Microvascular disease quadruples the risk of amputation of the legs

The presence of microvascular disease anywhere in the body greatly increases the risk of leg amputation over the next decade, as shown by the results of a large study on American veterans. In addition, in patients with MAP, microvascular diseases such as retinopathy and neuropathy significantly increase the risk to the lower limbs.

After a median follow-up of 9.3 years, microvascular disease – even after adjusting for demographic characteristics, risk factors for CVD and other potential confounding factors – was badociated with a risk amputation of the legs almost four times greater, while a diagnosis of MAP alone was badociated with a 14-fold increase in the rate of amputation.

"If you had both peripheral arterial disease and microvascular disease, compared to people without any of these things, you had a risk of amputation greater than 23 times over 10 years," he said. author Joshua A. Beckman, MD TN), said TCTMD. "It's literally like putting a match on gas."

In their article, published online on July 8, 2019, before its publication at circulationBeckman and colleagues report that the results suggest that microvascular disease plays "an important and independent role" under conditions that increase the risk of amputation. Beckman added that, according to TCTMD, these data allowed to paint a picture of these diseases as "big phenotype", which suggests a systemic phenomenon.

Higher risk regardless of the location of microvascular disease

The study included data from the cohort study on aging veterans covering 125,674 veterans, mostly men, with no history of amputation. Microvascular diseases accounted for 18% of all amputations, 21% of foot amputations, 15% of sub-knee amputations and 6% of above-knee amputations. The microvascular disease and MAP badociation accounted for 45% of all amputations and was badociated with the highest percentage of amputations at all limb levels. Beckman and his colleagues also found that patients with microvascular disease were more likely to have amputation under the ankle, while those with MAP were more likely to have amputation under the knee or under the knee.

In subgroup badyzes of diabetic patients, microvascular disease alone was badociated with a risk of amputation three times higher and MAP alone at an increased risk of 7.9 times. The combination of both in diabetic patients conferred an increased risk of amputation of 15.9 times.

At a minimum, if you have microvascular disease in any place, you should start by warning patients to pay attention to their feet. Joshua Beckman

MACE was produced at a rate of 24 events per 1,000 person-years during the study period. "Unlike the strong badociation between microvascular disease and amputation, we describe a more modest relationship for myocardial infarction, coronary revascularization, and death," Beckman and colleagues write.

The findings have direct implications for clinical practice, Beckman said.

"At a minimum, if you have microvascular disease in any place, you should start by warning patients to pay attention to their feet. In this study, one out of six amputations came from the group that had only microvascular disease, "he said. Beckman also pointed out that clinicians should not be concerned only about their diabetic patients because the impact of microvascular disease observed here was the same for everyone. "Diabetes is only a very common way of getting microvascular disease, but it's not the only one," he added.

In their article, the researchers note that although they can not exclude the possibility that some patients may have undiagnosed diabetes, "undiagnosed diabetes is unlikely to significantly contribute to outcomes in our non-diabetic population. ".

Beckman said his advice to doctors was that any microvascular disease, even in the eyes, "should force you to remove shoes and socks." You have to look at the feet.

For specialists or other people who might not be comfortable with the foot exams, his advice was simple: "If anyone has a foot sore, it should be improved from time to time." minus 50% after 2 weeks. If this is not the case, it is the signal to send them to a podiatrist, or to a cardiovascular specialist if you examine them and there are no legumes. We can do a lot of prevention work by finding solutions sooner and by ensuring that people receive wound care, unload their feet or, if they need it, revascularize. "