ASSOCIATION BETWEEN PERIPHERAL ARTERIAL DISEASES AND METABOLIC SYNDROME IN PATIENTS WITH TYPE 2 DIABETES FROM NORTHWESTERN ALGERIA
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Abstract
Objective: This study aims to explore the correlation between peripheral arterial diseases (PAD) and individual components of metabolic syndrome among type 2 diabetic patients.
Methodology: Between December 2019 and March 2022, we carried out a cross-sectional investigation involving 191 patients diagnosed with type 2 diabetes. These patients were admitted to the internal medicine department at of the Public Hospital Establishment of "Ben Badis" and the Public Establishment of Local Health “Larbi Ben M'hidi Diabetes Centre” of Sidi-Bel-Abbes, Algeria. The criteria established by NCEP ATPIII (National Cholesterol Education Program Adult Treatment Panel III) were employed to define the presence of metabolic syndrome (MetS). Diagnosis of peripheral arterial disease (PAD) was based on Angiography and an ankle-brachial index (ABI) below 0.9.
Results: Of the 191 diabetic individuals, 47.1% had PAD and 78.5% had MetS; 52.66% of MetS patients developed PAD. Significant differences (p<0.05) in age, LDL, TG, CRP, serum chloride, and fibrinogen were noted between PAD and NPAD groups. Causal associations (p<0.05) were found between PAD and male gender, obesity, hypertension, dyslipidemia, inactivity, and MetS. PAD increased with MetS anomalies. Strongest PAD risks were low HDL, high TG, and blood sugar cluster (OR=10.75), followed by high waist circumference, TG, blood pressure, and blood sugar cluster (OR=8.361).
Conclusion: This study reveals a strong MetS-PAD association and highlights how specific MetS components independently influence PAD occurrence in adult type 2 diabetes patients.
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References
Magliano DJ, Boyko EJ. IDF Diabetes Atlas 10th edition scientific committee. IDF DIABETES ATLAS. 10th ed. Brus¬sels: International Diabetes Federation; 2021.IDF Atlas 10th edition 2021.
Saeedi P, Petersohn I, Salpea P, Malan¬da B, Karuranga S, Unwin N, et al. IDF Diabetes Atlas Committee. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract. 2019;157:107843. DOI: 10.1016/j.di¬abres.2019.107843.
Fowkes FG, Rudan D, Rudan I, Aboyans V, Denenberg JO, McDermott MM, et al. Comparison of global estimates of prevalence and risk factors for periph¬eral artery disease in 2000 and 2010: a systematic review and analysis. Lancet. 2013;19;382(9901):1329-40. DOI: 10.1016/S0140-6736(13)61249-0.
Zoppini G, Fedeli U, Schievano E, Dauriz M, Targher G, Bonora E, et al. Mortality from infectious diseases in diabetes. Nutr Metab Cardiovasc Dis. 2018;28(5):444-50. DOI: 10.1016/j. numecd.2017.12.007.
Cosentino F, Grant PJ, Aboyans V, Bailey CJ, Ceriello A, Delgado V, et al. 2019 ESC Guidelines on diabetes, pre-dia¬betes, and cardiovascular diseases de¬veloped in collaboration with the EASD. Eur Heart J. 2020;41(2):255-23. DOI: 10.1093/eurheartj/ehz486.
Fadini GP, Spinetti G, Santopaolo M, Madeddu P. Impaired Regeneration Con¬tributes to Poor Outcomes in Diabetic Peripheral Artery Disease. Arterioscler Thromb Vasc Biol. 2020;40(1):34-44. DOI: 10.1161/ATVBAHA.119.312863.
Ali SR, Ozdemir BA, Hinchliffe RJ. Criti¬cal Appraisal of the Quality of Evidence Addressing the Diagnosis, Prognosis, and Management of Peripheral Artery Disease in Patients with Diabetic Foot Ulceration. Eur J Vasc Endovasc Surg. 2018;56(3):401-8. DOI: 10.1016/j. ejvs.2018.05.009.
