Atherosclerosis of peripheral arteries in patients with coronary artery disease and type 2 diabetes mellitus


Cite item

Full Text

Abstract

Aim. To study the features of atherosclerosis of peripheral arteries in patients with coronary artery disease (CAD) depending on the presence of type 2 diabetes mellitus (T2DM) and to identify factors associated with multifocal atherosclerosis. Materials and methods. The study included 140 patients (77 men and 63 women) with CAD (mean age 62.0 (56.0-66.0) years). The first group included 70 people with CAD and T2DM, and the second group included 70 patients with CAD without T2DM. All patients underwent duplex scanning of the carotid and lower limb arteries (LLA). Local vascular stiffness of the common carotid artery (CCA) was assessed by ultrasound scanning. The Peterson elasticity modulus, distensibility and strain of the CCA were determined. The ankle - brachial index (ABI) was measured by the Doppler method. Results and discussion. In the group of patients with T2D, there were statistically more patients with atherosclerotic plaques in both carotid arteries and LLA. Also among patients with T2DM the severity of stenosis of carotid arteries and LLA at all levels was significantly greater. Local carotid stiffness was higher in the first group of patients. The proportion of individuals with reduced ABI <0.9 among the patients in the first group was greater in comparison with patients in the second group. According to stepwise logistic regression analysis, independent predictors of multifocal atherosclerosis in patients with CAD were T2DM, intermittent claudication and an increase in carotid stiffness. Conclusion. Patients with CAD and T2DM compared with nondiabetic patients differed significantly greater severity of carotid and lower limb arteries atherosclerosis. Independent predictors of multifocal atherosclerosis in patients with CAD were T2DM, intermittent claudication and an increase in carotid stiffness.

About the authors

V V Genkel

South-Ural State Medical University

Email: henkel-07@mail.ru
ассистент каф. пропедевтики внутренних болезней Chelyabinsk, Russia

A O Salashenko

South-Ural State Medical University

к.м.н., ассистент каф. пропедевтики внутренних болезней Chelyabinsk, Russia

T N Shamaeva

South-Ural State Medical University

к.п.н., доц. каф. математики, медицинской информатики, информатики и статистики, физики Chelyabinsk, Russia

V A Sumerkina

South-Ural State Medical University

к.м.н., с.н.с. центральной научно-исследовательской лаборатории Chelyabinsk, Russia

