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Decline in ankle-brachial index is stronger in poorly than in well controlled diabetes: Results from the Heinz Nixdorf Recall cohort study

  • Bernd Kowall
    Correspondence
    Corresponding author. Center of Clinical Epidemiology, c/o Institute of Medical Informatics, Biometry and Epidemiology (IMIBE), Hufelandstraße 55, 45147, Essen, Germany.
    Affiliations
    Center of Clinical Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany
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  • Raimund Erbel
    Affiliations
    Institute for Medical Informatics, Biometry and Epidemiology, University Clinic Essen, University Duisburg-Essen, Essen, Germany
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  • Susanne Moebus
    Affiliations
    Center for Urban Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, University Clinic Essen, Essen, Germany
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  • Nils Lehmann
    Affiliations
    Institute for Medical Informatics, Biometry and Epidemiology, University Clinic Essen, University Duisburg-Essen, Essen, Germany
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  • Knut Kröger
    Affiliations
    Clinic of Vascular Medicine, Helios Klinikum Krefeld, Krefeld, Germany
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  • Andreas Stang
    Affiliations
    Center of Clinical Epidemiology, Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty, University Duisburg-Essen, Essen, Germany

    School of Public Health, Department of Epidemiology Boston University, 715 Albany Street, Talbot Building, Boston, MA, 02118, USA
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      Highlights

      • Poorly controlled diabetes is associated with decline of ankle-brachial index (ABI).
      • Diabetes newly diagnosed by HbA1c is not associated with ABI decline after 10 years.
      • Incident Mönckeberg Disease is very rare in subjects with diabetes at baseline.

      Abstract

      Background and aims

      The ankle-brachial index (ABI) is a marker of atherosclerosis and a diagnostic criterion for peripheral arterial disease (PAD). We studied the association between HbA1c and ABI in subjects with and without diabetes.

      Methods

      In the Heinz Nixdorf Recall Study, a population-based cohort study in Germany (N = 4,814, age 45–75 years), ABI was measured at baseline, at 5- and 10-year follow-up. Subjects with ABI <0.9, ABI >1.4 or self-reported PAD at baseline were excluded from analyses. In 3199 participants, we assessed associations between HbA1c and incident PAD (ABI < 0.9) and change in ABI, respectively, using logistic and linear regression models. Subjects without diabetes, with HbA1c < 5.7% were used as reference group.

      Results

      Compared to the reference group, 10-year decline in ABI was −0.066 (95% confidence interval: −0.117; −0.016) and −0.021 (−0.063; 0.021) in subjects with poorly (≥7.0% HbA1c) and well (<7.0% HbA1c) controlled previously known diabetes; −0.010 (−0.054; 0.034) in those with newly detected diabetes diagnosed by HbA1c ≥ 6.5%, and −0.005 (−0.023; 0.013) in those without diabetes, with HbA1c 5.7–6.4%. For poorly controlled diabetes, odds ratios for low ABI (<0.9) were 3.5 (1.6–7.9), and 3.1 (1.3–7.0) after 5- and 10-year follow-up, respectively. The incidence of Mönckeberg disease (ABI > 1.4) was low (6/288 (2.4%) over 5 years).

      Conclusions

      Decline in ABI was stronger in poorly than well-controlled diabetes. Subjects with newly detected diabetes diagnosed by the new HbA1c criterion (≥6.5%) did not show an increased decline in ABI over 10 years.