Becker F, Robert-Ebadi H, Ricco JB, Setacci C, Cao P, de Donato G, et al. Chapter I: Definitions, epidemiology, clinical presentation and prognosis. Eur J Vasc Endovasc Surg. 2011;42 Suppl 2:S4-12. DOI: 10.1016/S1078- 5884(11)60009-9.
Aboyans V, Ricco JB, Bartelink ML, Björck M, Brodmann M, Cohner T, et al. ESC guidelines on the diagnosis and treatment of peripheral arterial diseas¬es, in collaboration with the European Society for Vascular Surgery (ESVS). Kardiologia Polska. 2017;75(11):1065- 160. DOI: 10.1093/eurheartj/ehx095.
Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, et al. AHA/ACC Guide¬line on the Management of Patients with Lower Extremity Peripheral Artery Disease: Executive Summary: A Report of the American College of Cardiology/ American Heart Association Task Force on Clinical Practice Guidelines. Circu¬lation. 2017;135(12):e686-725. DOI: 10.1161/CIR.0000000000000470.
Harzallah F, Alberti H, Ben Khalifa F. The metabolic syndrome in an Arab population: a first look at the new In¬ternational Diabetes Federation criteria. Diabet Med. 2006;23(4):441-4. DOI: 10.1111/j.1464-5491.2006.01866.x.
Guembe MJ, Fernandez-Lazaro CI, Sayon-Orea C, Toledo E, Moreno-Iribas C. Risk for cardiovascular disease as¬sociated with metabolic syndrome and its components: a 13-year prospective study in the RIVANA cohort. Cardio¬vasc Diabetol. 2020;19(1):1-4. DOI: 10.1186/s12933-020-01166-6.
O'Neill S, O'Driscoll L. Metabolic syn¬drome: a closer look at the growing epidemic and its associated patholo¬gies. Obes Rev. 2015;16(1):1-12. DOI: 10.1111/obr.12229.
National Cholesterol Education Pro¬gram (NCEP) Expert Panel on De¬tection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). Third Report of the National Cholesterol Education Pro¬gram (NCEP) Expert Panel on Detec¬tion, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treat¬ment Panel III) final report. Circulation. 2002;106(25):3143-421.
Zhang X, Ran X, Xu Z, Cheng Z, Shen F, Yu Y, et al. China DIA-LEAD Study Inves¬tigators. Epidemiological characteristics of lower extremity arterial disease in Chinese diabetes patients at high risk: a prospective, multicenter, cross-sec¬tional study. J Diabetes Complications. 2018;32(2):150-6. DOI: 10.1016/j.jdi¬acomp.2017.10.003.
Gao L, Zhao W, Liu Q, Qin M. Associa¬tion Between Metabolic Syndrome and Peripheral Arterial Disease in Elderly Patients with Type 2 Diabetes. Diabetes Metab Syndr Obes. 2021;14:4783-9. DOI: 10.2147/DMSO.S343441.
Althouse AD, Abbott JD, Forker AD, Ber¬tolet M, Barinas-Mitchell E, Thurston RC, et al. BARI 2D Study Group. Risk factors for incident peripheral arterial disease in type 2 diabetes: results from the By¬pass Angioplasty Revascularization In¬vestigation in type 2 Diabetes (BARI 2D) Trial. Diabetes Care. 2014;37(5):1346- 52. DOI: 10.2337/dc13-2303.
Emdin CA, Anderson SG, Callender T, Conrad N, Salimi-Khorshidi G, Mohseni H, et al. Usual blood pressure, periph¬eral arterial disease, and vascular risk: cohort study of 4.2 million adults. BMJ. 2015;351:h4865. DOI: 10.1136/bmj. h4865.
