Brachial-ankle pulse wave velocity as a risk stratification index for the short-term prognosis of type 2 diabetic patients with coronary artery disease
- 12 August 2010
- journal article
- Published by Springer Science and Business Media LLC in Hypertension Research
- Vol. 33 (10), 1018-1024
- https://doi.org/10.1038/hr.2010.126
Abstract
The incidence of diabetes is increasing, and the disease has become an important predictor of prognosis in patients with coronary artery disease (CAD), although adverse events often occur without warning. Thus, risk stratification of diabetic CAD patients is important for secondary prevention. This study tests the hypothesis that brachial-ankle pulse wave velocity (baPWV), a marker for arterial stiffness obtained by simple and noninvasive automated devices, can be a risk stratification index to predict prognosis in diabetic patients with CAD. The prognosis of CAD patients with diabetes in the Shinken Database cohort study was investigated by dividing patients into two groups based on baPWV measurements. The composite endpoint was death, nonfatal myocardial infarction, repeat revascularization or readmission for heart failure. Data were available on 564 CAD patients, with a median follow-up of 25.4 months. Of these patients, 191 had type 2 diabetes. The higher baPWV among diabetic patients was defined as a median baPWV of 1730 cm s(-1) or more. The 3-year Kaplan-Meier estimates of event-free survival were 72.8% in diabetic patients with lower baPWV and 51.3% in those with higher baPWV, respectively (P=0.031). Multivariate analysis revealed that a higher baPWV was independently associated with poorer short-term prognosis (hazard ratio, 1.97; 95% confidence interval, 1.01-3.84) in diabetic CAD patients. In conclusion, baPWV, a marker for arterial stiffness, can be a risk stratification index for short-term prognosis in clinical practice, suggesting the need for further aggressive treatment and strict follow-up in CAD patients with diabetes and higher baPWV.Keywords
This publication has 42 references indexed in Scilit:
- Differences in Restenosis Rate With Different Drug-Eluting Stents in Patients With and Without Diabetes Mellitus: A Report From the SCAAR (Swedish Angiography and Angioplasty Registry)Journal of the American College of Cardiology, 2009
- Intensive Glycemic Control and the Prevention of Cardiovascular Events: Implications of the ACCORD, ADVANCE, and VA Diabetes TrialsCirculation, 2009
- 10-Year Follow-up of Intensive Glucose Control in Type 2 DiabetesThe New England Journal of Medicine, 2008
- Impact of Ethnicity and Gender Differences on Angiographic Coronary Artery Disease Prevalence and In-Hospital Mortality in the American College of Cardiology–National Cardiovascular Data RegistryCirculation, 2008
- Impact of diabetes mellitus on long-term outcomes in the drug-eluting stent eraAmerican Heart Journal, 2007
- Trends in the Incidence of Type 2 Diabetes Mellitus From the 1970s to the 1990sCirculation, 2006
- Intensive Diabetes Treatment and Cardiovascular Disease in Patients with Type 1 DiabetesThe New England Journal of Medicine, 2005
- Excess risk of fatal coronary heart disease associated with diabetes in men and women: meta-analysis of 37 prospective cohort studiesBMJ, 2005
- Propensity Analysis of Long-Term Survival After Surgical or Percutaneous Revascularization in Patients With Multivessel Coronary Artery Disease and High-Risk FeaturesCirculation, 2004
- Mortality in Adults With and Without Diabetes in a National Cohort of the U.S. Population, 1971–1993Diabetes Care, 1998