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Fauzi NBM, Huang X, Cheng LJ, Luo N, Hilal S. Association of a healthy ageing index with health-related outcomes in a multi-ethnic cohort from Singapore. BMC Geriatr 2024; 24:508. [PMID: 38862903 PMCID: PMC11165847 DOI: 10.1186/s12877-024-05099-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 05/21/2024] [Indexed: 06/13/2024] Open
Abstract
BACKGROUND The global population is ageing rapidly and it is important to promote healthy ageing. The Healthy Ageing Index (HAI) is a comprehensive measure of health, but there is limited research on its association with other age-related outcomes. The management of an aging population necessitates considerations even among generally healthy adults, as age-related diseases often remain unaccounted for until later stages of life. This study explores the association of risk factors with HAI and its association with peripheral artery disease (PAD), muscle strength, health-related quality of life (HRQoL), and psychological distress in the Singapore Multi-Ethnic Cohort study. METHODS This cross-sectional study involved 1909 participants (median (Q1, Q3) age: 53 (48, 60) years and 59.3% females) from Singapore Multi-Ethnic Cohort study. The risk factors of HAI included age, gender, ethnicity, education level, smoking, alcohol consumption, employment, BMI and past medical histories. PAD was assessed using ankle-brachial index (ABI), handgrip strength (HGS), HRQoL with the EQ-5D-5 L questionnaire and psychological distress via the Kessler Psychological Distress Scale (K10). HAI components were assessed using relevant marker tests. RESULTS Older age, Malay and Indian ethnicities, unemployment, high BMI and histories of CHD, hypercholesterolaemia, tumours and TIA/stroke were associated with lower HAI scores indicative of poorer health. Higher HAI scores were associated with females and higher education levels. Lower HAI scores were significantly associated with low ABI, high K10 scores, mobility and anxiety/depression dimensions of EQ-5D-5 L. CONCLUSION The most important factors associated with HAI were age, sex, ethnicity, education, unemployment, BMI and a history of health conditions. Lower HAI scores were significantly associated with PAD, lower HRQoL and psychological distress. Thus, the HAI demonstrates promise as an evaluation method for assessing PAD, overall muscle strength and HRQoL in a population-based setting.
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Affiliation(s)
- Nazira Binte Muhammad Fauzi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building, 12 Science Drive 2, #10-03U, 117549, Singapore, Singapore
| | - Xiangyuan Huang
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building, 12 Science Drive 2, #10-03U, 117549, Singapore, Singapore
| | - Ling Jie Cheng
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building, 12 Science Drive 2, #10-03U, 117549, Singapore, Singapore
| | - Nan Luo
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building, 12 Science Drive 2, #10-03U, 117549, Singapore, Singapore
| | - Saima Hilal
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Tahir Foundation Building, 12 Science Drive 2, #10-03U, 117549, Singapore, Singapore.
- Department of Pharmacology, National University of Singapore, Singapore, Singapore.
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Phate NG, Kumar S, Acharya S, Agrawal SR, Wanjari A, Wakode M, Gemnani RR. Ankle brachial index and its correlation with cardiovascular risk factors in pre-diabetes: Two-year cross-sectional study. J Family Med Prim Care 2023; 12:2894-2902. [PMID: 38186819 PMCID: PMC10771145 DOI: 10.4103/jfmpc.jfmpc_227_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 01/09/2024] Open
Abstract
Background A state of impaired glucose tolerance is called prediabetes. The diagnosis of prediabetes is controversial, yet it still puts a person at risk for developing diabetes. The ankle-brachial index (ABI) is useful for identifying persons at risk for peripheral artery disease and for diagnosing the condition in those who have symptoms in their lower extremities and subclinical atherosclerosis. This study highlights ABI and its correlation with cardiovascular risk factors like lipid profile and anthropometric measurement including neck circumference in prediabetes so that primary care physicians may be able to diagnose early before advancing to diabetes. Materials and Methods This cross-sectional study of 2 years duration from December 2020 to September 2022 was conducted in the Department of Medicine, at a tertiary care teaching hospital situated in a rural area. Patients with pre-diabetes were enrolled and Ankle Brachial Index was calculated. The correlation of ABI with anthropometric measures and lipid profile was assessed. Results On calculating ABI by manual method 21% which is 42 out of 200 had low ABI (<0.9). On the other hand, on calculating ABI by probe method low range of ABI was found to be 37% which is 74 patients out of 200. There was a significant correlation between ABI and body mass index and lipid profile. The diagnostic performance of ABI < 0.9 had 56.8% sensitivity and 100.0% specificity. Conclusion ABI can be used as a noninvasive and cost-effective modality for assessing subclinical atherosclerosis in patients with prediabetes and thus prevent its morbid complications even assessed at the primary care physician level.
