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Rhee, Oh, Choi, Kim, Cha, Lee, Ha, Lee, Park, Chung, Kim, Lee, Koong, Park, Min, and Kim: Multi-country Study on the Prevalence and Clinical Features of Peripheral Arterial Disease in Type 2 Diabetic Patients Who are at High Risk for Atherosclerosis
Original Article
Journal of Korean Society of Endocrinology

Journal of Korean Society of Endocrinology 2006; 21(4): 290-301.

Published online: 20 August 2006

DOI: https://doi.org/10.3803/jkes.2006.21.4.290

Multi-country Study on the Prevalence and Clinical Features of Peripheral Arterial Disease in Type 2 Diabetic Patients Who are at High Risk for Atherosclerosis

Sang Youl Rhee, Seungjoon Oh, Young-Kil Choi1, Doo-Man Kim2, Bong-Yun Cha3, Hyun-Chul Lee4, Seung-Woo Ha5, In-Kyu Lee6, Tae-Sun Park7, Min-Young Chung8, In-Joo Kim9, Moon-Kyu Lee10, Sung-Soo Koong11, Kyung-Soo Park12, Kyung-Wan Min13, Young-Seol Kim

Department of Endocrinology and Metabolism, School of Medicine, Kyung Hee University, Korea.

1Department of Endocrinology and Metabolism, College of Medicine, Pochon CHA University, Korea.

2Department of Endocrinology and Metabolism, College of Medicine, Hallym University, Korea.

3Department of Endocrinology and Metabolism, College of Medicine, The Catholic University of Korea, Korea.

4Department of Endocrinology and Metabolism, Yonsei University College of Medicine, Korea.

5Department of Endocrinology and Metabolism, Kyungpook National University, School of Medicine, Korea.

6Department of Endocrinology and Metabolism, Keimyung University, School of Medicine, Korea.

7Department of Endocrinology and Metabolism, Chonbuk National University, School of Medicine, Korea.

8Department of Endocrinology and Metabolism, Chonnam National University Medical School, Korea.

9Department of Endocrinology and Metabolism, College of Medicine, Pusan National University, Korea.

10Department of Endocrinology and Metabolism, Sungkyunkwan University School of Medicine, Korea.

11Department of Endocrinology and Metabolism, College of Medicine, Chungbuk National University, Korea.

12Department of Endocrinology and Metabolism, Seoul National University College of Medicine, Korea.

13Department of Endocrinology and Metabolism, Eulji University College of Medicine, Korea.

Received 3 June 2005       Accepted 10 April 2006

Copyright © 2006 Korean Endocrine Society

Abstract

Background

PAD-SEARCH (Peripheral Arterial Disease - Screening and Evaluation of diabetic patients in Asian Regions Characterized by High risk factors) is the first international study to investigate the prevalence of peripheral arterial disease (PAD) in Asian type 2 diabetic patients and to demonstrate the relationships between the putative risk factors and PAD in this population.

Methods

A total of 6,625 type 2 diabetic patients (2,873 males and 3,752 females aged 50 and older) were enrolled in PAD-SEARCH in Korea, China, Taiwan, Hong Kong, Indonesia, Thailand and Philippines from October 2003 to March 2004. The Fukuda vascular profile VS-1000™ was used to determine the ankle-brachial index (ABI) and the brachial-ankle pulse wave velocity (baPWV).

Results

The mean patient age was 63.7 ± 8.2 years and the mean duration of diabetes was 10.3 ± 8.0 years. 1,172 (17.7%) subjects were diagnosed as PAD by the ABI (≤ 0.9). Subjects with PAD had a significantly longer duration of diabetes or hypertension, a higher HbA1c level and a significantly lower mean BMI than did the non-PAD subjects. In terms of the lipid profiles, triglyceride was the only significant variable. Notably, the mean ABI and baPWV in the females were significantly poorer than the age matched males for the in subjects with a normal ABI. However, the mean ABI and baPWV in males were significantly poorer than those of the age matched females for the subjects with PAD. On the multivariate analysis, gender, age, BMI, smoking status, duration of diabetes and a previous history of cerebrovascular disease were identified as the independent risk factors of PAD.

Conclusion

These findings suggest that PAD is a common complication in Asian type 2 diabetic patients. Therefore, PAD screening and treatment should be emphasized for Asian diabetic patients with high risk factors.

Keywords: Asia, Diabetes complications, Diabetes mellitus, Epidemiology, Peripheral vascular diseases, Risk factors

Figures and Tables

Fig. 1
Age and gender specific direct standardized prevalence of PAD in Asian patients with type 2 diabetes mellitus.
jkse-21-290-g001
Table 1
Inclusion and exclusion criteria of the PAD-SEARCH study subjects
jkse-21-290-i001

CVA, cerebrovascular accident; MI, myocardial infarction.

Table 2
Clinical characteristics of study subjects
jkse-21-290-i002

Mean ± SD.

DM, diabetes mellitus; HTN, hypertension; HDL, high density lipoprotein; LDL, low density lipoprotein.

Table 3
Mean ABI and baPWV values of the subjects determined using VS-1000™
jkse-21-290-i003

Mean ± SD.

ABI, ankle-brachial index; baPWV, brachial-ankle pulse wave velocity.

Table 4
Comparison of subjects according to the presence and severity of PAD
jkse-21-290-i004

Mean ± SD.

DM, diabetes mellitus; HTN, hypertension; HDL, high density lipoprotein; LDL, low density lipoprotein; ABI, ankle-brachial index; baPWV, brachial-ankle pulse wave velocity.

Table 5
Comparison of subjects by age
jkse-21-290-i005

Mean ± SD.

ABI, ankle-brachial index; baPWV, brachial-ankle pulse wave velocity.

Table 6
Adjusted odds ratio of PAD for the different independent indicators
jkse-21-290-i006

CVD, cerebrovascular disease; DM, diabetes mellitus; IHD, ischemic heart disease; OHA, oral hypoglycemic agent; PAD, peripheral arterial disease.

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