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Results of Blood Inflammatory Markers Are Associated More Strongly With Toe-Brachial Index Than With Ankle-Brachial Index in Patients With Type 2 Diabetes

¹ Department of Internal Medicine, Koshigaya Hospital, Dokkyo University School of Medicine, Koshigaya, Japan
² Department of Cardiology, Koshigaya Hospital, Dokkyo University School of Medicine, Koshigaya, Japan

Address correspondence and reprint requests to Yoshimasa Aso, MD, Department of Internal Medicine, Dokkyo University School of Medicine, Koshigaya Hospital, Saitama, Japan. E-mail: yaso{at}dokkyomed.ac.jp

OBJECTIVE—Three blood markers of inflammation (high-sensitivity C-reactive protein [hsCRP], interleukin [IL]-6, and fibrinogen) were compared with markers of atherosclerotic cardiovascular disease (CVD) (history of stroke or cardiac ischemia and measured toe-brachial index [TBI]) to determine whether inflammatory markers are associated with atherosclerosis in patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS—Of 103 patients with type 2 diabetes, 26 had CVD. TBI was plethysmographically determined in both great toes. Serum hsCRP was immunonephelometrically determined. Plasma IL-6 was measured by an enzyme immunoassay.

RESULTS—Both ABI and TBI were lower in diabetic patients with CVD than in those without CVD (1.05 ± 0.19 vs. 1.14 ± 0.09, P < 0.05, and 0.75 ± 0.20 vs. 0.95 ± 0.21, P < 0.001, respectively). By linear regression, right TBI but not right ABI showed a significant negative correlation with serum hsCRP (r = –0.372, P < 0.01) and plasma fibrinogen (r = –0.224, P < 0.05). Serum hsCRP was also negatively correlated with lower TBI, but not lower ABI. We found no significant correlation between plasma IL-6 and ABI or TBI.

CONCLUSIONS—TBI was strongly associated with CVD, serum hsCRP, and plasma fibrinogen. Of these inflammatory markers, serum hsCRP may be the most promising marker for vascular inflammation.

Abbreviations: ABI, ankle-brachial index • CRP, C-reactive protein • CVD, cardiovascular disease • hsCRP, high-sensitivity CRP • IL, interleukin • PVD, peripheral vascular disease • TBI, toe-brachial index

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