Prognostic Usefulness of Metabolic Syndrome Compared with Diabetes in Korean Patients with Critical Lower Limb Ischemia Treated with Percutaneous Transluminal Angioplasty

Overview

Journal Yonsei Med J

Specialty General Medicine

Date 2013 Dec 17

PMID 24339286

Citations 2

Authors

Ki-Bum Won

Hyuk-Jae Chang

Sung-Jin Hong

Young-Guk Ko

Myeong-Ki Hong

Yangsoo Jang

Donghoon Choi

Affiliations

Soon will be listed here.

Abstract

Purpose: Metabolic syndrome (MS) is a clinical condition that shares many common characteristics with diabetes. However, unlike diabetes, the usefulness of MS as a prognostic entity in peripheral arterial disease is uncertain. This study evaluated the prognostic usefulness of MS in critical lower limb ischemia (CLI) patients.

Materials And Methods: We compared the 2-year clinical outcomes in 101 consecutive CLI patients (66±14 years; 78% men) with 118 affected limbs treated with percutaneous transluminal angioplasty (PTA) according to the presence of MS and diabetes.

Results: The number of MS patients was 53 (52%), of which 45 (85%) had diabetes. During a 2-year follow-up, the incidence of clinical outcomes, including reintervention, major amputation, minor amputation, and survival, was not significantly different between MS and non-MS patients; however, the incidence of minor amputation was significantly higher in diabetic than in non-diabetic patients (42% vs. 17%; p=0.011). Cox regression analysis for the 2-year primary patency demonstrated no association between MS and 2-year primary patency [hazard ratio (HR), 1.02; 95% confidence interval (CI), 0.45-2.30; p=0.961], whereas there was a significant association between diabetes and 2-year primary patency (HR, 2.81; 95% CI, 1.02-7.72; p=0.046). Kaplan-Meier analysis revealed no significant difference in the 2-year primary patency between MS and non-MS patients; however, the 2-year primary patency was lower in diabetic than in non-diabetic patients (p=0.038).

Conclusion: As a prognostic concept, MS might conceal the adverse impact of diabetes on the prognosis of CLI patients treated with PTA.

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References

Simmons R, Alberti K, Gale E, Colagiuri S, Tuomilehto J, Qiao Q . The metabolic syndrome: useful concept or clinical tool? Report of a WHO Expert Consultation. Diabetologia. 2009; 53(4):600-5. DOI: 10.1007/s00125-009-1620-4. View

Hwang M, Chung W, Gallagher D, Kim D, Shin H, Song M . How useful is waist circumference for assessment of abdominal obesity in Korean pre-menopausal women during weight loss?. Asia Pac J Clin Nutr. 2008; 17(2):229-34. PMC: 2861982. View

Lim S, Shin H, Song J, Kwak S, Kang S, Yoon J . Increasing prevalence of metabolic syndrome in Korea: the Korean National Health and Nutrition Examination Survey for 1998-2007. Diabetes Care. 2011; 34(6):1323-8. PMC: 3114326. DOI: 10.2337/dc10-2109. View

Klein B, Klein R, Lee K . Components of the metabolic syndrome and risk of cardiovascular disease and diabetes in Beaver Dam. Diabetes Care. 2002; 25(10):1790-4. DOI: 10.2337/diacare.25.10.1790. View

Ferraresi R, Centola M, Ferlini M, Da Ros R, Caravaggi C, Assaloni R . Long-term outcomes after angioplasty of isolated, below-the-knee arteries in diabetic patients with critical limb ischaemia. Eur J Vasc Endovasc Surg. 2008; 37(3):336-42. DOI: 10.1016/j.ejvs.2008.12.001. View

Stern M, Williams K, Gonzalez-Villalpando C, Hunt K, Haffner S . Does the metabolic syndrome improve identification of individuals at risk of type 2 diabetes and/or cardiovascular disease?. Diabetes Care. 2004; 27(11):2676-81. DOI: 10.2337/diacare.27.11.2676. View

