Relationships Between Lower Extremity Artery Disease And Coronary Artery Disease In T2DM

?Objective?To investigate the prevalence of coronary heart disease with lower extremity vascular disease in diabetic patients and analyze the association between them and to find out the risk factors in predicting coronary heart disease.?Methods?A total of 265 Chinese subjects(156 men, mean age 67.29±7.54) diagnosed of diabetes with lower extremity disease were recuited in this study. Demographic, clinical and biochemical parameters, ABI values, lower extremity arterial CTA or MRA findings and coronary CTA(including the results of coronary angiography in 42 patients) were retrospectively analyzed. Lower extremity arterial disease was divided into superior genicular arteries and infragenicular arteries by diseased peripheral vascular territory. Based on the findings of the coronary CT angiography, patients were divided into subgroups: absent, single, double and triple vessels disease(as defined by ?50% stenosis in each major coronary artery). All vascular lesions were graded according to the degree of stenosis, respectively: 0 for no stenosis, 1 <50% for mild stenosis, 2 50%-70% for moderate stenosis, 3 70%-90% for severe stenosis, 4 for more than 90% and occlusion.?Results? 1. The coronal artery lesions in T2 DM patients with LEAD were frequently involved the three vessels, the majority of them were diffuse and multiple segmental stenosis greater than 50%.2. The angiographic characteristics in type 2 diabetes mellitus patients with LEAD were widely involved in the artery below the knee.3. Statistical result indicated that the duration of diabetes, the Friesinger scores, HT,SBP, LDL-C, UA, CKD and the history of smoking were significantly higher in coronary stenosi ?50% groups than that of < 50% group(P <0. 05), whereas ABI was significantly lower(P <0. 05).4. Univariate analysis showed that coronary artery Friesinger scores correlated positively with age(r =0.286,P<0.001), duration of diabetes(r =0.165,P=0.007), SBP(r = 0. 195,P=0.005), TG(r=0. 149,P=0.018), LDL-C(r=0.139,P<0.001), UA(r=0.196,P=0.003)and the history of smoking(r=0.135,P<0.001, correlated negatively with Fontaine staging(r=-0. 229,P<0.001), preoperative ABI values(r=-0.418,P<0.001).5. Multiple Logistic regression showed that coronary artery stenosis 50% was associated with over 65 years(OR: 1.278;95 CI: 1.125-1.453;P<0.001), a long duration of DM(OR: 1.230;95 CI: 1.068-1.416;P=0.004), low ABI(OR: 0.014;95 CI: 0.001-0.231;P=0.003).6. With the progress of lower extremity vascular disease, the prevalence of coronary artery disease increased.7. ABI value was negatively correlated with coronary FS score(r=-0.418,P<0.001), thus ABI value can be used as a predictor of coronary heart disease in type 2 diabetes patients.?Conclusion?Coronary heart disease was high and was underestimated in diabetic patients with lower extremity vascular disease. We recommend that coronal artery screening should be performed in patients with severe LEAD.