PATTERN OF PERIPHERAL ARTERIAL DISEASE IN DIABETIC AND NON DIABETIC PATIENTS: ASSOCIATION AND RISKS CORRELATION

Abstract

Background and Aim:Peripheral arterial disease (PAD) is a common cardiovascular complication in patients with diabetes. The presence of PAD is a potent marker of increased cardiovascular risk.Importantly, PAD is associated with a substantial increase in the risk of fatal and non-fatal cardiovascular and cerebrovascular events, including myocardial infarction (MI) and stroke. We aimed to examine the pattern and risk association of PAD in diabetics ersu nondiabetics in Egyptians scheduled for coronary angiography.
Methods:The study included 200 patients with lower extremity arterial stenotic lesions, proved by peripheral angiography, in the cardiac catheterization laboratory of the Faculty of medicine, Zagazig University Hospital, during the period from November 2012 to January 2014. All patients were subjected to all of the following: Complete history taking, full general and local examination, ECG analysis, transthoracic echocardiography, peripheral angiography, calculation of Bollinger score for assessment of the PAD severity and the following laboratory work up: hs-CRP, HbA1C, Albumin in urine, GFR calculation, total cholesterol and total triglycerides.
Results:There was no significant difference between both groups regarding age, sex, hypertension, smoking and positive family history (p-value >0.05), There was no significant difference between both groups regarding LVEDD, LVESD and EF (p-value >0.05), There was significant difference between both groups regarding hs-CRP, HbA1c, GFR, Albuminuria, Total cholesterol and Triglycerides (p-value ˂0.05), being higher in group (1), There was no significant difference between both groups regarding mean Bollinger score of the aorta, common iliac, external iliac, internal iliac, superficial femoral and profundafemoris arteries while there was highly significant difference between both groups regarding mean total Bollinger score, mean Bollinger score of popliteal, anterior tibial, peroneal artery and posterioirtibial arteries (below the knee arteries); being higher in group (1).There was significant positive correlation between total Bollinger score and hs-CRP, total Cholesterol and triglycerides in both groups, (p<0.05), while in group (1) there was significant positive correlation between total Bollinger score and each of HbA1C and Albuminuria (p<0.05), and significant negative correlation between total Bollinger score and GFR (p<0.05).
Conclusions: The current study showed that peripheral arterial disease differs in diabetic patients compared to non-diabetics in severity (being more severe in diabetics), distribution (tends to more distal affection among diabetic patients), associated risk factors and predictors of severity (as in diabetics it depends more on HbA1C, GFR, dyslipidemia, hs-CRP and albuminuria while in non-diabetic patients it depends only on hs-CRP and dyslipidemia)
Key Words: PAD (Peripheral artery disease), Diabetes Mellites, Bollinger score.