Original Article
Myocardial ischemia, carotid, and peripheral arterial disease and their interrelationship in type 2 diabetes patients

https://doi.org/10.1007/s12350-009-9118-5Get rights and content

Abstract

Background

Cardiovascular disease (CVD) is the leading cause of death in type 2 diabetes mellitus (T2DM) patients. We examined the relationship between CVD in different vascular territories.

Methods

T2DM patients without known or suspected CVD (n = 305) referred consecutively to a diabetes clinic for the first time and age-matched nondiabetic reference subjects (n = 40) were screened for myocardial ischemia, carotid, and peripheral arterial disease by means of myocardial perfusion scintigraphy, carotid artery ultrasonography, and peripheral ankle and toe systolic blood pressure measurements.

Results

In the T2DM patients, the prevalence of myocardial ischemia, carotid, and peripheral arterial disease was 30%, 42%, and 15%, respectively, almost three times higher than in the reference subjects (P = 0.007, P = 0.001, and P = 0.09, respectively). T2DM patients with myocardial ischemia, carotid, or peripheral arterial disease had a significantly increased risk of CVD in other vascular territories as well (OR: 1.99, 2.09, and 3.09, respectively). However, 40%, 52%, and 22% of the T2DM patients with myocardial ischemia, carotid, or peripheral arterial disease demonstrated exclusively this particular type of CVD manifestation.

Conclusions

In T2DM patients, signs of CVD in one vascular territory carry a significantly increased risk of CVD in other territories, although many patients only presented one manifestation.

Section snippets

Study Population

Our study was a single center consecutive trial considering all 753 T2DM patients referred for the first time to the outpatient diabetes clinic at Odense University Hospital, Denmark, from January 1, 2006 to December 21, 2007. Patients were referred by their General Practitioner for one of two reasons: (1) diabetes education at the local four-day diabetes school or (2) glycemic regulation of dysregulated diabetes. No T2DM patient was referred because of symptoms or suspicion of CVD. Inclusion

Results

Characteristics of the T2DM and reference groups are presented in Table 1.

Discussion

Studies using MPS have found a generally high prevalence of myocardial ischemia among asymptomatic patients with T2DM,8, 9, 10, 11, 12, 13, 14 albeit with prevalences varying from 17% to 59%. In this study, we observed a prevalence of myocardial ischemia on MPS that was three times higher in the T2DM group compared with the age-matched nondiabetic reference group (P = 0.007). Even in the asymptomatic T2DM patients (n = 236), the prevalence of myocardial ischemia was as high as 26% (95% CI:

Conclusion

In a consecutive series of T2DM patients, with less than 5 years’ average diabetes duration and without known or suspected CVD, referred to a diabetes clinic for the first time, signs of CVD in one vascular territory carried a significantly increased risk of CVD in other territories as well. The relations between CVD manifestations were, however, not strong enough to allow us to examine only one single vascular territory and then identify all cases of CVD. Therefore, if screening for CVD in

Acknowledgments

Thanks to the laboratory technicians, nurses, and secretaries: Lone Hansen, Charlotte Olsen, Pia Hedegaard, Irene Knudsen, Stella Hold, Tina Godskesen, Mette Høilund-Carlsen, Janne Milton, Charlotte Anker, Jane Petersen, Helle Arnsted, Karin Koertz, and Bente Wichman. Thanks to Lars Videbæk, MD, PhD, for making it possible to perform the ultrasound scans of the carotid arteries. The study was funded by the Danish Cardiovascular Research Academy (DaCRA), The Danish Diabetes Association, The

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