K V Nikushkina

South-Ural State Medical University

к.м.н., в.н.с. НИИ иммунологии Chelyabinsk, Russia

I I Shaposhnik

South-Ural State Medical University

д.м.н., проф., зав. каф. пропедевтики внутренних болезней Chelyabinsk, Russia

References

  1. Барбараш О.Л., Зыков М.В., Кашталап В.В., Барбараш Л.С. Распространенность и клиническая значимость мультифокального атеросклероза у пациентов с ишемической болезнью сердца. Кардиология. 2011;51(8):66-71.
  2. Панченко Е.П., Беленков Ю.Н. Характеристика и исходы атеротромбоза у амбулаторных больных в Российской Федерации (по материалам международного регистра REACH). Кардиология. 2008;(2):17-24.
  3. Li M.F, Zhao C.C, Li T.T, Tu Y.F, Lu J.X, Zhang R, Chen M.Y, Bao Y.Q, Li L.X, Jia W.P. The coexistence of carotid and lower extremity atherosclerosis further increases cardio - cerebrovascular risk in type 2 diabetes. Cardiovasc Diabetol. 2016;15:43. doi: 10.1186/s12933-016-0360-2
  4. Сумин А.Н., Безденежных Н.А., Безденежных А.В., Иванов С.В., Барбараш О.Л., Барбараш Л.С. Влияние сахарного диабета 2-го типа на распространенность мультифокального атеросклероза у пациентов с ишемической болезнью сердца. Кардиология. 2012;52(11):33-41.
  5. Сумин А.Н. Субклинический мультифокальный атеросклероз: как его выявлять и надо ли? Артериальная гипертензия. 2017;23(1):69-73. doi: 10.18705/1607-419Х-2017-23-1-69-73
  6. Дедов И.И., Шестакова М.В., Майоров А.Ю. Алгоритмы специализированной медицинской помощи больным сахарным диабетом. Сахарный диабет. 2017;20(1S):1-112. doi: 10.14341/DM20171S8
  7. Ершова А.И., Мешков А.Н., Шальнова С.А., Щербакова Н.В., Андреенко Е.Ю., Романчук С.В., Шутемова Е.А., Белова О.А., Бойцов С.А. Ультразвуковые параметры атеросклероза сонных и бедренных артерий у больных ишемической болезнью сердца. Профилактическая медицина. 2014;17(6):56-63. doi: 10.17116/profmed201417656-63
  8. Touboul P.J, Hennerici M.G, Meairs S, Adams H, Amarenco P, Bornstein N, Csiba L, Desvarieux M, Ebrahim S, Hernandez Hernandez R, Jaff M, Kownator S, Naqvi T, Prati P, Rundek T, Sitzer M, Schminke U, Tardif J.C, Taylor A, Vicaut E, Woo K.S. Mannheim carotid intima - media thickness and plaque consensus (2004-2006-2011). An update on behalf of the advisory board of the 3rd, 4th and 5th watching the risk symposia, at the 13th, 15th and 20th European Stroke Conferences, Mannheim, Germany, 2004, Brussels, Belgium, 2006, and Hamburg, Germany, 2011. Cerebrovasc Dis. 2012;34(4):290-6. doi: 10.1159/000343145
  9. Akazawa S, Tojikubo M, Nakano Y, Nakamura S, Tamai H, Yonemoto K, Sadasima E, Kawasaki T, Koga N. Usefulness of carotid plaque (sum and maximum of plaque thickness) in combination with intima - media thickness for the detection of coronary artery disease in asymptomatic patients with diabetes. J Diabetes Investig. 2016;7(3):396-403. doi: 10.1111/jdi.12403
  10. De Marco J.K, Spence J.D. Plaque Assessment in the Management of Patients with Asymptomatic Carotid Stenosis. Neuroimaging Clin N Am. 2016;26(1):111-27. doi: 10.1016/j.nic.2015.09.009
  11. Spence J.D. Measurement of carotid plaque burden. JAMA Neurol. 2015;72(4):383-4. doi: 10.1001/jamaneurol.2014.3002
  12. Мельников И.Ю., Григоричева Е.А., Яшина Л.М. Сравнительная оценка локальной жесткости артерий у пациентов с гипертонической болезнью, ишемической болезнью сердца и сахарным диабетом. Регионарное кровообращение и микроциркуляция. 2011;10(2):53-7.
  13. Van Sloten T.T, Schram M.T, van den Hurk K, Dekker J.M, Nijpels G, Henry R.M, Stehouwer C.D. Local stiffness of the carotid and femoral artery is associated with incident cardiovascular events and all - cause mortality: the Hoorn study. J Am Coll Cardiol. 2014;63(17):1739-47. doi: 10.1016/j.jacc.2013.12.041
  14. Boesen M.E, Singh D, Menon B.K, Frayne R. A systematic literature review of the effect of carotid atherosclerosis on local vessel stiffness and elasticity. Atherosclerosis. 2015;243(1):211-22. doi: 10.1016/j.atherosclerosis.2015.09.008
