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 < or =0.90.
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 < or =0.9 (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 < or = 0.90.
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.
Objetivo: Estudiar la relación entre lapresencia de arteriopatía periférica (AP) y morbimortalidad a los 6 años, y el valor delíndice tobillo-brazo (ITB) como predictorde 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 ≤ 0,90.
Mediciones principales: Se citó a los pacientespara conocer la incidencia de eventosmicrovasculares y macrovasculares mortales yno mortales y se revisaron las historias. Seexcluyó 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 ≤ 0,9 (30,2%) y 21 (10,1%) en el grupocon 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 unamayor probabilidad de presentar un episodiono 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 mayorprobabilidad de presentar un eventocardiovascular, mortal o no (p < 0,001).Tras el análisis multivariable se observa unaumento de morbimortalidad cardiovascular(odds ratio [OR] = 2,81; intervalo deconfianza [IC] del 95%, 1,16-6,78), ACV(OR = 3,47; IC del 95%, 1,19-10,07) einsuficiencia cardíaca (OR = 6,75; IC del95%, 1,34-33,81) en los diabéticos con ITB = 0,90.
Conclusiones: Los diabéticos tipo 2 con AP presentan una mayor morbimortalidad. ElITB es un buen predictor de morbimortalidad cardiovascular e insuficiencia cardíaca.