Arteriopatía periférica de extremidades inferiores y morbimortalidad en pacientes diabéticos tipo 2 / Peripheral artery disease of the lower limbs and morbidity/mortality in type 2 diabetics

RESUMEN

Objetivo. Estudiar la relación entre la presencia de arteriopatía periférica (AP) y morbimortalidad a los 6 años, y el valor del índice tobillo-brazo (ITB) como predictor de morbimortalidad en la diabetes mellitus tipo 2. Diseño. Estudio de cohorte retrospectivo. Seguimiento de 6 años. Emplazamiento. Centro de salud urbano. Participantes. En total, 269 diabéticos no insulinodependientes, de los cuales 63 tenían AP en 1996 20 estaban previamente diagnosticados y 43 presentaban un ITB ¾ 0,90. Mediciones principales. Se citó a los pacientes para conocer la incidencia de eventos microvasculares y macrovasculares mortales y no mortales y se revisaron las historias. Se excluyó a 6 por no disponer de todos los datos. Resultados. Han fallecido 39 pacientes, 19 de los cuales presentaban AP en 1996 (30,1%) y 20 no (9,7%) (p = 0,001). Fallecieron 16 pacientes en el grupo con ITB ¾ 0,9 (30,2%) y 21 (10,1%) en el grupo con valores de ITB normales (p = 0,001). Murieron por causa cardiovascular 7 pacientes (13,2%) con ITB patológico y 8 (3,9%) con exploración normal (p = 0,009). La presencia de AP se ha asociado con una mayor probabilidad de presentar un episodio no mortal de cardiopatía isquémica (p = 0,04), un accidente cerebrovascular (ACV) (p < 0,001) y úlceras (p = 0,006). Un ITB bajo se ha asociado con una mayor probabilidad de presentar un evento cardiovascular, mortal o no (p < 0,001). Tras el análisis multivariable se observa un aumento de morbimortalidad cardiovascular (odds ratio [OR] = 2,81; intervalo de confianza [IC] del 95%, 1,16-6,78), ACV (OR = 3,47; IC del 95%, 1,19-10,07) e insuficiencia cardíaca (OR = 6,75; IC del 95%, 1,34-33,81) en los diabéticos con ITB ¾ 0,90. Conclusiones. Los diabéticos tipo 2 con AP presentan una mayor morbimortalidad. El ITB es un buen predictor de morbimortalidad cardiovascular e insuficiencia cardíaca

ABSTRACT

Objective. To study the relationship between the presence of peripheral artery disease (PAD) and the morbidity and mortality at 6 years, and the ankle-brachial index (ABI) as a predictor of morbidity and mortality in type 2 diabetes mellitus. Design. Retrospective cohort study. Six years follow-up. Setting. Urban health centre. Participants. A total of 269 type 2 diabetics, of which 63 had PAD in 1996 20 were previously diagnosed and 43 had an ABI of ¾0.90. Principal measurements. An appointed was made with the patients to find out the incidence of fatal and non-fatal microvascular and macrovascular events and the histories were reviewed. Six patients were excluded as all their data were not available. Results. Thirty nine patients had died, of whom 19 had PAD in 1996 (30.1%) and 20 did not (9.7%) (P=.001). Sixteen patients died in the group with an ABI ¾0.9 (30.2%) and 21 (10.1%) in the group with normal ABI values (P=.001). 7 (13.2%) patients died due to a cardiovascular cause with a pathological ABI, and 8 (3.9%) with a normal value (P=.009). The presence of PAD has been associated with a higher probability of having a non-fatal episode of ischaemic cardiac disease (P=.04), a cerebrovascular accident (CVA) (P<.001) and ulcers (P=.006). A low ABI has been associated with a higher probability of presenting with a fatal or non-fatal cardiovascular event (P<.001). After the multivariate analysis an increase was observed in cardiovascular (odds ratio [OR] =2.81; 95% confidence interval [CI], 1.16-6.78), CVA (OR=3.47; 95% CI, 1.19-10.07), and cardiac failure (OR=6.75; 95% CI, 1.34-33.81), morbidity and mortality in diabetics with an ABI of ¾0.90. Conclusions. The type 2 diabetics with PAD present with a higher morbidity and mortality. The ABI is a good predictor of cardiovascular disease and heart failure morbidity and mortality