Won KB, Chang HJ, Hong SJ, Ko YG, Hong MK, Jang Y, et al. Prognostic use¬fulness of metabolic syndrome com¬pared with diabetes in Korean patients with critical lower limb ischemia treated with percutaneous transluminal angio¬plasty. Yonsei Med J. 2014;55(1):46- 52. DOI: 10.3349/ymj.2014.55.1.46.
Gorter PM, Olijhoek JK, van der Graaf Y, Algra A, Rabelink TJ, Visseren FL; SMART Study Group. Prevalence of the metabolic syndrome in patients with coronary heart disease, cerebro¬vascular disease, peripheral arterial disease or abdominal aortic aneurysm. Atherosclerosis. 2004;173(2):361- 7. DOI: 10.1016/j.atherosclero¬sis.2003.12.033.
Olijhoek JK, van der Graaf Y, Banga JD, Algra A, Rabelink TJ, Visseren FL; SMART Study Group. The metabolic syndrome is associated with advanced vascular damage in patients with cor¬onary heart disease, stroke, peripheral arterial disease or abdominal aortic an¬eurysm. Eur Heart J. 2004;25(4):342- 8. DOI: 10.1016/j.ehj.2003.12.007.
Brevetti G, Schiano V, Sirico G, Giugliano G, Laurenzano E, Chiariello M. Metabolic syndrome in peripheral arterial disease: relationship with severity of peripheral circulatory insufficiency, inflammatory status, and cardiovascular comorbidity. J Vasc Surg. 2006;44(1):101-7. DOI: 10.1016/j.jvs.2006.02.048.
Qadan LR, Ahmed AA, Safar HA, Al-Bad¬er MA, Ali AA. Prevalence of metabol¬ic syndrome in patients with clinically advanced peripheral vascular disease. Angiology. 2008;59(2):198-202. DOI: 10.1177/0003319707304582.
Wild SH, Byrne CD, Smith FB, Lee AJ, Fowkes FG. Low ankle-brachial pres¬sure index predicts increased risk of cardiovascular disease independent of the metabolic syndrome and conven¬tional cardiovascular risk factors in the Edinburgh Artery Study. Diabetes Care. 2006;29(3):637-42. DOI: 10.2337/di¬acare.29.03.06.dc05-1637.
Piazzolla G, Candigliota M, Fanelli M, Castrovilli A, Berardi E, Antonica G, et al. Hyperhomocysteinemia is an inde¬pendent risk factor of atherosclerosis in patients with metabolic syndrome. Di¬abetol Metab Syndr. 2019;11:87. DOI: 10.1186/s13098-019-0484-0.
Wilcox T, Newman JD, Maldonado TS, Rockman C, Berger JS. Periph¬eral vascular disease risk in diabetic individuals without coronary heart dis¬ease. Atherosclerosis. 2018;275:419- 25. DOI: 10.1016/j.atherosclero¬sis.2018.04.026.
Akram J, Aamir AU, Basit A, Qureshi MS, Mehmood T, Shahid SK, et al. Prev¬alence of peripheral arterial disease in type 2 diabetics in Pakistan. J Pak Med Assoc. 2011;61(7):644-8.
Ali Z, Ahmed SM, Bhutto AR, Chaudhry A, Munir SM. Peripheral artery disease in type II diabetes. J Coll Physicians Surg Pak. 2012;22(11):686-9.
Khan AM, Lohana P, Anvekar P, Musta¬fa SH, Kumar R, Adnan LN, et al. Risk Factors of Peripheral Vascular Disease in Diabetes Mellitus in Abbottabad, Pa¬kistan: A Cross-Sectional Study. Cureus. 2021;13(8):e17556. DOI: 10.7759/cu¬reus.17556.
Urbano L, Portilla E, Muñoz W, Hofman A, Sierra-Torres CH. Prevalence and risk factors associated with peripher¬al arterial disease in an adult popula¬tion from Colombia. Arch Cardiol Mex. 2018;88(2):107-15. DOI: 10.1016/j. acmx.2017.02.002.