      Graphical abstract

      Keywords

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      References

        • Selvin E.
        • Marinopoulos S.
        • Berkenblit G.
        • et al.
        Meta-analysis: glycosylated hemoglobin and cardiovascular disease in diabetes mellitus.
        Ann. Intern. Med. 2004; 141: 421-431
        • Selvin E.
        • Coresh J.
        • Golden S.H.
        • Brancati F.L.
        • Folsom A.R.
        • Steffes M.W.
        Glycemic control and coronary heart disease risk in persons with and without diabetes. the atherosclerosis risk in communities study.
        Arch. Intern. Med. 2005; 165: 1910-1965
        • Selvin E.
        • Steffes M.W.
        • Zhu H.
        • et al.
        Glycated hemoglobin, diabetes, and cardiovascular risk in nondiabetic adults.
        N. Engl. J. Med. 2010; 362: 800-811
        • Kowall B.
        • Lehmann N.
        • Mahabadi A.A.
        • Moebus S.
        • Budde T.
        • Seibel R.
        • et al.
        Progression of coronary artery calcification is stronger in poorly than in well controlled diabetes: results from the heinz nixdorf recall study.
        J. Diabet. Complicat. 2017; 31 (234‐40)
        • Won K.B.
        • Han D.
        • Lee J.H.
        • et al.
        Impact of optimal glycemic control on the progression of coronary artery calcification in asymptomatic patients with diabetes.
        Int. J. Cardiol. 2018; 266: 250-253
        • Kowall B.
        HbA1c target goals in type 2 diabetes: novel arguments from measurement of coronary artery calcification.
        Int. J. Cardiol. 2018; 266: 256-257
        • McNeely M.J.
        • McClelland R.L.
        • Bild D.E.
        • et al.
        The association between A1C and subclinical cardiovascular disease.
        Diabetes Care. 2009; 32: 1727-1733
        • Aboyans V.
        • Criqui M.H.
        • Abraham P.
        • et al.
        Measurement and interpretation of the ankle-brachial index. a scientific statement from the American Heart Association.
        Circulation. 2012; 126: 2890-2909
        • Diehm C.
        • Lange S.
        • Darius H.
        • et al.
        Association of low ankle brachial index with high mortality in primary care.
        Eur. Heart J. 2006; 27: 1743-1749
        • Qu B.
        • Liu Q.
        • Li J.
        Systematic review of association between low ankle-brachial index and all-cause cardiovascular, or non-cardiovascular mortality.
        Cell Biochem. Biophys. 2015; 73: 571-575
        • Fowkes F.G.
        • Murray G.D.
        • Butcher I.
        • et al.
        Ankle brachial index combined with Framingham risk score to predict cardiovascular events and mortality: a meta-analysis.
        J. Am. Med. Assoc. 2008; 300: 197-208
        • Resnick H.E.
        • Lindsay R.S.
        • McDermott M.M.
        • et al.
        Relationship of high and low ankle brachial index to all-cause and cardiovascular disease mortality. the strong heart study.
        Circulation. 2004; 109: 733-739
        • O'Hare A.M.
        • Katz R.
        • Shlipak M.G.
        • Cushman M.
        • Newman A.B.
        Mortality and cardiovascular risk across the ankle-arm index spectrum. results from the cardiovascular health study.
        Circulation. 2006; 113: 388-393
        • Criqui M.H.
        • McClelland R.L.
        • McDermott M.M.
        • et al.
        The ankle-brachial index and incident cardiovascular events in the Multi-Ethnic Study of Atherosclerosis (MESA).
        J. Am. Coll. Cardiol. 2010; 56: 1506-1512
        • Weatherley B.D.
        • Nelson J.J.
        • Heiss G.
        • et al.
        The association of the ankle-brachial index with incident coronary heart disease: the Atherosclerosis Risk in Communities (ARIC) study, 1987-2001.
        BMC Cardiovasc. Disord. 2007; 16: 3
        • Selvin E.
        • Wattanakit K.
        • Steffes M.W.
        • Coresh J.
        • Sharrett A.R.
        HbA1c and peripheral arterial disease in diabetes: the Atherosclerosis Risk in Communities study.
        Diabetes Care. 2006; 29: 877-882
        • Hoe J.
        • Koh W.P.
        • Jin A.
        • Sum C.F.
        • Lim S.C.
        • Tavintharan S.
        Predictors of decrease in ankle‐brachial index among patients with diabetes mellitus.
        Diabet. Med. 2012; 29: e304-307
        • Chen S.C.
        • Lee M.Y.
        • Huang J.C.
        • et al.
        Association of diabetes mellitus with decline in ankle-brachial index among patients on hemodialysis: a 6-year follow-up study.
        PLoS One. 2017; 12e0175363
        • Ding N.
        • Kwak L.
        • Ballew S.H.
        • et al.
        Traditional and nontraditional glycemic markers and risk of peripheral artery disease: the Atherosclerosis Risk in Communities (ARIC) study.
        Atherosclerosis. 2018; 274: 86-93
        • Jude E.B.
        • Oyibo S.O.
        • Chalmers N.
        • Boulton A.J.M.
        Peripheral arterial disease in diabetic and nondiabetic patients.
        Diabetes Care. 2001; 24: 1433-1437
        • American Diabetes Association
        Executive summary: standards of medical care in diabetes – 2012.