  15. Aboyans V, Criqui M.H, Abraham P, Allison M.A, Creager M.A, Diehm C, Fowkes F.G, Hiatt W.R, Jönsson B, Lacroix P, Marin B, Mc Dermott M.M, Norgren L, Pande R.L, Preux P.M, Stoffers H.E, Treat-Jacobson D; American Heart Association Council on Peripheral Vascular Disease; Council on Epidemiology and Prevention; Council on Clinical Cardiology; Council on Cardiovascular Nursing; Council on Cardiovascular Radiology and Intervention, and Council on Cardiovascular Surgery and Anesthesia. Measurement and interpretation of the ankle - brachial index: a scientific statement from the American Heart Association. Circulation. 2012;126(24):2890-909. doi: 10.1161/CIR.0b013e318276fbcb
  16. Gerhard-Herman M.D, Gornik H.L, Barrett C, Barshes N.R, Corriere M.A, Drachman D.E, Fleisher L.A, Fowkes F.G, Hamburg N.M, Kinlay S, Lookstein R, Misra S, Mureebe L, Olin J.W, Patel R.A, Regensteiner J.G, Schanzer A, Shishehbor M.H, Stewart K.J, Treat-Jacobson D, Walsh M.E. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology / American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2017;69(11):71-126. doi: 10.1161/CIR.0000000000000471
  17. Aboyans V. Polyvascular Disease: Definition, Epidemiology, and Relevance. In: Lanzer P, ed. Pan Vascular Medicine. Springer, Berlin, Heidelberg, 2014. doi: 10.1007/978-3-642-37393-0_213-1
  18. Грачева С.А., Бирагова М.С., Глазунова А.М., Клефортова И.И., Шамхалова М.Щ., Джавелидзе М.И., Солдатова Т.В., Ильин А.В., Шестакова М.В., Тугеева Э.Ф., Бузиашвили Ю.И. Факторы риска и прогностическая значимость мультифокального атеросклероза у больных сахарным диабетом. Терапевтический архив. 2014;86(10):20-6.
  19. Aboyans V, Ricco J.B, Bartelink M.E.L, Björck M, Brodmann M, Cohnert T, Collet J.P, Czerny M, De Carlo M, Debus S, Espinola-Klein C, Kahan T, Kownator S, Mazzolai L, Naylor A.R, Roffi M, Röther J, Sprynger M, Tendera M, Tepe G, Venermo M, Vlachopoulos C, Desormais I; ESC Scientific Document Group. 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS): Document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: the European Stroke Organization (ESO)The Task Force for the Diagnosis and Treatment of Peripheral Arterial Diseases of the European Society of Cardiology (ESC) and of the European Society for Vascular Surgery (ESVS). Eur Heart J. 2017 Aug 26. doi: 10.1093/eurheartj/ehx095 [Epub ahead of print].
  20. López-Melgar B, Fernández-Friera L, Oliva B, García-Ruiz J.M, Peñalvo J.L, Gómez-Talavera S, Sánchez-González J, Mendiguren J.M, Ibáñez B, Fernández-Ortiz A, Sanz J, Fuster V. Subclinical Atherosclerosis Burden by 3D Ultrasound in Mid-Life: The PESA Study. J Am Coll Cardiol. 2017;70(3):301-13. doi: 10.1016/j.jacc.2017.05.033
  21. Jönelid B, Johnston N, Berglund L, Andrén B, Kragsterman B, Christersson C. Ankle brachial index most important to identify polyvascular disease in patients with non-ST elevation or ST-elevation myocardial infarction. Eur J Intern Med. 2016;30:55-60. doi: 10.1016/j.ejim.2015.12.016
  22. Moyer V.A, U.S. Preventive Services Task Force. Screening for peripheral artery disease and cardiovascular disease risk assessment with the ankle - brachial index in adults: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2013;159(2):342-8. doi: 10.7326/0003-4819-159-5-201309030-00008
  23. Collet F.P. AMERICA: Systematic detection and management of multivascular involvement of atherothrombosis in coronary patients in comparison with treatment of coronary disease only. European Society of Cardiology 2016 Congress. August 29, 2016. Abstract 4160.
  24. Al-Thani H, Shabana A, Hussein A, Sadek A, Sharaf A, Koshy V, El-Menyar A. Cardiovascular complications in diabetic patients undergoing regular hemodialysis: a 5-year observational study. Angiology. 2015;66(3):225-30. doi: 10.1177/0003319714523672
