Peripheral arterial disease and diabetes

Atenolol, betaxolol, bisoprolol, and metoprolol are cardioselective /3 -blockers. Therefore, they are safer than nonselective fi -blockers in patients with asthma, COPD, peripheral arterial disease, and diabetes who have a compeUing indication for a /6-blocker. However, cardioselectivity is a dose-dependent phenomenon. At higher doses, cardioselective agents lose their relative selectivity for /6i-receptors and block /32-receptors as effectively as they block /6i-receptors. The dose at which cardioselectivity is lost varies from patient to patient. In general, cardioselective /6-blockers are preferred when using a /3-blocker to treat hypertension. 

The HPS (I I) provided further important answers, Among 20,536 patients aged 40 to 80 years with CHD, cerebrovascular or peripheral arterial disease or diabetes, simvastatin reduced all-cause mortality from 14.7% to 12.9% (P = 0,0003). The reduction in vascular events was similar and significant in important prespecified subgroups. These included those in whom there had been residual uncertainty, including patients with manifestations of vascular disease other than CHD, women, those aged over 70 years at baseline, and those with LDL or total cholesterol levels less than 3.0 or 5,0mmol/L (116 or 193 mg/dL), respectively. 

Siitonen O, VusitupaM, Pyorala K, Voutilainen E, Lansimies E. Peripheral arterial disease and its relationship to cardiovascular risk factors and coronary artery disease in newly diagnosed non-insuUn dependent diabetes mellitus. Act Med Scand 1986 220 205-212. 

Clearly, diabetics who have peripheral arterial disease have higher mortality rates than those who do not have arterial disease. A recent study by Vogt et al. (15) evaluated the relationship between peripheral arterial disease and mortality in a population of close to 2000 individuals over a 13-year period. All patients 50 years of age and older with no history of lower extremity surgery were evaluated for the presence of peripheral arterial disease. Analysis of the data stratified by populations and comorbid conditions showed that a low ankle-brachial index is an independent predictor of all causes of mortality in both men and women with peripheral arterial disease. This increase is a relative risk and is unchanged after exclusions of all patients with a clinical history of cardiovascular disease or diabetes. Thus, a low ankle-brachial index is an important measurement to obtain to assess the risk of mortality among those who smoke and have either angina or diabetes. 

As the prevalence of obesity increases worldwide, so does the prevalence of associated co-morbidities type-2 diabetes, chronic obstructive sleep apnoea, cardiovascular disease (hyper-tension, coronary artery disease and congestive heart failure, stroke and peripheral vascular disease), fatty liver disease, various malignancies (Table 7.2), gallstones, subfertility, musculo-skeletal problems and depression. 

Reduction in risk of Ml, stroke, and death from cardiovascular causes - In patients 55 years of age or older at high risk of developing a major cardiovascular event because of a history of coronary artery disease, stroke, peripheral vascular disease, or diabetes that is accompanied by at least 1 other cardiovascular risk factor (eg, hypertension, elevated total cholesterol levels, low FIDL levels, cigarette smoking, documented microalbuminuria). 

The book is comprised of five sections with part I covering systemic and endoluminal therapy with an incisive overview of hemostasis and thrombosis part II covers local therapy with several chapters devoted to drug-eluting stents and restenosis therapies part III covers cell therapy and therapeutic angiogenesis and includes chapters on cell transplantation and clinical trials in cellular therapy part IV covers adjunctive pharmacotherapy with chapters devoted to various patient populations including those with heart failure, diabetes, atrial fibrillation, peripheral artery disease,... 

Type 2 diabetes and insulin resistance per se are frequently associated with dyslipidemia (i.e., borderline elevation of LDL cholesterol, elevated triglycerides, and low HDL cholesterol), and a markedly increased incidence of atherosclerotic disease (i.e., coronary, cerebral, and peripheral artery disease). Atherosclerotic cardiovascular disease is... 

Elam MB, Hunninghake DB, Davis KB, et al. Effect of niacin on lipid and lipoprotein levels and glycemic control in patients with diabetes and peripheral arterial disease The ADMIT study. A randomized trial. Arterial Disease Multiple Intervention Trial. JAMA 2000 284 1263-1270. 

Neri Semeri GG, Coccheri S, Marubini E, Violi F (2004) Picotamide, a combined inhibitor of thromboxane A2 synthase and receptor, reduces 2-year mortality in diabetics with peripheral arterial disease the DAVID study. Eur Heart 125 1845-1852... 

This chapter will review the available studies that report the incidence and prevalence of peripheral vascular disease in both type 1 and type 2 diabetic patients. It will focus not only on risk factors associated with the development of peripheral arterial disease, but also touch on pathophysiologic changes that may help to account for some epidemiologic trends. Lastly, it will highlight differences between diabetic and nondiabetic subjects concerning localization of disease and its association with mortality and limb loss. 

Strandness DE Jr, Priest RE, Gibbons GE. Combined clinical and pathologic study of diabetic and nondiabetic peripheral arterial disease. Diabetes 1964 13 366-372. 

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