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Affiliation(s)
- Neha G. Phate
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, Maharashtra, India
| | - Sunil Kumar
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, Maharashtra, India
| | - Sourya Acharya
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, Maharashtra, India
| | - Sachin R. Agrawal
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, Maharashtra, India
| | - Anil Wanjari
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, Maharashtra, India
| | - Monish Wakode
- Department of Medicine, NKP Salve Institute of Medical Sciences, Nagpur, Maharashtra, India
| | - Rinkle R. Gemnani
- Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research (Deemed to be University), Wardha, Maharashtra, India
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Rerkasem A, Sripan P, Pongtam S, Ounjaijean S, Kulprachakarn K, Wongthanee A, Chaiwarith R, Supparatpinyo K, Salee P, Arworn S, Rerkasem K. The Prevalence and Risk Factors for Peripheral Arterial Disease in Adults Living With Human Immunodeficiency Virus. INT J LOW EXTR WOUND 2021; 22:332-338. [PMID: 33900138 DOI: 10.1177/15347346211009404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Adult patients with human immunodeficiency virus (HIV) appear to be at high risk of cardiovascular disease (CVD). Peripheral arterial disease (PAD) is particularly concerning as it is associated with myocardial infarction and stroke. Nevertheless, the incidence of PAD is still unknown. The authors prospectively recruited HIV-infected patients from the outpatient clinic of the Department of Internal Medicine in our center. We assessed ankle-brachial index (ABI) using the VaSera system™ (Fukuda Denshi Co., Ltd). Patients were grouped into 3 ABI levels: an ABI ≤0.90 was considered abnormal and evidence of PAD, an ABI 1.0 to 1.40 was considered normal, and 0.91 to 0.99 was considered borderline. Cardiovascular risk factors were compared across all 3 levels of ABI and were analyzed using multivariate ordinal logistic regression. Eight hundred ninety-two patients were recruited. The mean age was 42.9 ± 10.0 years and 458 (51.4%) were males. There were 704, 149, and 39 patients in the normal, borderline, and abnormal ABI groups, respectively. The latter group of 39 patients was considered to have PAD, yielding a prevalence of 4.37% (95% confidence interval [CI] 3.21-5.93). Sex ratio, age, education levels, smoking rate, body mass index (BMI), blood pressure, prevalence of comorbidities with hypertension and coronary heart disease, median triglyceride level, reduced kidney function and HIV-1 RNA undetectable ratio, duration of HIV diagnosis, and duration on antiretroviral treatment were significantly different among 3 ABI subgroups. Independent risk factors associated with PAD were being female (odds ratio [OR]: 2.86; 95% CI: 1.94-4.22), being <30 years of age (OR: 4.66; 95% CI: 2.78-7.81), being overweight (BMI 25-25.9; OR: 0.39; 95% CI: 0.20-0.76), being obese (BMI: 30; OR: 3.53; 95% CI: 1.51-8.22), having a diastolic blood pressure ≥80 mmHg (OR: 0.50; 95% CI: 0.35-0.71), and having detectable HIV-1 RNA ≥20 copies/mL (OR: 1.85; 95% CI: 1.13-3.03). In conclusion, the prevalence of PAD in HIV-infected Thais was 4.37% in infected patients on therapy attending outpatient clinics. For this population, PAD appears to be relatively poorly correlated with traditional risk factors of CVD.
