-invasive measurements such as pulse-wave velocity (PWV) and intima-media thickness (IMT) of the carotid arteries were estimated. MACE was defined as cardiovascular death or hospitalization for non fatal myocardial infarction or non fatal stroke. Patients were followed for incidence of MACE using the national Swedish Cause of Death Registry and the Inpatient Register. Results: During the follow-up for a period of 9 years MACE occurred in 97 patients and 85 patients died. TBI tertile, 1 versus 3, was significantly related to MACE (HR 2.67, 95%CI 1.60–4.50; p < 0.001) and to all-cause mortality (HR 1.98, 95%CI 1.16–3.83; p = 0.01). TBI tertile 1 as compared to TBI tertile 3 predicted MACE, but not all-cause mortality, independently of age, sex, diabetes duration and treatment, antihypertensive treatment, previous cardiovascular diseases, office systolic blood pressure, HbA1c, LDL cholesterol, estimated glomerular filtration rate, body mass index, current smoking PWV, IMT and carotid plaque presence (HR 3.39, 95%CI 1.53–7.51; p = 0.003 and HR 1.81, 95%CI 0.87–3.76; p = 0.1, respectively). Conclusions: Low TBI predicts an increased risk for MACE independently of arterial stiffness in patients with type 2 diabetes. Trial registration : Clinical Trials.gov number NCT 01049737. Registered January 14, 2010.