        Diabetes Care. 2012; 35: S4-S10
        • Allison M.A.
        • Cushman M.
        • Solomon C.
        • et al.
        Ethnicity and risk factors for change in the ankle-brachial index: the multi-ethnic study of atherosclerosis.
        J. Vasc. Surg. 2009; 50: 1049-1056
        • Kröger K.
        • Stang A.
        • Kondratieva J.
        • Moebus S.
        • Beck E.
        • Schmermund A.
        • et al.
        Prevalence of peripheral arterial disease ‐ results of the Heinz Nixdorf recall study.
        Eur. J. Epidemiol. 2006; 21: 279-285
        • Schmermund A.
        • Möhlenkamp S.
        • Stang A.
        • et al.
        Assessment of clinically silent atherosclerotic disease and established and novel risk factors for predicting myocardial infarction and cardiac death in healthy middle-aged subjects: rationale and design of the Heinz Nixdorf RECALL Study. Risk factors, evaluation of coronary calcium and lifestyle.
        Am. Heart J. 2002; 144: 212-218
        • Ainsworth B.E.
        • Haskell W.L.
        • Herrmann S.D.
        • et al.
        Compendium of physical activities: a second update of codes and MET values.
        Med. Sci. Sports Exerc. 2011; 43 (2011): 1575-1581
        • Sterne J.A.C.
        • Davey Smith G.
        Sifting the evidence – what's wrong with significance tests?.
        BMJ. 2001; 322: 226-231
        • Lash T.L.
        Heuristic thinking and inference from observational epidemiology.
        Epidemiology. 2007; 18: 67-72
        • American Diabetes Association
        Standards of medical care in diabetes – 2016. Glycemic targets.
        Diabetes Care. 2016; 39: S39-S46
        • Muntner P.
        • Wildman R.P.
        • Reynolds K.
        • Desalvo K.B.
        • Chen J.
        • Fonseca V.
        Relationship between HbA1c level and peripheral arterial disease.
        Diabetes Care. 2005; 28: 1981-1987
        • Krishna S.M.
        • Moxon J.V.
        • Golledge J.
        A review of the pathophysiology and potential biomarkers for peripheral artery disease.
        Int. J. Mol. Sci. 2015; 16: 11294-11322
        • Lanzer P.
        • Boehm M.
        • Sorribas V.
        • et al.
        Medical vascular calcification revisited: review and perspectives.
        Eur. Heart J. 2014; 35: 1515-1525
        • Du Y.
        • Heidemann C.
        • Schaffrath Rosario A.
        • et al.
        Changes in diabetes care indicators: findings from German national Health interview and examination Surveys 1997-1999 and 2008-2011.
        BMJ Open Diabetes Res Care. 2015; 3e000135https://doi.org/10.1136/bmjdrc-2015-000135
        • Claessen H.
        • Narres M.
        • Haastert B.
        • et al.
        Lower-extremity amputations in people with and without diabetes in Germany, 2008-2012 – an analysis of more than 30 million inhabitants.
        Clin. Epidemiol. 2018; 10: 475-488
        • Icks A.
        • Claessen H.
        • Kvitkina T.
        • et al.
        Incidence and relative risk of stroke in the diabetic and the non-diabetic population between 1998 and 2014: a community-based stroke register.
        PLoS One. 2017; 12e0188306
        • Kowall B.
        • Rathmann W.
        HbA1c for diagnosis of type 2 diabetes. Is there an optimal cut point to assess high risk of diabetes complications, and how well does the 6.5% cutoff perform?.
        Diabetes Metab. Syndr. Obes. 2013; 6: 477-491
        • Selvin E.
        • Erlinger T.P.
        Prevalence of and risk factors for peripheral arterial disease in the United States. results from the national health and nutrition examination survey, 1999-2000.
        Circulation. 2004; 110: 738-743
        • Kennedy M.
        • Solomon C.
        • Manolio T.A.
        • et al.
        Risk factors for declining ankle-brachial index in men and women 65 years and older.
        Arch. Intern. Med. 2005; 165: 1896-1902
        • Allison M.A.
        • Cushman M.
        • Solomon C.
        • et al.
        Ethnicity and risk factors for change in the ankle-brachial index: the multi-ethnic study of atherosclerosis.
        J. Vasc. Surg. 2009; 50: 1049-1056
        • Krause D.
        • Burghaus I.
        • Thiem U.
        • et al.
        The risk of peripheral artery disease in older adults – seven-year results of the getABI study.
        Vasa. 2016; 45: 403-410
        • Conen D.
        • Rexrode K.M.
        • Creager M.A.
        • Ridker P.M.
        • Pradhan A.D.
        Metabolic syndrome, inflammation and risk of symptomatic peripheral artery disease in women: a prospective study.
        Circulation. 2009; 120: 1041-1047
        • Garg P.K.
        • Biggs M.L.
        • Carnethon M.
        • et al.
        Metabolic syndrome and risk of incident peripheral artery disease: the cardiovascular health study.
        Hypertension. 2014; 63: 413-419
        • Vidula H.
        • Liu K.
        • Criqui M.H.
        • et al.
        Metabolic syndrome and incident peripheral artery disease – the multi-ethnic study of atheroslerosis.
        Atherosclerosis. 2015; 243: 198-203

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