The Combination of the Ankle Brachial Index and Brachial Ankle Pulse Wave Velocity Exhibits a Superior Association with Outcomes in Diabetic Patients

Li-Hsin Chang; Hong-Da Lin; Ching-Fai Kwok; Justin G.S. Won; Harn-Shen Chen; Chia-Huei Chu; Chii-Min Hwu; Chin-Sung Kuo; Tjin-Shing Jap; Kuang-Chung Shih; Liang-Yu Lin

doi:10.2169/internalmedicine.53.2999

ORIGINAL ARTICLES

The Combination of the Ankle Brachial Index and Brachial Ankle Pulse Wave Velocity Exhibits a Superior Association with Outcomes in Diabetic Patients

Li-Hsin Chang, Hong-Da Lin, Ching-Fai Kwok, Justin G.S. Won, Harn-Shen Chen, Chia-Huei Chu, Chii-Min Hwu, Chin-Sung Kuo, Tjin-Shing Jap, Kuang-Chung Shih, Liang-Yu Lin

Author information

Li-Hsin Chang
Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital Taoyaun Branch, Taiwan
Hong-Da Lin
Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taiwan
Ching-Fai Kwok
Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taiwan
Faculty of Medicine, National Yang-Ming University, Taiwan
Justin G.S. Won
Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taiwan
Faculty of Medicine, National Yang-Ming University, Taiwan
Harn-Shen Chen
Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taiwan
Faculty of Medicine, National Yang-Ming University, Taiwan
Chia-Huei Chu
Faculty of Medicine, National Yang-Ming University, Taiwan
Division of Otology, Department of Otorhinolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taiwan
Chii-Min Hwu
Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taiwan
Faculty of Medicine, National Yang-Ming University, Taiwan
Chin-Sung Kuo
Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taiwan
Faculty of Medicine, National Yang-Ming University, Taiwan
Tjin-Shing Jap
Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taiwan
Faculty of Medicine, National Yang-Ming University, Taiwan
Kuang-Chung Shih
Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taiwan
Faculty of Medicine, National Yang-Ming University, Taiwan
Liang-Yu Lin
Division of Endocrinology and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taiwan
Faculty of Medicine, National Yang-Ming University, Taiwan
Institute of Pharmacology, National Yang-Ming University, Taiwan

Keywords: ankle brachial index, brachial ankle pulse wave velocity, type 2 diabetes mellitus, cardiovascular outcomes

JOURNAL OPEN ACCESS

2014 Volume 53 Issue 21 Pages 2425-2431

DOI https://doi.org/10.2169/internalmedicine.53.2999

Details

Abstract

Objective Patients with type 2 diabetes mellitus (T2DM) and peripheral arterial disease are classified as having very high cardiovascular risks. We therefore sought to determine whether assessments of the ankle brachial index (ABI) and brachial ankle pulse wave velocity (baPWV) together exhibited a superior association with the outcomes of T2DM.
Methods A retrospective analysis of patients receiving ABI and baPWV during the period 2005-2007 was performed.
Patients A total of 452 subjects were enrolled and followed-up for a mean 5.8 years after being grouped according to the ABI (<0.9 vs. ≥0.9) and baPWV (<1,700 cm/s vs. ≥1,700 cm/s).
Results The outcomes were all-cause mortality and composite events (all-cause mortality, hospitalization for coronary artery disease, stroke, re-vascularization, amputation and diabetic foot). Inter-group differences in the smoking rate, duration of diabetes, systolic and pulse blood pressure, anti-platelet drugs, estimated glomerular filtration rate, and urine albumin excretion were significant. During the follow-up period, 17 (3.7%) individuals died and composite events were recorded in 64 cases (14.1%). A low ABI plus high baPWV was found be associated with poor outcomes compared with a normal ABI plus low baPWV (p<0.001). Meanwhile, a low ABI plus high baPWV was associated with an increased risk of all-cause mortality [hazard ratio (HR) 17.01, 95% confidence interval (CI) 1.57-183.73, p=0.019] and composite events (HR 8.53, 95% CI 3.31-21.99, p<0.001).
Conclusion In this study, the outcomes of patients with a low ABI plus high baPWV were the worst, while the subjects with a low ABI plus low baPWV or normal ABI exhibited similar outcomes. Therefore, the ABI plus baPWV exhibits a better association with the outcomes of T2DM.

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