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Affiliation(s)
- Amaraporn Rerkasem
- Research Institute for Health Sciences, 26682Chiang Mai University, Chiang Mai, Thailand
| | - Patumrat Sripan
- Research Institute for Health Sciences, 26682Chiang Mai University, Chiang Mai, Thailand
| | - Sasinat Pongtam
- Research Institute for Health Sciences, 26682Chiang Mai University, Chiang Mai, Thailand
| | - Sakaewan Ounjaijean
- Research Institute for Health Sciences, 26682Chiang Mai University, Chiang Mai, Thailand
| | - Kanokwan Kulprachakarn
- Research Institute for Health Sciences, 26682Chiang Mai University, Chiang Mai, Thailand
| | - Antika Wongthanee
- Department of Internal Medicine, Faculty of Medicine, 26682Chiang Mai University, Chiang Mai, Thailand
| | - Romanee Chaiwarith
- Department of Internal Medicine, Faculty of Medicine, 26682Chiang Mai University, Chiang Mai, Thailand
| | - Khuanchai Supparatpinyo
- Research Institute for Health Sciences, 26682Chiang Mai University, Chiang Mai, Thailand.,Department of Internal Medicine, Faculty of Medicine, 26682Chiang Mai University, Chiang Mai, Thailand
| | - Parichat Salee
- Department of Internal Medicine, Faculty of Medicine, 26682Chiang Mai University, Chiang Mai, Thailand
| | - Supapong Arworn
- Department of Surgery, Faculty of Medicine, 26682Chiang Mai University Chiang Mai, Thailand
| | - Kittipan Rerkasem
- Research Institute for Health Sciences, 26682Chiang Mai University, Chiang Mai, Thailand.,Department of Surgery, Faculty of Medicine, 26682Chiang Mai University Chiang Mai, Thailand
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Akalu Y, Birhan A. Peripheral Arterial Disease and Its Associated Factors among Type 2 Diabetes Mellitus Patients at Debre Tabor General Hospital, Northwest Ethiopia. J Diabetes Res 2020; 2020:9419413. [PMID: 32090126 PMCID: PMC7008281 DOI: 10.1155/2020/9419413] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 01/18/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Peripheral arterial disease (PAD), one of the major macrovascular complications of diabetes, is associated with cardiovascular mortality and a high rate of disability following the amputation of an extremity in diabetes patients. However, there is no data on the prevalence of PAD among type 2 diabetes patients in Ethiopia. Therefore, the current study is aimed at determining the prevalence and associated factors of PAD among type 2 diabetes patients at Debre Tabor General Hospital, Debre Tabor, Northwest Ethiopia. METHODS An institution-based cross-sectional study was conducted among type 2 diabetes mellitus patients from February 1 to August 30, 2019. A pretested interviewer-administered questionnaire was used to collect the data. The presence of stenosis and its grading were determined by color Doppler ultrasonography. Data were entered using EpiData-V.4.6 and analyzed by STATA-14. Bivariable and multivariable logistic regression was performed to identify associated factors of peripheral arterial disease. Adjusted odds ratio (AOR) and its confidence interval were estimated for potential predictors included in the final model. P ≤ 0.05 was used to declare statistical significance. RESULTS The mean age of the study participants was 61.2 ± 7.3 years. One hundred seventy-two (61.4%) patients were males. The prevalence of PAD in this study was 30.7% (95% CI (25.3-36.2%)). Of these, 37 (43%) were symptomatic. Age (AOR = 1.09, 95% CI (1.03-1.16)), higher HbA1c (AOR = 1.97, 95% CI (1.03-3.40)), being an ex-smoker (AOR = 4.68, 95% CI (1.93-11.30)), and current cigarette smoking (AOR = 5.84, 95% CI (1.79-19.04)) were significantly associated with PAD. CONCLUSION The prevalence of peripheral arterial disease among type 2 diabetes patients was high. Increasing age, high HbA1c, and being cigarette smokers increase the likelihood of developing peripheral arterial disease. Clinicians should prevent PAD; screen T2DM patients who are aged, with high HbA1c, and cigarette smokers; and treat them timely.
