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Cardiovascular disease (CVD) remains the primary cause of diabetes-associated death and disability. Research published in the American Journal of Cardiology has demonstrated that many patients with diabetes already have evidence of early stage CVD, and it is essential that these patients be treated early to reduce their risk of future cardiovascular events.
Previous efforts have failed to provide accurate yet inexpensive screening techniques to detect CVD in diabetic patients. We believe that ankle brachial indices (ABI) testing may prove to be a low-cost, effective screening technique for diabetic patients without known CVD.
ABI screening is a patient-friendly, inexpensive technique that compares blood pressures between the patient’s arms and ankles. ABI can be performed at any physician’s office in 15 minutes or less. Unfortunately, ABI testing is severely underused in the primary care setting. An abnormal ABI score (greater than 0.9) demonstrates the presence of blockages in the arteries of the legs. Research is now focused on the association between an abnormal ABI and the presence of CVD. In a 2001 issue of the Journal of the American Medical Association, 56 percent of nondiabetic subjects having an abnormal ABI also had other evidence of CVD. We believed that this number would be larger among diabetic patients.
Our trial evaluated 100 diabetic patients having an abnormal ABI and without known CVD. Patients were tested at the South Carolina Heart Center in Columbia, South Carolina, using nuclear stress testing to determine the presence of CVD.
Our results demonstrated that 71 of the 100 diabetics with an abnormal ABI also had at least one form of cardiovascular disease. Furthermore, out of all of the measured traditional risk factors for heart disease, only an abnormal ABI score was highly predictive of the presence of CVD among our diabetic patients.
Our study provides new information for the diabetic patient without known cardiovascular disease. With the number of diabetic patients increasing rapidly, it becomes imperative that we develop screening for early stage CVD detection. ABI screening appears a reliable method of safely and cost-effectively screening these vulnerable patients. ABI screening has been demonstrated to be highly accurate in predicting CVD among diabetics, who are known to have an inherently elevated risk for cardiovascular disease.
Diabetic patients, with or without cardiovascular disease symptoms, should request an ABI test from their healthcare provider, because an abnormal score is highly predictive of the presence of one or more forms of cardiovascular disease.
Type 2s and Heart Failure—Assessing the Risk
The use of any pharmacological therapy for type 2 diabetes in the first year of diagnosis appears to increase the risk of heart failure significantly. Heart failure is caused by the loss of the pumping power of the heart, resulting in fluids collecting in the body (edema), especially in the feet and the lungs.
A total of 25,690 British diabetes patients were categorized retrospectively from the U.K. General Practice Research Database. They took either insulin, sulfonylureas, metformin or other oral hypoglycemic agents as stand-alone therapy or in various combinations of these therapies.
Out of 25,690 patients, 1,409 developed heart failure. Heart failure occurred most frequently in those taking only sulfonylureas. After adjusting for outside factors, there was no difference in effects among type-specific therapies.
Patients with any drug use within the first year after diagnosis of diabetes had a 4.75-fold higher risk for heart failure than those with drug-free status. There was no increased risk in subsequent years, and risk does not appear to differ among the types of drug therapy evaluated. The researchers conclude that it is the severity of the diabetes or the duration of the diabetes prior to diagnosis and the need for drug therapy, and not the therapy itself, that is an explanation of the risk of heart failure in type 2s.
—Diabetes Care, January 2005
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