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PERIPHERAL ARTERIAL DISEASE PROGRESSION IN THE BYPASS ANGIOPLASTY REVASCULARIZATION INVESTIGATION 2 DIABETES TRIAL
A156.E1462 JACC Maarch 9, 2010 Volume 55, issue 10A
VASCULAR DISEASE PERIPHERAL ARTERIAL DISEASE PROGRESSION IN THE BYPASS ANGIOPLASTY REVASCULARIZATION INVESTIGATION 2 DIABETES TRIAL ACC Poster Contributions Georgia World Congress Center, Hall B5 Sunday, March 14, 2010, 9:30 a.m.-10:30 a.m.
Session Title: Peripheral Arterial/Carotid Disease/Aortic Disease Abstract Category: Peripheral Arterial/Carotid Disease/Aortic Disease Presentation Number: 1055-341 Authors: J. Dawn Abbott, Manuel Lombardero, Jean-Claude Tardif, Ivan Pena-Sing, Luisa Buitron, Prem Singh, Gail Woodhead, Greg Barsness, Sherry Kelsey, BARI 2D Investigators, Brown University, Providence, RI, University of Pittsburgh, Pittsburgh, PA Background: The rate of peripheral arterial disease (PAD) progression among patients with type 2 diabetes (T2DM) and coronary artery disease (CAD) receiving aggressive medical therapy and according to glycemic treatment is unknown. Methods: We analyzed the incidence of PAD in 1,389 patients in the BARI 2D trial who had a normal ankle brachial index (ABI; 0.91-1.3) at baseline and ABI assessed beyond baseline. Incident PAD was defined as a new low ABI (≤0.9) during annual follow-up. Arterial stiffness was defined as a new non-compressible ankle artery. Results: Newly manifest PAD was diagnosed in 6.9% of patients at year 1, 6.8% at year 2, and 5.4% at year 5. New arterial stiffness was identified in 3.4% of patients at year 1, 2.7% at year 2, and 3.9% at year 5. In patients randomized within BARI2D to the insulin sensitizing compared to insulin providing strategy, the rate of a new low ABI was significantly lower (p=0.0005) (Table), while the rate of new arterial stiffness was similar (p>0.5). Conclusions: Despite aggressive medical therapy and risk modification, a significant proportion of patients with T2DM and CAD developed newly manifest PAD or non-compressible ankle arteries during follow-up, suggesting that high risk patients should be routinely screened for PAD. Additionally, in T2DM, an insulin sensitizing glycemic strategy may be associated with less progression of lower extremity vascular disease and is an area that deserves further study. Annual Incidence of a NEW Low Ankle Brachial Index By Glycemic Strategy Insulin Providing Strategy Year N % with NEW low ABI 1 662 6.8 2 585 8.7 3 527 5.5 4 425 6.6 5 235 7.2 6 122 4.9 P=0.0005
Insulin Sensitizing Strategy N 673 603 554 465 281 132
% with NEW low ABI 7.0 5.0 3.4 3.4 3.9 1.5
VASCULAR DISEASE PERIPHERAL ARTERIAL DISEASE PROGRESSION IN THE BYPASS ANGIOPLASTY REVASCULARIZATION INVESTIGATION 2 DIABETES TRIAL ACC Poster Contributions Georgia World Congress Center, Hall B5 Sunday, March 14, 2010, 9:30 a.m.-10:30 a.m.
Session Title: Peripheral Arterial/Carotid Disease/Aortic Disease Abstract Category: Peripheral Arterial/Carotid Disease/Aortic Disease Presentation Number: 1055-341 Authors: J. Dawn Abbott, Manuel Lombardero, Jean-Claude Tardif, Ivan Pena-Sing, Luisa Buitron, Prem Singh, Gail Woodhead, Greg Barsness, Sherry Kelsey, BARI 2D Investigators, Brown University, Providence, RI, University of Pittsburgh, Pittsburgh, PA Background: The rate of peripheral arterial disease (PAD) progression among patients with type 2 diabetes (T2DM) and coronary artery disease (CAD) receiving aggressive medical therapy and according to glycemic treatment is unknown. Methods: We analyzed the incidence of PAD in 1,389 patients in the BARI 2D trial who had a normal ankle brachial index (ABI; 0.91-1.3) at baseline and ABI assessed beyond baseline. Incident PAD was defined as a new low ABI (≤0.9) during annual follow-up. Arterial stiffness was defined as a new non-compressible ankle artery. Results: Newly manifest PAD was diagnosed in 6.9% of patients at year 1, 6.8% at year 2, and 5.4% at year 5. New arterial stiffness was identified in 3.4% of patients at year 1, 2.7% at year 2, and 3.9% at year 5. In patients randomized within BARI2D to the insulin sensitizing compared to insulin providing strategy, the rate of a new low ABI was significantly lower (p=0.0005) (Table), while the rate of new arterial stiffness was similar (p>0.5). Conclusions: Despite aggressive medical therapy and risk modification, a significant proportion of patients with T2DM and CAD developed newly manifest PAD or non-compressible ankle arteries during follow-up, suggesting that high risk patients should be routinely screened for PAD. Additionally, in T2DM, an insulin sensitizing glycemic strategy may be associated with less progression of lower extremity vascular disease and is an area that deserves further study. Annual Incidence of a NEW Low Ankle Brachial Index By Glycemic Strategy Insulin Providing Strategy Year N % with NEW low ABI 1 662 6.8 2 585 8.7 3 527 5.5 4 425 6.6 5 235 7.2 6 122 4.9 P=0.0005
Insulin Sensitizing Strategy N 673 603 554 465 281 132
% with NEW low ABI 7.0 5.0 3.4 3.4 3.9 1.5