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Diabetes major risk factor for ‘Lowcountry disease’

MUSC vascular surgeons who have come to MUSC from other parts of the country call it a Lowcountry disease. They're amazed at the incidence of peripheral vascular disease, a blockage of blood circulation to the foot.

In the February "Journal of Vascular Surgery," they report diabetes mellitus to be the major risk factor contributing to peripheral vascular disease, especially in African American women. The disease often requires bypass surgery to avoid amputation.

Atherosclerosis is usually to blame for the loss of circulation to the foot, said vascular surgeon Thomas Brothers, M.D., author of the paper along with Jacob G. Robison, M.D., and Bruce M. Elliott, M.D. Peripheral vascular disease is essentially the same as coronary artery disease, differing only in location.

In both conditions, cholesterol plaque deposits form in arteries, interfering with their ability to carry blood. The result is pain during exertion, because the muscles normally receiving blood through the arteries are becoming starved for oxygen. Bypass surgery restores blood circulation and oxygen to the muscles.

Surgeons treat peripheral vascular disease with a procedure similar to coronary bypass surgery. They bypass the blocked portion of the blood vessel with healthy blood vessels taken from another part of the body.

The physicians examined 764 patients who had undergone bypass surgery for peripheral vascular disease during a five-year period at the Medical University Hospital and the Charleston Veterans Administration Medical Center.

The investigators looked at the relative contribution of diabetes compared with other potential risk factors. Among their patients, 70 percent of the African American women had diabetes. Of the African American men in the study, 46 percent had diabetes. Forty-nine percent of the Caucasian women and 42 percent of the Caucasian men had diabetes.

Because diabetes mellitus is proportionally greater in African Americans and women, the investigators also sought to compare the relative contribution of diabetes mellitus to other risk factors in patients undergoing the bypass procedure.

This was accomplished by obtaining data on the statewide prevalence of diabetes mellitus, hypertension and smoking from the Behavior Risk Factor Surveillance System conducted in 1995 by the Center for Health Promotion of the South Carolina Department of Health and Environmental Control.

They found that despite the high prevalence of hypertension among the African American population, the relative contribution of hypertension to the need for lower extremity arterial reconstruction actually appears to be lower than that of diabetes. Tobacco use also contributed substantially less than diabetes such that the reduction in the prevalence of smoking among African American women in South Carolina by nearly half during the last 10 years has probably contributed little to the overall prevalence of peripheral vascular disease in this group.

The researchers concluded that diabetes contributes a three- to four-fold greater risk for end-stage extremity vascular disease requiring the bypass procedure and/or amputation than either smoking or hypertension.