Frequency of Peripheral Arterial Disease Diagnosed by Measurement of the Ankle Brachial Index Among Diabetics with No Symptoms of Intermittent Claudication
Abstract
Objective. The ankle brachial index (ABI) was measured at rest and after the six-minute walk test (6MWT) to determine the frequency of peripheral arterial disease among diabetics with no symptoms of intermittent claudication.
Methodology. A total of 70 participants were enrolled in the study taken from at the outpatient department of Manila Doctors Hospital and Our Lady of Remedies Health Center, Malate from September to October 2011. Based from the blood pressure resting and after the 6MWT, ABI was computed such that a result of < 0.90 is diagnostic of PAD.
Results. Mean age of participants was 60 years (SD + 12.2). Among the participants 74% were females, 63% were hypertensive, and 14% were smokers. Systolic and diastolic blood pressure was 140+18.32, 82+12.3 respectively. Participants who were hypertensive and who smoke was above 30%. ABI classified as non-compressible and borderline was 1.42 % and above 10% respectively. The frequency of PAD using ABI was 33% at rest and 37% after the 6MWT. No severe PAD was seen both resting and after 6MWT.
Conclusion. The frequency of PAD among diabetics with no symptoms of intermittent claudication using ABI seen at the outpatient department of Manila Doctors Hospital and Our Lady of Remedies Health Center was relatively higher after the 6 MWT.
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References
Raj Mohan L.N., et al. Peripheral arterial disease in community-based patients with diabetes in Singapore: Results from a primary Healthcare Study. Department of Medicine, Khoo Teck Puat Hospital, Singapore. Annals of the Academy of Medicine, Singapore. July 2010; 39(7):525-(7)
Norgren, L et al. TASC II 2009 Epidemiology of Peripheral Artery Disease.
MacGregor AS, Price JF, Hau CM et al. Role of systolic blood pressure and plasma triglycerides in diabetic peripheral arterial disease. The Edinburgh Artery Study. Diabetes Care. 1999, 22:453-458
Kallio M, Forsblom C, Groop PH et al. Development of new peripheral arterial occlusive disease in patients with Type 2 diabetes during the mean follow up of 11 years. Diabetes Care 2003;26:1241-5.
Sy, R. et al. Abstract. PAD-Search. Diabetes Res Clin Pract. Apr 2007. 76(1):82-92.
Bowlin SJ, Medalie JH, Flocke SA et al. Epidemiology of intermittent claudication in the middle-aged men. Am J Epidemiol.1994; 140: 418-430.
Dans, A. et.al., “National Nutrition and Health Survey: Atherosclerosis-related diseases and risk factors”. Philippine Journal of Internal Medicine, 2005; 43:103-115.
PHILPAD Group 2000. Prevalence of PAD: NCR Study.
Gallardo, MD et al, The severity of peripheral arterial disease by Ankle-Brachial Index Determination, predictor of the severity and Jeopardy score of coronary artery disease Philippine Heart Center, PJC Vol. 37 No 1 January to June 2009 page 10-16.
Norgren, L, Hiatt WR, Dormandy JA et al. Inter-Society consensus for the management of peripheral arterial disease (TASC II). Eur J Vasc Endovasc Surg. 2007 ; 45 (Suppl S) : 5-67.
Burns P, Gough S, Bradbury AW. Management of peripheral arterial disease in primary care. BMJ 2003; 326:584-8.
Olin J.W. The clinical evaluation and office-based detection of peripheral arterial disease. In: Hirsch AT. Olin FW, eds. An Office-Based Approach to the Diagnosis and Treatment of Peripheral Arterial Disease 1: The Epidemiology and Practical Detection of Peripheral Arterial Disease. Am J Med. Continuing Education Series. Bellmead, NJ: Excerpta Medica, Inc.,1998:10-17
Montogomery P.S., Gardner A.W. The clinical utility of a six-minute walk test in peripheral arterial occlusive disease patients. J Am Geriatr Soc. 1998 Jun; 46(6):706-11
ATS Statement: Guidelines for the Six-Minute Walk Test. Am J Respir Crit Care Med. 2002, 166: 111-117
Hirsch A, Haskal ZJ, Hertzer N. et al. ACC/AHA 2005 Guidelines for the Management of Patients With Peripheral Arterial Disease (Lower Extremity, Renal, Mesenteric, and Abdominal Aortic): Executive Summary A Collaborative Report From the American Association for Vascular Surgery/Society for Vascular Surgery, Society for Cardiovascular Angiography and Interventions, Society for Vascular Medicine and Biology, Society of Interventional Radiology, and the ACC/AHA Task Force on Practice Guidelines (Writing Committee to Develop Guidelines for the Management of Patients With Peripheral Arterial Disease): Endorsed by the American Association of Cardiovascular and Pulmonary Rehabilitation; National Heart, Lung, and Blood Institute; Society for Vascular Nursing; TransAtlantic Inter-Society Consensus; and Vascular Disease Foundation. J Am Coll Cardiol. 2006; 47(6):1239-1312.
Rooke T, Hirsch A, Misra S et al. 2011 ACCF/AHA Focused update of the guideline for the management of patients with peripheral artery disease (Updating the 2005 Guideline). J Am Coll Cardiol. 2011; 58(19):2020-2045
Harrison’s 17th ed. Principles of Internal Medicine p1568-1569.
Quigley F.G., Faris I.B., Duncan H.J. A comparison of Doppler ankle pressures and skin perfusion pressure in subjects with and without diabetes. Clin Physiol 1991; 11:21–25.
Taguchi J.T., Suwangool P. “Pipe-stem” brachial arteries: A cause of pseudo hypertension. JAMA 1974; 228: 733.
Ouriel K, Zarins C.K. Doppler ankle pressure: An evaluation of three methods of expression. Arch Surg 1982; 117: 1297–300.
Kempczinski RF. Segmental volume plethysmography in the diagnosis of lower extremity arterial disease. J Cardiovasc Surg 1982; 23: 125–29.
Darling R.C, Raines J.K, Brener B.J, Austen W.G. Quantitative segmental pulse volume recorder: A clinical tool. Surgery 1972; 6: 873–87.
Symes J.F, Graham A.M, Mousseau M. Doppler waveform analysis versus segmental pressure and pulse-volume recording: Assessment of occlusive disease in the lower extremity. Can J Surg. Jul 1984; 27(4):345-347.
Carter S.A. Response of ankle systolic pressure to leg exercise in mild or questionable arterial disease. N Engl J Med 1972; 287: 578–82.
Ouriel K, McDonnell AE, Metz CE, Zarins CK. Critical evaluation of stress testing in the diagnosis of peripheral vascular disease. Surgery 1982; 91: 686–93.
Melov S, Shoffner JM, Kaufman A, Wallace DC. Marked increase in the number and variety of mitochondrial DNA rearrangements in aging human skeletal muscle. Nucleic Acids Res. 1995; 23:4122–4126.
Stewart KJ, Hiatt WR, Regensteiner JG, Hirsch AT. Exercise training for claudication. N Engl J Med. 2002; 347:1941
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