Sub-clinical vascular disease in type 2 diabetic subjects: Relationship with chronic complications of diabetes and the presence of cardiovascular disease risk factors

BackgroundWe evaluated the association between a low ankle-brachial index (ABI), chronic complications of diabetes, and the presence of traditional cardiovascular disease risk factors in subjects with type 2 diabetes but without known cardiovascular disease.MethodsWe included diabetic subjects (n = 923; 52% male; age range 50–85 years) without clinical evidence of coronary, cerebrovascular, or peripheral artery disease (PAD). A history of nephropathy, retinopathy, or neuropathy was collected from the medical records. A 12-lead electrocardiogram and ABI measurements were conducted on all study participants.ResultsThe mean duration of diabetes was 9.6 years. Prevalence of a low ABI (< 0.9) was 26.2%. Multivariate analysis indicated that factors significantly associated with a low ABI were age (OR: 1.06; 95%CI: 1.033–1.084; p < 0.001), plasma triglyceride concentration (OR: 1.002; 95%CI: 1.001–1.004; p = 0.006), duration of diabetes (OR: 1.029; 95%CI: 1.008–1.051; p = 0.007), and smoking habit (OR: 1.755; 95%CI: 1.053–2.925; p = 0.03). The presence of nephropathy, neuropathy, retinopathy, left ventricular hypertrophy, left bundle branch block, and atrial fibrillation were all associated with a low ABI, but only renal disease remained significant after adjusting for age, duration of diabetes, and cardiovascular risk factors.ConclusionA low ABI is highly prevalent in subjects with diabetes and is related to age, duration of diabetes, smoking habit, and hypertriglyceridemia. Although chronic complications are frequently associated with a low ABI, only renal damage is independently associated with peripheral artery disease.