The Ankle-Brachial Index for assessing the prevalence of peripheral artery disease and cardiovascular risk in patients with type 2 diabetes mellitus

Published:November 19, 2022DOI:
      This paper is only available as a PDF. To read, Please Download here.


      • Based on our results, the prevalence of PAD in the Italian population with T2DM is actually 17%, which is consistent with other international studies.
      • There is a need to standardize the definition of PAD and consider ABI> 1.30, which shows arterial medial calcifications, diagnostic for PAD in T2DM.
      • ABI is quick and easy to obtain and could be integrated with the calculation of an individual’s CV risk score.


      Background and Aims

      Type 2 diabetes mellitus (T2DM) is an important risk factor for peripheral artery disease (PAD). Ankle Brachial Index (ABI) was found associated with a higher cardiovascular (CV) risk and mortality. The main goals of this study were to establish the prevalence of PAD in a T2DM population, and assess the relationship between PAD and the CV risk calculated with the CUORE Project score (CPS) ( The association between the ABI, the main risk factors for PAD and T2DM complications was also investigated.

      Methods and Results

      Two hundred patients were consecutively enrolled. The prevalence of PAD in this population was 17%. The CV risk tended to be higher (p=0.0712) in the group with a pathological ABI than in the group with a normal ABI. Glycated hemoglobin (r = -0.1591; p = 0.0244), total cholesterol (r = -0.1958; p = 0.0054), LDL cholesterol (r = -0.1708; p = 0.0156) and systolic blood pressure (r = -0.1523; p = 0.0313) correlated significantly and inversely with the left ABI. The frequency of diabetic retinopathy was significantly higher in the group with a pathological ABI (p = 0.0316).


      The data reveal a high prevalence of PAD in patients with T2DM. The CPS confirmed that patients with a pathological ABI have tendency to a higher CV risk. The results point to the importance of an accurate CV assessment – also measuring individuals’ ABI and calculating their CPS - to better pinpoint those at high risk of PAD, especially among patients with T2DM.



      T2DM (type 2 diabetes mellitus), ABI (ankle brachial index), PAD (peripheral arterial disease), CPS (CUORE project score), CV (cardiovascular)