Category: Diabetes/Prediabetes/Hypoglycemia

Monitor: 32

32 - THE ANKLE BRACHIAL INDEX EXHIBITS BETTER ASSOCIATION WITH CARDIOVASCULAR OUTCOMES THAN INTER-ARM SYSTOLIC BLOOD PRESSURE DIFFERENCE IN PATIENTS WITH TYPE 2 DIABETES

Thursday, Apr 25
11:30 AM – 12:00 PM

Objective : Increased inter-arm systolic blood pressure difference (IASBPD) is associated with mortality and 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.


Methods : Total 446 asymptomatic patients with type 2 diabetes who were followed up for a mean 5.8 years divided into ABI (<0.9 v.s. ≥0.9) or IASBPD (<10  mmHg v.s. ≥10 mmHg) groups.The primary outcome was a composite of all-cause mortality, hospitalization for coronary artery disease, non-fatal stroke, carotid or peripheral revascularization, amputations, and diabetic foot syndrome. The secondary endpoint was all-cause mortality.


Results : Sixty four composite events and 17 deaths were identified in the medical records. The primary and all-cause mortality rates in the group with ABI<0.9 were higher than those in the group with ABI>=0.9 (32.8% vs. 11.6%, p<0.005 for primary outcome; 14.0% vs. 2.3%, p<0.005 for all-cause mortality).  However, IASBPD cannot exhibit a prognostic value.  ABI<0.9 was the dominant risk factor of both endpoints after adjusting for other factors (for composite events: HR, 2.39; 95% CI, 1.26–4.53; p=0.007; for all-cause mortality: HR, 3.27: 95% CI, 1.91–5.60; p<0.001).


Discussion : We demonstrated that ABI<0.9 rather than IASBPD≥10 mmHg exhibited a significant association with composite events and all-cause mortality in patients with type 2 diabetes. The tremendous increment of risk in cardiovascular outcomes was found in the lowest quartile group of ABI. The risk of cardiovascular events increased along with increment in IASBPD; however, the HR of the highest quartile group with IASBPD majorly >10 mmHg did not reach statistical significance. Neither ABI < 0.9 plus IASBPD ≥ 10 mmHg nor IASBPD associated with all-cause mortality demonstrated that the non-HDL-c was less important factor to be influenced on the risk of composite events and all-cause mortality in this analysis comparing ABI.


Conclusion : ABI was more associated with cardiovascular outcomes in patients with diabetes than IASBPD. Therefore, using ABI as routine screening tool is suggested even in asymptomatic patients with diabetes.

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Liang-Yu Lin

Attending physician, Assistant Professor
Taipei Veterans General Hospital
Taipei City, Taiwan (Republic of China)

I am also Assistant Professor of Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.

Li-Hsin Chang

Attending physician
Tao-Yuan Branch of Taipei Veterans General Hospital, Taoyuan, Taiwan (Republic of China)

Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan Taipei Veteran General Hospital Taoyuan Branch

Liang-Yu Lin

Attending physician, Assistant Professor
Taipei Veterans General Hospital
Taipei City, Taiwan (Republic of China)

I am also Assistant Professor of Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.