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Affiliation(s)
- Yonas Akalu
- Department of Physiology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ambaye Birhan
- Department of Radiology, College of Medicine and Health Sciences, Debre Tabor University, Debre Tabor, Ethiopia
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Vitalis A, Lip GYH, Kay M, Vohra RK, Shantsila A. Ethnic differences in the prevalence of peripheral arterial disease: a systematic review and meta-analysis. Expert Rev Cardiovasc Ther 2017; 15:327-338. [DOI: 10.1080/14779072.2017.1305890] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Antonios Vitalis
- Institute of Cardiovascular Sciences, University of Birmingham, City Hospital, Birmingham, UK
- Department of Vascular Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Gregory Y. H. Lip
- Institute of Cardiovascular Sciences, University of Birmingham, City Hospital, Birmingham, UK
| | - Mark Kay
- Department of Vascular Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Rajiv K. Vohra
- Department of Vascular Surgery, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham, UK
| | - Alena Shantsila
- Institute of Cardiovascular Sciences, University of Birmingham, City Hospital, Birmingham, UK
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Lin QF, Qiu CS, Wang SL, Huang LF, Chen ZY, Chen Y, Chen G. A Cross-sectional Study of the Relationship Between Habitual Tea Consumption and Arterial Stiffness. J Am Coll Nutr 2015; 35:354-61. [DOI: 10.1080/07315724.2015.1058197] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Chen SC, Lee WH, Hsu PC, Huang JC, Lee CS, Lin TH, Voon WC, Lai WT, Sheu SH, Su HM. Association of body mass index and left ventricular mass index with abnormally low and high ankle-brachial indices in chronic kidney disease. Hypertens Res 2015; 39:166-70. [DOI: 10.1038/hr.2015.128] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 09/15/2015] [Accepted: 10/06/2015] [Indexed: 12/28/2022]
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Solanki JD, Makwana AH, Mehta HB, Gokhale PA, Shah CJ. A Study of Prevalence and Association of Risk Factors for Diabetic Vasculopathy in an Urban Area of Gujarat. J Family Med Prim Care 2013; 2:360-4. [PMID: 26664842 PMCID: PMC4649872 DOI: 10.4103/2249-4863.123906] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Peripheral arterial disease (PAD) is an aftermath of type 2 diabetes posing a significant health problem in developing countries. Its silent progression warrants presymptomatic screening by ankle brachial index (ABI), which cannot be applied to the whole population. We tried to measure the burden of PAD in diabetics of this region correlating various risk factors for it quantitatively and qualitatively. MATERIALS AND METHODS From various out-patient departments, 110 known under treatment type 2 diabetics were recruited. They underwent thorough assessment for general, symptomatic, medical history and risk factor screening that included 11 well-known risk factors. ABI was measured by Versadop instrument using the standard protocol with ABI <0.9 being considered as abnormal. RESULTS There was a high prevalence of asymptomatism, hypertension, positive family history and age <52 years in the study group. Relative risk was highest for asymptomatism followed by high body mass index, hyperlipidemia, cardiovascular disease and smoking, but less significant for age, gender, fasting sugar level, family history. More adverse ABI profile was noticed with the increase in number of five modifiable risk factors cumulatively. CONCLUSION There was a high prevalence of low ABI in our region that is an evidence of PAD mainly affected by risk factors many of which were modifiable. Defining those who are at risk to develop PAD in Diabetes, one can use ABI better in early screening and prompt treatment of this complication to stop its further progression and primary prevention can be served as felt the need for health-care effectively.
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Affiliation(s)
- Jayesh D. Solanki
- Department of Physiology, Government Medical College, Bhavnagar, Gujarat, India
| | - Amit H. Makwana
- Department of Physiology, Government Medical College, Bhavnagar, Gujarat, India
| | - Hemant B. Mehta
- Department of Physiology, Government Medical College, Bhavnagar, Gujarat, India
| | - Pradnya A. Gokhale
- Department of Physiology, Government Medical College, Bhavnagar, Gujarat, India
| | - Chinmay J. Shah
- Department of Physiology, Government Medical College, Bhavnagar, Gujarat, India
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Matheus ASDM, Tannus LRM, Cobas RA, Palma CCS, Negrato CA, Gomes MDB. Impact of diabetes on cardiovascular disease: an update. Int J Hypertens 2013; 2013:653789. [PMID: 23533715 PMCID: PMC3603160 DOI: 10.1155/2013/653789] [Citation(s) in RCA: 274] [Impact Index Per Article: 24.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 01/31/2013] [Accepted: 01/31/2013] [Indexed: 12/18/2022] Open
Abstract
Cardiovascular diseases are the most prevalent cause of morbidity and mortality among patients with type 1 or type 2 diabetes. The proposed mechanisms that can link accelerated atherosclerosis and increased cardiovascular risk in this population are poorly understood. It has been suggested that an association between hyperglycemia and intracellular metabolic changes can result in oxidative stress, low-grade inflammation, and endothelial dysfunction. Recently, epigenetic factors by different types of reactions are known to be responsible for the interaction between genes and environment and for this reason can also account for the association between diabetes and cardiovascular disease. The impact of clinical factors that may coexist with diabetes such as obesity, dyslipidemia, and hypertension are also discussed. Furthermore, evidence that justify screening for subclinical atherosclerosis in asymptomatic patients is controversial and is also matter of this review. The purpose of this paper is to describe the association between poor glycemic control, oxidative stress, markers of insulin resistance, and of low-grade inflammation that have been suggested as putative factors linking diabetes and cardiovascular disease.
