Tibial artery calcification predicts foot ulceration

Jan 9 2013

By Lynda Williams, Senior medwireNews Reporter

Tibial artery calcification (TAC) is a significant risk factor for foot ulcers in patients with Type 2 diabetes, research suggests.

Patients with foot ulcers were almost three times more likely to have an elevated TAC score than those without foot injury, after adjusting for age, gender, and a peripheral artery occlusion index based on computed tomography angiography findings.

"This suggests that foot ulcers may be more common in patients with increased calcium scores because they have a higher incidence of neuropathy," or due to another mechanism independent of occlusion, say Raul Guzman and co-workers, from Vanderbilt Medical Center in Nashville, Tennessee, USA.

Overall, 31 of the 162 patients studied had a foot ulcer. Patients with foot ulcers were significantly older and more likely to have a history of tobacco use than those without. The groups were comparable with regard to gender, race, and incidence of hypertension and hyperlipidemia.

However, patients with a foot ulcer had a significantly higher TAC score than those without, at a median of 4324.6 versus 9.4 Agatston units. Patients with a foot ulcer also had significantly greater scores on the peripheral occlusion index, at 5.5 versus 2.2.

In multivariate analysis, the odds ratio for foot ulcer increased by 2.76 per 1-U increase in TAC score, after adjusting for age, gender, race, body mass index, smoking, hyperlipidemia, hypertension, and peripheral occlusion index.

Advanced peripheral artery occlusive disease also significantly and independently predicted the likelihood for foot ulcer, with an odds ratio of 2.88 after adjustment for TAC score and other confounders.

"We believe that the clinical value of tibial artery calcification scoring may be in the identification of a group of high risk, vulnerable patients with type 2 diabetes who deserve more aggressive foot protection efforts," Guzman et al write in Diabetes Research and Clinical Practice.

"It is also hoped, however, that future clinical efforts to reduce arterial calcification, either through risk factor modification or pharmacologic intervention, may prevent foot ulcer development and its consequences."

They conclude: "Further efforts to determine whether calcification may independently contribute to foot ulcer development are needed, as are attempts to prevent amputation in our patients with diabetes."

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