Relationship between Waist-To-Calf Circumference Ratio and Carotid Atherosclerosis in Patients of Type 2 Diabetes Mellitus

ABSTRACT

Background: Obesity and Diabetes mellitus are well knownrisk factors for cardiovascular diseases (CVD). Though bodyfat appears to play important role in insulin resistance, the waybody fat is distributed is also significant. Waist circumference(WC), calf circumference (CC), and wait to calf ratio (WCR)can be used as predictors of risk of CVD. This study aims toevaluate the utility of WCR as a simple non-invasive, cheaper,easy to use and non-instrumental modality which can be usedas screening tool and as an indicator of coronaryatherosclerosis and resulting cardiovascular risk in patients(OPD as well as Inpatients) with Diabetes mellitus bycorrelating WCR with Carotid Intima Media Thickness (CIMT)which itself is an established indicator for risk of CVD.Methods: 100 adult patients with Type-2 diabetes werediagnosed on the basis of latest ADA criteria. Detailed history,clinical examination, anthropometric measurements,biochemical indices were assessed for all the selectedpatients. Carotid atherosclerosis was measured by scanningthe bilateral common carotid arteries using a high resolutionUSG system with 10 MHz linear transducer. The carotid intimamedia thickness (CIMT) was measured at three points on farwall of mid and distal CCA and 1 cm proximal to dilation ofcarotid bulb. Mean value of six measurements from right andleft CCA were used.Results: There is an expected negative correlationbetween calf circumference and prevalence of abnormal CIMT(p<0.011). WCR correlated with CIMT more strongly than theindependent measures with (p<0.001) and is a good predictorof CIMT abnormality as AUC (area under the curve) is 97.7%Conclusion: Waist to calf circumference ratio is a simple noninvasive, cheaper, easy to use and non-instrumental modalitywhich can be used as screening tool in assessment ofatherosclerotic burden of the vasculature at an early stage intype 2 diabetic OPD as well as in patients. WCR will serve assurrogate marker of coronary artery disease.