Risk factors for development of peripheral and carotid artery disease among type 2 diabetic patients.

(Full text is available at http://www.manu.edu.mk/prilozi). The study was aimed to define the risk factors for development of peripheral arterial (PAD) and carotid artery disease (CARD) among type 2 diabetic patients (T2D). The study population consisted of 30 patients diagnosed with type 2 diabetes and absent vascular disease. the mean age of the study population was 53.3 +/- 7.3 years. 60% of patients were women and 40% of them men. Patients were followed up for three years for development of peripheral and carotid artery disease. Peripheral arterial disease (PAD) was defined by ankle-brachial index < 0.9 or > 1.3. Carotid arterial disease was defined if carotid plaque or stenosis (> 50%) presented. We built a multivariable logistic regression analysis to define the factors of development of vascular disease and a multiple linear regression analysis to identify the factors associated independently with numerous values of carotid IMT and ABI. Development of PAD and CARD were registered in 43.8% of patients. Progression of carotid IMT was found in 62.5 % of pts. Progression of PAD was predicted by HDL - cholesterol and urea, systolic blood pressure and diabetes duration. Progression of carotid IMT was determinate with: BMI, weight, diastolic blood pressure and age. Our study defined risk factors that independently influence the development of PAD and CARD in pts with T2D. This data has clinical usefulness in the improvement of prevention and in optimizing the treatment of type 2 diabetic patients. Key words: peripheral arterial disease, ankle-brachial index, carotid plaque, carotid stenosis, IMT, type 2 diabetes.

Is assessment of peripheral endothelial dysfunction useful tool for risk stratification of type 2 diabetic patients with manifested coronary artery disease?

Endothelial dysfunction, per se, in coronary arteries can stratify a risk in coronary artery disease patients. Selected studies evaluating endotheliopathy as predictor of events in patients with type 2 diabetes, but without coronary artery disease. We hypothesized that peripheral endothelial dysfunction could predict prognosis of type 2 diabetic patients who presented coronary artery disease. Our data presented endothelial dysfunction as prognostic marker of cardiovascular events in type 2 diabetic patients with manifested coronary artery disease, according univariate regression model.

Premature atherosclerosis in patients with growth hormone deficiency and diabetes mellitus.

In this article cases of two sisters with premature atherosclerosis have been described. The first one aged 31 with diagnosis of growth hormone deficiency (GHD) and diabetes mellitus presented with calf intermittent claudication as a result of tibial arteries occlusions. The second one aged 34 with impaired fasting glycemia and without any sign of GHD presented with sudden calf pain as a result of tibial posterior arterial acute occlusion. These cases support the hypothesis that in GH deficiency patients is a higher incidence of diabetes mellitus and early atherosclerosis and they are more vulnerable to vascular thrombotic events (Tab. 1, Ref. 5).

Prevalence of metabolic syndrome components in the type 2 diabetic population who presented coronary artery disease.

The scope of our study was to assess the prevalence of metabolic syndrome (MSy) and its components in the type 2 diabetic population with symptomatic coronary artery disease in a sample of the Macedonian population. 327 pts with type 2 diabetes and manifested coronary artery disease were randomly included in a survey. MSy was defined according ATP III criteria. The data presented a prevalence of MSy in 86.2%, respectively. 98% of pts had at least one more MSy component than impaired glycaemia. Study groups with four and three MSy components were most frequent in the study population. The data presented gender differences in MSy prevalence: 93.4% in women vs. 82.8% in men (p 0.009), as women tend to have a much more increased waist, arterial hypertension and low HDL. The most prevalent metabolic syndrome component was arterial hypertension (78.3%). Low HDL was detected in 67.9%, hypertriglicerydaemia in 62.7%, and an increased waist in 49.8% of the study population.

Usefulness of D-Dimers and fibrinogen plasma determination in patients with polyvascular disease.

