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Below-the-ankle arterial disease: a new marker of coronary artery disease in patients with diabetes and foot ulcers

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A Letter to the Editor to this article was published on 18 July 2023

Abstract

Aim

The aim of the current study is to evaluate the association between below-the-ankle (BTA) arterial disease and coronary artery disease (CAD) in patients with diabetic foot ulcers (DFUs).

Methods

The study group was composed of patients with an active neuro-ischaemic DFUs managed in a tertiary care diabetic foot clinic. All patients received a pre-set limb salvage protocol including lower limb revascularization. By a retrospective analysis of individual angiograms, patients were divided in two groups: below-the-ankle (BTA) and above-the-ankle (ATA) arterial disease groups. The rate of CAD at baseline assessment and the new events of acute myocardial ischaemia (AMI) during 1-year of follow-up were evaluated and compared between the two groups.

Results

Two hundreds seventy-two (272) patients were included, 120 (44.1%) showed BTA arterial disease while 152 (55.9%) ATA arterial disease. The mean age was 68.9 ± 9.6 years, 198 (72.8%) were male, 246 (90.4%) had type 2 diabetes, the mean diabetes duration was 20.7 ± 11.6 years, the mean HbA1c was 7.8 ± 4.2% (62 ± 22 mmmol/mol). The whole population reported CAD in 172 cases (63.4%), and the rate in the BTA group was significantly higher than in ATA group, respectively, 90 (75.4%) vs 82 (54.1%), p < 0.0001. During the follow-up, BTA group had 5% of new cases of AMI in comparison to 1.3% in ATA group (p < 0.001). At the multivariate analysis BTA resulted an independent marker of CAD [OR 1.9 CI 9 5% (1.3–4.5) p = 0.0001].

Conclusion

The current study shows a significant association between BTA arterial disease and CAD. A close cardiovascular screen should be required in patients with DFUs.

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Authors and Affiliations

  1. Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy

    Marco Meloni, Alfonso Bellia, Laura Giurato & Davide Lauro

  2. University Hospital Fondazione Policlinico Tor Vergata, Rome, Italy

    Marco Meloni, Alfonso Bellia, Laura Giurato & Davide Lauro

  3. CTO Andrea Alesini Hospital, Division of Endocrinology and Diabetes Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy

    Luigi Uccioli

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Meloni, M., Bellia, A., Giurato, L. et al. Below-the-ankle arterial disease: a new marker of coronary artery disease in patients with diabetes and foot ulcers. Acta Diabetol 59, 1331–1338 (2022). https://doi.org/10.1007/s00592-022-01932-w

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