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Diabetes mellitus is the major risk factor for African Americans who undergo peripheral bypass graft operation
T E Brothers1, J G Robison, B M Elliott
1Department of Surgery, Section of Vascular Surgery, Medical University of South Carolina, USA.
Insights
Diabetes mellitus significantly increases the risk of lower extremity bypass graft surgery, particularly for African American women. This highlights diabetes as a critical factor in vascular health disparities.
Area of Science:
- Vascular Surgery
- Public Health
- Epidemiology
Background:
- African Americans, especially women, face higher risks of lower extremity ischemia requiring infrainguinal bypass grafts.
- The disproportionately higher prevalence of diabetes mellitus in this demographic necessitates investigating its role compared to other risk factors.
Purpose of the Study:
- To compare the contribution of diabetes mellitus with other risk factors (smoking, hypertension) for infrainguinal bypass graft operations.
- To analyze the impact of diabetes on the need for bypass graft surgery and subsequent limb salvage rates in different ethnic and gender groups.
Main Methods:
- Retrospective case-control study involving 764 patients undergoing infrainguinal revascularization.
- Comparison with the 1995 statewide Behavior Risk Factor Surveillance System database.
- Analysis of risk factors including diabetes mellitus, smoking, and hypertension.
Main Results:
- Diabetes mellitus showed a significantly higher odds ratio (OR) for bypass graft surgery across all groups, especially in African American women (OR, 24.9).
- Diabetes was a stronger predictor (OR, 15.7) than smoking (OR, 4.5) or hypertension (OR, 4.6).
- African American patients had worse limb salvage rates at 3 years (64%) compared to other groups (75%), despite similar graft patency.
Conclusions:
- Diabetes mellitus is the primary risk factor driving the need for bypass graft operations, particularly in African American women.
- Higher diabetes prevalence may explain increased tissue necrosis and distal bypass grafting needs in this population.
- Diabetes contributes to reduced long-term limb salvage observed in African American women undergoing these procedures.
Objective:
African Americans, especially African American women, have a greater risk of lower extremity ischemia that necessitates an infrainguinal bypass graft operation and amputation. Because the prevalence of diabetes mellitus is proportionally greater in this ethnic/racial group, the relative contribution of diabetes was compared with other potential risk factors.
Methods:
This study was designed as a retrospective case control study at the University and Veterans Hospitals. In a 5-year period, 764 consecutive patients who required infrainguinal revascularizations were compared with a statewide population that was described by the 1995 Behavior Risk Factor Surveillance System database. The main outcome measure was the requirement for infrainguinal revascularization.
Results:
Diabetes mellitus was more common among African American women who underwent bypass graft operation (70%; odds ratio [OR], 24.9; 95% confidence interval [CI], 20.3 to 30.4) than African American men (46%; OR, 11.6; 95% CI, 8.9 to 15.2), white women (49%; OR, 15.9; 95% CI, 13.0 to 19.5), or white men (42%; OR, 14.8; 95% CI, 12.5 to 17.4). Overall, bypass graft operation was associated more strongly with diabetes mellitus for all groups (OR, 15.7; 95% CI, 13.5 to 18. 3) than with smoking (OR, 4.5; 95% CI, 3.8 to 5.2) or hypertension (OR, 4.6; 95% CI, 4.0 to 5.3). Life-table analysis revealed limb salvage to be worse at 3 years among African American patients (64% vs 75%; P <.005) despite similar primary and cumulative secondary graft patency rates.
Conclusion:
Diabetes mellitus is the dominant risk factor that contributes to the need for bypass graft operation, especially among African American women. A greater prevalence of diabetes mellitus may account for the higher incidence of tissue necrosis and the increased requirement for distal bypass grafting and may contribute to the reduction in long-term limb salvage that was observed with these women.