  25. Franzone A, Piccolo R, Gargiulo G, Ariotti S, Marino M, Santucci A, Baldo A, Magnani G, Moschovitis A, Windecker S, Valgimigli M. Prolonged vs Short Duration of Dual Antiplatelet Therapy After Percutaneous Coronary Intervention in Patients With or Without Peripheral Arterial Disease: A Subgroup Analysis of the PRODIGY Randomized Clinical Trial. JAMA Cardiol. 2016;1(7):795-803. doi: 10.1001/jamacardio.2016.2811
  26. Bonaca M.P, Bhatt D.L, Storey R.F, Steg P.G, Cohen M, Kuder J, Goodrich E, Nicolau J.C, Parkhomenko A, Lopez-Sendon J, Dellborg M, Dalby A, Spinar J, Aylward P, Corbalan R, Abola M.T, Jensen E.C, Held P, Braunwald E, Sabatine M.S. Ticagrelor for prevention of ischemic events after myocardial infarction in patients with peripheral artery disease. J Am Coll Cardiol. 2016;67:2719-28. doi: 10.1016/j.jacc.2016.03.524
  27. Valgimigli M, Bueno H, Byrne R.A, Collet J.P, Costa F, Jeppsson A, Jüni P, Kastrati A, Kolh P, Mauri L, Montalescot G, Neumann F.J, Petricevic M, Roffi M, Steg P.G, Windecker S, Zamorano J.L. 2017 ESC focused update on dual antiplatelet therapy in coronary artery disease developed in collaboration with EACTS: The Task Force for dual antiplatelet therapy in coronary artery disease of the European Society of Cardiology (ESC) and of the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2017 Aug 26. doi: 10.1093/eurheartj/ehx419
  28. Tam M.C, Longenecker C.T, Chow C, Vest M, Sukeena R, Madan Mohan S.K, Carman T, Parikh S.A, Josephson R.A. Occult peripheral artery disease is common and limits the benefit achieved in cardiac rehabilitation. Vasc Med. 2016;21(2):130-6. doi: 10.1177/1358863X15625370
  29. Heran B.S, Chen J.M, Ebrahim S, Moxham T, Oldridge N, Rees K, Thompson D.R, Taylor R.S. Exercise - based cardiac rehabilitation for coronary heart disease. Cochrane Database Syst Rev. 2011;(7):CD001800. doi: 10.1002/14651858.CD001800.pub2
  30. Martin B.J, Arena R, Haykowsky M, Hauer T, Austford L.D, Knudtson M, Aggarwal S, Stone J.A; APPROACH Investigators. Cardiovascular fitness and mortality after contemporary cardiac rehabilitation. Mayo Clin Proc. 2013;88:455-63. doi: 10.1016/j.mayocp.2013.02.013
  31. González-Clemente J.M, Piniés J.A, Calle-Pascual A, Saavedra A, Sánchez C, Bellido D, Martín-Folgueras T, Moraga I, Recasens A, Girbés J, Sánchez-Zamorano M.A, Mauricio D; PADiD Study Group. Cardiovascular risk factor management is poorer in diabetic patients with undiagnosed peripheral arterial disease than in those with known coronary heart disease or cerebrovascular disease. Results of a nationwide study in tertiary diabetes centres. Diabet Med. 2008;25(4):427-34. doi: 10.1111/j.1464-5491.2008.02402.x
  32. Загребельный А.В., Марцевич С.Ю., Лукьянов М.М., Воробьев А.Н., Мосейчук К.А., Якушин С.С., Ершова А.И., Бойцов С.А. Качество гиполипидемической терапии в амбулаторно - поликлинической практике: данные регистра РЕКВАЗА. Профилактическая медицина. 2016;19(1):9-14. doi: 10.17116/profmed20161919-14
  33. Perrone V, Sangiorgi D, Buda S, Esposti L.D. Residual cardiovascular risk in patients who received lipid - lowering treatment in a real - life setting: retrospective study. Clinicoecon Outcomes Res. 2016;8:649-55. doi: 10.2147/CEOR.S107992
  34. Van den Berg M.J, Bhatt D.L, Kappelle L.J, de Borst G.J, Cramer M.J, van der Graaf Y, Steg P.G, Visseren F.L; SMART study group; REACH Registry investigators. Identification of vascular patients at very high risk for recurrent cardiovascular events: validation of the current ACC/AHA very high risk criteria. Eur Heart J. 2017. doi: 10.1093/eurheartj/ehx102 [Epub ahead of print].

Copyright (c) 2019 Consilium Medicum

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
 
 


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies