Endocrine Abstracts

Background: Earlier identification of diabetes patients at high risk of developing cardiovascular complication will help develop new therapeutic targets for the prevention of secondary diseases and death.

Objectives: We aim to test the predictive value of toe brachial index (TBI) as a risk marker of major adverse cardiovascular events (MACE) in patients with type 2 diabetes.

Methods: TBI was measured in 741 patients with type 2 diabetes (T2D) who participated in the epidemiological study CARDIPP (Cardiovascular Risk Factors in Patients with Diabetes-a Prospective Study in Primary Care; ClinicalTrials.gov identifier NCT010497377). Conventional risk markers for vascular disease as well as non-invasive measurements for arterial stiffness; carotid-femoral pulse-wave velocity (PWV, with applanation-tonometry) and intima-media thickness of carotid arteries (IMT, with B-mode ultrasound) were estimated. Patients were followed for incidence of major acute cardiovascular events using the national Swedish Cause and death and Hospitalization registries.

Results: During the follow-up for a period of 7 years 74 patients died or were hospitalized for MACE. TBI tertiles 1 versus 3 levels (crude) were negatively related to MACE (hazard ration HR for each unit of TBI 3.02, CI 1.71 to 5.99; P<0.001). TBI predicted MACE independently of age, sex, diabetes duration and treatment, anti-hypertensive treatment, previous cardiovascular diseases, HbA_1C, LDL cholesterol, eGFR, mean ambulatory systolic BP (HR 3.16, CI 1.50–6.70; P=0.003). This finding of increased MACE occurrence related to low TBI levels was also statistically significant when carotid-femoral PWW, atherosclerosis plaque identification, and IMT were added to the previous model (HR 3.12, 1.32–7.35; P=0.009).

Conclusions: In patients with type 2, TBI predicted the incidence of MACE independently of other cardio-metabolic as well atherosclerosis risk factors.