. Long-term mortality and its predictors in patients with critical leg ischaemia. The I.C.A.I. Group (Gruppo di Studio dell'Ischemia Cronica Critica degli Arti Inferiori). The Study Group of Criticial Chronic Ischemia of the Lower Exremities. Eur J Vasc Endovasc Surg. 1997; 14(2):91-5. View

Gupta A, Prieto-Merino D, Dahlof B, Sever P, Poulter N . Metabolic syndrome, impaired fasting glucose and obesity, as predictors of incident diabetes in 14 120 hypertensive patients of ASCOT-BPLA: comparison of their relative predictability using a novel approach. Diabet Med. 2011; 28(8):941-7. DOI: 10.1111/j.1464-5491.2011.03330.x. View

Levey A, Coresh J, Balk E, Kausz A, Levin A, Steffes M . National Kidney Foundation practice guidelines for chronic kidney disease: evaluation, classification, and stratification. Ann Intern Med. 2003; 139(2):137-47. DOI: 10.7326/0003-4819-139-2-200307150-00013. View

10.

. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001; 285(19):2486-97. DOI: 10.1001/jama.285.19.2486. View

11.

Alexander C, Landsman P, Teutsch S, Haffner S . NCEP-defined metabolic syndrome, diabetes, and prevalence of coronary heart disease among NHANES III participants age 50 years and older. Diabetes. 2003; 52(5):1210-4. DOI: 10.2337/diabetes.52.5.1210. View

12.

Koehler C, Ott P, Benke I, Hanefeld M . Comparison of the prevalence of the metabolic syndrome by WHO, AHA/NHLBI, and IDF definitions in a German population with type 2 diabetes: the Diabetes in Germany (DIG) Study. Horm Metab Res. 2007; 39(9):632-5. DOI: 10.1055/s-2007-985816. View

13.

Cheng S, Ting A, Lau H, Wong J . Survival in patients with chronic lower extremity ischemia: a risk factor analysis. Ann Vasc Surg. 2000; 14(2):158-65. DOI: 10.1007/s100169910028. View

14.

Larsen J, Brekke M, Bergengen L, Sandvik L, Arnesen H, Hanssen K . Mean HbA1c over 18 years predicts carotid intima media thickness in women with type 1 diabetes. Diabetologia. 2005; 48(4):776-9. DOI: 10.1007/s00125-005-1700-z. View

15.

Rutherford R, Baker J, Ernst C, Johnston K, Porter J, Ahn S . Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg. 1997; 26(3):517-38. DOI: 10.1016/s0741-5214(97)70045-4. View

16.

Won K, Chang H, Kim H, Jeon K, Lee H, Shin S . Differential impact of metabolic syndrome on subclinical atherosclerosis according to the presence of diabetes. Cardiovasc Diabetol. 2013; 12:41. PMC: 3599532. DOI: 10.1186/1475-2840-12-41. View

17.

Nakanishi N, Takatorige T, Fukuda H, Shirai K, Li W, Okamoto M . Components of the metabolic syndrome as predictors of cardiovascular disease and type 2 diabetes in middle-aged Japanese men. Diabetes Res Clin Pract. 2004; 64(1):59-70. DOI: 10.1016/j.diabres.2003.10.001. View

18.

Faglia E, Dalla Paola L, Clerici G, Clerissi J, Graziani L, Fusaro M . Peripheral angioplasty as the first-choice revascularization procedure in diabetic patients with critical limb ischemia: prospective study of 993 consecutive patients hospitalized and followed between 1999 and 2003. Eur J Vasc Endovasc Surg. 2005; 29(6):620-7. DOI: 10.1016/j.ejvs.2005.02.035. View

19.

Gurka M, Ice C, Sun S, DeBoer M . A confirmatory factor analysis of the metabolic syndrome in adolescents: an examination of sex and racial/ethnic differences. Cardiovasc Diabetol. 2012; 11:128. PMC: 3489601. DOI: 10.1186/1475-2840-11-128. View

20.

Grundy S, Cleeman J, Daniels S, Donato K, Eckel R, Franklin B . Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation. 2005; 112(17):2735-52. DOI: 10.1161/CIRCULATIONAHA.105.169404. View