Abstract 13418: Atherosclerotic Risk Factors and Biomarkers Among Diabetics with Subclavian Stenosis: The Penn Diabetes Health Study
Introduction: Subclavian stenosis (SS) is clinically defined as >15 mm difference in the brachial systolic arm pressures. Previous epidemiologic studies have identified an increased incidence of SS among those with diabetes, though there is little data regarding risk factor or biomarker correlates in the diabetic population. We hypothesized that SS would be prevalent in the diabetic population and be associated with biomarkers formerly linked to peripheral arterial disease.
Methods: Within the Penn Diabetes Heart Study (PDHS, N = 1856, 36% women, 61% Caucasian), a cross-sectional study of diabetic individuals without clinical cardiovascular disease, we used ANOVA, the chi-square test and logistic regression to compare CVD risk factors and biomarkers among those with and without SS (defined as brachial arm pressure difference > 15 mm Hg).
Results: SS was present in 12.2% in the PDHS cohort. Those with SS were more likely to be female (46.7% vs 34.7%) and have a greater body mass index (BMI) (33.9 vs 32.5 lb/in2; both p < 0.01). Age, hypertension, hyperlipidemia, insulin use, and smoking status did not differ among the groups. C-reactive protein and Lp(a) levels were not different, but leptin levels were higher in those with SS (+23.5%; p < 0.01), even in models accounting for BMI. Patients with SS were more likely to have an ankle-brachial index < 0.9 (OR 2.0, CI 1.37 - 3.0, p < 0.01) despite the incorporation of multiple traditional and non-traditional CVD risk factors. SS was not associated with an increased prevalence of coronary artery calcium (65.0% vs 63.7%, p = 0.69).
Conclusion: The prevalence of SS among diabetics without overt cardiovascular disease is higher than that reported in non-diabetic populations, and occurred more frequently in tandem with other indices of peripheral, but not coronary, atherosclerosis. In addition, the relationship between leptin, body mass index and SS has not formerly been reported, and provides a framework for the mechanistic investigation of the link between obesity and SS.
- © 2012 by American Heart Association, Inc.