OBJECTIVES: The goal of our study was to evaluate the value of fibrinogen, D-Dimers and antithrombin III plasma levels to prognosticate mortality in patients suffering from both peripheral artery disease (PAD) and coronary artery disease (CAD). MATERIAL AND METHODS: 90 patients with coexistent PAD and CAD were inrolled in 36 months study and evaluated for the following parameters: age, sex, current smoking, ankle-brachial index, claudicating distance, ejection fraction, triglycerides, cholesterol, LDL, fibrinogen, D-Dimers, antithrombin III, creatinin, glycaemia, histories of myocardial infarction, stroke, diabetes and previous revascularization, as well as number of other concurrent diseases. We developed linear regression model for identification of variables, associated with cardiovascular events, and multivariate regression model to define the predictors of mortality. RESULTS: We registered 126 cardiovascular events during three years follow-up. Number of cardiovascular events correlate with fibrinogen (r=0,59, p<0,01) and with D-Dimers (r=0,48, p<0,01). Mortality of 8,89% was found for the period of three years in patients with coexistent PAD and CAD. The variables independently associated with mortality found by mutlivariate analysis were fibrinogen (r= 0,21, p<0,02, score 2,78), D-Dimers (r=0,94, p<0,01, score 17,24) and ankle-brachial index (r=0,40, p<0,03, score 4,84). CONCLUSION: The reported data demonstrated fibrinogen and D-Dimers as independent predictors of mortality in pts with polyvascular disease.

Risk factors for development of critical limb ischemia -- a survey of diabetic vs. nondiabetic population.

The aim of this study is to identify the risk factors for development of chronic critical limb ischemia (CLI) in diabetic and nondiabetic patients with peripheral arterial disease (PAD). 127 patients (pts) with PAD (63 with type 2 diabetes and 64 nondiabetic) were randomly included in a cross sectional study. Out of them 17 were with CLI. Population was investigated for age, height, weight, sex, duration of PAD and diabetes, arterial hypertension, hyperlipidemia, smoking, obesity, systolic blood pressure, value of ankle-brachial index, previous claudicating distance and peripheral intervention, amputation, medical treatment with prostanoids, insulin and antiplatelet drugs and histories of cerebrovascular disease, coronary artery disease and other concomitant diseases. After adjudging linear correlation between mentioned variables and presence of CLI, logistic regression model was built. There were no significant differences in demographic data between both populations. Hyperlipidemia was more frequent in nondiabetic population. Multiple regression model show ankle-brachial index < 0,5, measured in previous 1-3 years (OR 3.39 CI 95% 0.28-40.78), microvascular complication retinopathy (OR 12.98 CI 95% 1.76-95.58), heart failure (OR 1.91 CI 95% 0.29-2.72) and previous prostanoids treatment (OR 15.92 CI 95% 0.53-476.58) as predictors of development of CLI in diabetic population with PAD. After heart failure exclusion of model of nondiabetic pts, previous surgery (OR 3.14 CI 95% 0.61-16.09) and smoking (OR 0.35 CI 95% 0.78-1.62) were presented as prognostic factors for CLI's onset. Our results indicate differences between predictors of CLI's onset in diabetic and nondiabetic population with PAD. Presence of retinopathy, previous measured ankle-brachial index and prostanoids treatment are predictors of development of CLI in diabetic population. Previous surgery is independent predictor for CLI'onset in nondiabetics. Treating concomitant heart failure for both populations and modifying risk factor smoking in nondiabetic population, have an important clinical usefulness in risk assessment approach of peripheral arterial disease patients.

Prognostic importance of haemostatic parameters in polyarterial disease.

UNLABELLED: The goal of our study was to evaluate the value of fibrinogen, D-dimers and antithrombin III plasma levels in prognosticating mortality in patients suffering from both peripheral arterial disease (PAD) and coronary artery disease (CAD). PATIENTS AND METHODS: 90 patients with coexistent PAD and CAD were enrolled in a 36 months study, and evaluated for the following parameters: age, sex, current smoking, ankle-brachial index, claudicating distance, ejection fraction, triglycerides, cholesterol, LDL, fibrinogen, D-Dimers, antithrombin III, creatinine, glycaemia, histories of myocardial infarction, stroke, diabetes and previous revascularization, as well as a number of other concurrent diseases. We developed a linear regression model for identification of variables, associated with cardiovascular events, and a multivariate regression model to define the predictors of mortality. RESULTS: We registered 126 cardiovascular events during three years' follow-up. The number of cardiovascular events correlated with fibrinogen (r=0.59, p=0.01) and with D-dimers (r=0.48, p=0.01). A mortality of 8.89% was found for the period of three years in patients with coexistent PAD and CAD. The variables independently associated with mortality found by mutlivariate analysis were fibrinogen (r=0.21, p 0.02, score=2.78), DD (r=0.94, p=0.01, score=17.24) and ankle-brachial index (r=0.40, p=0.03, score=4.84). CONCLUSIONS: The reported data demonstrated fibrinogen and D-dimers as independent predictors of mortality in patients with polyarterial disease.