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Affiliation(s)
- Alessandra Saldanha de Mattos Matheus
- Department of Internal Medicine, Diabetes Unit, State University of Rio de Janeiro, Avenida 28 de Setembro 77, Terceiro Andar, Vila Isabel, 20551-030 Rio de Janeiro, RJ, Brazil
| | - Lucianne Righeti Monteiro Tannus
- Department of Internal Medicine, Diabetes Unit, State University of Rio de Janeiro, Avenida 28 de Setembro 77, Terceiro Andar, Vila Isabel, 20551-030 Rio de Janeiro, RJ, Brazil
| | - Roberta Arnoldi Cobas
- Department of Internal Medicine, Diabetes Unit, State University of Rio de Janeiro, Avenida 28 de Setembro 77, Terceiro Andar, Vila Isabel, 20551-030 Rio de Janeiro, RJ, Brazil
| | - Catia C. Sousa Palma
- Department of Internal Medicine, Diabetes Unit, State University of Rio de Janeiro, Avenida 28 de Setembro 77, Terceiro Andar, Vila Isabel, 20551-030 Rio de Janeiro, RJ, Brazil
| | - Carlos Antonio Negrato
- Department of Internal Medicine, Bauru's Diabetics Association, Rua Saint Martin 27-07, 17.012-433 Bauru, SP, Brazil
| | - Marilia de Brito Gomes
- Department of Internal Medicine, Diabetes Unit, State University of Rio de Janeiro, Avenida 28 de Setembro 77, Terceiro Andar, Vila Isabel, 20551-030 Rio de Janeiro, RJ, Brazil
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Zhang Y, Chen J, Zhang K, Kong M, Wang T, Chen R, Wang L, Wang J, Huang H. Inflammation and oxidative stress are associated with the prevalence of high aankle-brachial index in metabolic syndrome patients without chronic renal failure. Int J Med Sci 2013; 10:183-90. [PMID: 23329891 PMCID: PMC3547217 DOI: 10.7150/ijms.5308] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Accepted: 12/25/2012] [Indexed: 01/06/2023] Open
Abstract
AIMS High ankle-brachial index (ABI) is marker of increased cardiovascular morbidity and mortality, while the relationship and mechanism between high ABI and metabolic syndrome (MetS) are unclear. The objectives of this study were to determine the relationship and possible mechanism of MetS with high ABI. METHODS 341 participants without CRF were recruited. Among these participants, 58 participants (ABI ≥ 1.3) were include in high ABI group and the other 283 participants (0.9 < ABI < 1.3) were include in normal ABI group. Furthermore, these 341 participants were also divided into MetS group (n = 54) and non-MetS group (n = 287). All participants received examinations including body mass index (BMI), ABI and related biochemical parameters. RESULTS Compared with non-MetS group, the prevalence of high ABI was higher in MetS group (27.8% vs. 15%, p < 0.05). Participants with 3-4 metabolic risk factors had higher prevalence of high ABI than those with 0-1 metabolic risk factors (27.8% vs. 12.7%, p < 0.05). The prevalence of high ABI in overweight participants was higher than those with normal body weight. And the participants with hypertension also had higher prevalence of high ABI than normotensive participants. BMI, high-sensitivity C-reactive protein (hsCRP) and superoxide dismutase (SOD) were all higher in high ABI group than normal ABI group (p < 0.05). CONCLUSIONS More metabolic risk factors have increased the risk of high ABI. Inflammation and oxidative stress are associated with prevalence of high ABI in metabolic syndrome patients without chronic renal failure.
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Affiliation(s)
- Yinyin Zhang
- Department of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, 510120 China
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