Low Adherence to Guideline for the Control of Major Cardiovascular Risk Factors in Diabetic Patients with Peripheral Arterial Disease: A Study in Northern Part of Thailand
Keywords:
blood pressure, diabetes, dyslipidemia, peripheral arterial disease, smokingAbstract
Objective: The control of major cardiovascular risk factors is an important issue in the treatment of patients withperipheral arterial diseases (PAD), and several large trials and many guidelines have stressed the importance of
detection and treatment of these risk factors. This is even critical in diabetic patients with PAD because such patients
carry higher risk of cardiovascular problem than non diabetic patients. However, it is not known to what extent this has
been applied to such patients. The objective of this study was to investigate the adequacy of risk factor management
in diabetic patients with PAD.
Methods: A cross-sectional study was conducted in 286 consecutive diabetic patients with PAD. A medical
history, medication history, and fasting venous blood sample were taken for each patient. The plasma concentrations
of cholesterol were determined. PAD was diagnosed when patients had low ankle brachial index (≤ 0.9). Then we
classified whether patients had good or poor control in each criteria according to the recommended guidelines between
PAD and non PAD.
Results: There were 2,247 diabetic patients, 874 (38.9) males and 1373 (61.1) females. Among them were 286
PAD patients. Diabetic patients with PAD had histories of cardiovascular events (angina pectoris, myocardial infarction,
unstable angina, stroke and transient ischemic attack) more than those without PAD. Apart from smoking, the
percentage of appropriate control of risk factors was around only 15-30% in PAD patients. When authors focused on
further details between non PAD, mild PAD and severe PAD, severe PAD had lower BMI and lower waist circumference
than those in other groups. Eighteen out of 286 PAD patients were still smoking.
Conclusion: Although the risk factors in vascular disease management are well understood and many guidelines
have been published, they do not seem to be well managed in diabetic patients with PAD.
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Fowkes FG. Inter-society consensus for the management of
peripheral arterial disease (TASC II). J Vas Surg 2007;45 Suppl
S:S5-67.
3. Hirsch AT, Haskal ZJ, Hertzer NR, Bakal CW, Creager MA,
Halperin JL, et al. ACC/AHA 2005 guidelines for the
management of patients with peripheral arterial disease
(lower extremity, renal, mesenteric, and abdominal aortic):
executive summary a collaborative report from the American
Association for Vascular Surgery/Society for Vascular Surgery,
Society for Cardiovascular Angiography and Interventions,
Society for Vascular Medicine and Biology, Society of
Interventional Radiology, and the ACC/AHA Task Force on
Practice Guidelines. J Am Coll Cardiol 2006;47:1239-312.
4. Rooke TW, Hirsch AT, Misra S, Sidawy AN, Beckman JA, Findeiss
LK, et al. 2011 ACCF/AHA focused update of the guideline for
the management of patients with peripheral artery disease
(updating the 2005 guideline): a report of the American
College of Cardiology Foundation/American Heart
Association Task Force on Practice Guidelines. J Am Coll
Cardiol 2011;58:2020-45.
5. Thai Medical Council TRCoPoT. Guideline for tertiary care in
arterial disease prevention Bangkok: 2011.
6. Aspry KE, Holcroft JW, Amsterdam EA. Physician recognition of
hypercholesterolemia in patients undergoing peripheral and
carotid artery revascularization. Am J Prev Med 1995;11:336-
41.
7. Musser DJ, Nicholas GG, Reed JF 3rd. Death and adverse
cardiac events after carotid endarterectomy. J Vas Surg
1994;19:615-22.
8. Talbert RL. New therapeutic options in the National Cholesterol
Education Program Adult Treatment Panel III. Am J Managed
Care 2002;8:S301-7.
9. Joensuu T, Salonen R, Winblad I, Korpela H, Salonen JT.
Determinants of femoral and carotid artery atherosclerosis. J
Int Med 1994;236:79-84.
10. Rittoo D, Cramb R, Odogwu S, Khaira H, Duddy M, Smith S, et
al. Worsening lipid profile is associated with progression of
carotid artery stenosis. Int Angiol 2001;20:47-50.
11. Das MB, Hertzer NR, Ratliff NB, O’Hara PJ, Beven EG. Recurrent
carotid stenosis. A five-year series of 65 reoperations. Ann Surg
1985;202:28-35.
12. Rapp JH, Qvarfordt P, Krupski WC, Ehrenfeld WK, Stoney RJ.
Hypercholesterolemia and early restenosis after carotid
endarterectomy. Surgery 1987;101:277-82.
13. Furberg CD, Adams HP Jr, Applegate WB, Byington RP,
Espeland MA, Hartwell T, et al. Effect of lovastatin on early
carotid atherosclerosis and cardiovascular events.
Asymptomatic Carotid Artery Progression Study (ACAPS)
Research Group. Circulation 1994;90:1679-87.
14. Cuming R, Worrell P, Woolcock NE, Franks PJ, Greenhalgh RM,
Powell JT. The influence of smoking and lipids on restenosis
after carotid endarterectomy. Eur J Vas Surg 1993;7:572-6.
15. Ockene IS, Miller NH. Cigarette smoking, cardiovascular
disease, and stroke: a statement for healthcare professionals
from the American Heart Association. American Heart
Association Task Force on Risk Reduction. Circulation 1997;
96:3243-7.
16. Wolf PA, D’Agostino RB, Kannel WB, Bonita R, Belanger AJ.
Cigarette smoking as a risk factor for stroke. The Framingham
Study. JAMA 1988;259:1025-9.
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Published
2015-06-30
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Arworn S, Orrapin S, Kosachunhanun N, Sony K, Inpankaew N, Rerkasem K. Low Adherence to Guideline for the Control of Major Cardiovascular Risk Factors in Diabetic Patients with Peripheral Arterial Disease: A Study in Northern Part of Thailand. Thai J Surg [Internet]. 2015 Jun. 30 [cited 2024 Nov. 6];36(2). Available from: https://he02.tci-thaijo.org/index.php/ThaiJSurg/article/view/226195
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