Summary
Medial arterial calcification was studied among 4,553 subjects in a 20-year, longitudinal study of Pima Indians. The prevalence and incidence of medial arterial calcification were highest among men, the elderly, and patients with Type 2 (non-insulin-dependent) diabetes mellitus. Medial arterial calcification was most commonly observed in the feet and appeared to progress proximally. Proportional hazards analysis was used to evaluate risk factors for medial arterial calcification in the feet and to evaluate medial arterial calcification as a risk factor for death and for complications of diabetes. Among diabetic patients, risk factors for medial arterial calcification were impaired vibration perception, long duration of diabetes, and high plasma glucose concentration (p<0.01 for each). Among nondiabetic subjects, age, male gender (p<0.01 for each), and high serum cholesterol concentration (p=0.02) were risk factors for medial arterial calcification. Nondiabetic subjects with medial arterial calcification did not have higher mortality rates than subjects without medial arterial calcification (rate ratio = 0.95, 95% confidence interval = 0.7–1.3). Diabetic patients with medial arterial calcification, compared with diabetic patients without medial arterial calcification, had 1.5-fold the mortality rate (95% confidence interval = 1.0–2.1), 5.5-fold the rate of amputations (95% confidence interval = 2.1–14.1), 2.4-fold the rate of proteinuria (95% confidence interval = 1.3–4.5), 1.7-fold the rate of retinopathy (95% confidence interval = 0.98–2.8), and 1.6-fold the rate of coronary artery disease (95% confidence interval = 0.48–5.4).
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Lachman AS, Spray TL, Kerwin DM, Shugell GI, Roberts WC (1979) Medial calcinosis of Mönckeberg. A review of the problem and a description of a patient with involvement of peripheral, visceral and coronary arteries. Am J Med 63: 615–622
Lindbom Å (1950) Arteriosclerosis and arterial thrombosis in the lower limb. A roentgenological study. Acta Radiol [Suppl] 80: 1–80
Bierman EL (1983) Atherosclerosis and other forms of arteriosclerosis In: Petersdorf RG, Adams RD, Braunwald E, Isselbacher KJ, Martin JB, Wilson JD (eds) Harrison's principles of internal medicine, 10th edn. McGraw-Hill, New York, pp 1465–1475
Bevan RD (1975) Effect of sympathetic denervation on smooth muscle cell proliferation in the growing rabbit ear. Circ Res 37: 14–19
Bevan RD, Tsuru H (1979) Long-term denervation of vascular smooth muscle causes not only functional but structural change. Blood Vessels 16: 109–112
Edmonds ME, Morrison N, Laws JW, Watkins PJ (1982) Medial arterial calcification and diabetic neuropathy. Br Med J 284: 928–930
Goebel F-D, Füssl HS (1983) Mönckeberg's sclerosis after sympathetic denervation in diabetic and non-diabetic subjects. Diabetologia 24: 347–350
Ferrier TM (1964) Radiologically demonstrable arterial calcification in diabetes mellitus. Aust Ann Med 13: 222–228
Parfitt AM (1969) Soft-tissue calcification in uremia. Arch Intern Med 124: 544–555
Neubauer B (1971) A quantitative study of peripheral arterial calcification and glucose tolerance in elderly diabetics and non-diabetics. Diabetologia 7: 409–413
Lithner F, Hietala S-O, Steen L (1984) Skeletal lesions and arterial calcifications of the feet in diabetics. Acta Med Scand [Suppl] 687: 47–54
Kreines K, Johnson E, Albrink M, Knatterud G, Levin M, Lewitan A, Newberry W, Rose F (1985) The course of peripheral vascular disease in non-insulin-dependent diabetes. Diabetes Care 8: 235–243
Nilsson SE, Lindholm H, Bülow S, Frostberg N, Emilsson T, Stenkula G (1964) The Kristianstad survey 63–64. Acta Med Scand [Suppl] 428: 1–46
Knowler WC, Bennett PH, Hamman RF, Miller M (1978) Diabetes incidence and prevalence in Pima Indians: 19-fold greater incidence than in Rochester, Minnesota. Am J Epidemiol 108: 497–505
Shevky MC, Stafford DD (1923) A clinical method for the estimation of protein in urine and other body fluids. Arch Intern Med 32: 222–225
Ginsberg JM, Chang BS, Matarese RA, Garella S (1983) Use of single voided urine samples to estimate quantitative proteinuria. N Engl J Med 309: 1543–1546
Shaw AB, Risdon P, Lewis-Jackson JD (1983) Protein creatinine index and Albustix in assessment of proteinuria. Br Med J 287: 929–932
Blackburn H (1969) Classification of the electrocardiogram for population studies: Minnesota code. J Electrocardiol 2: 305–310
Mantel N, Haenszel W (1959) Statistical aspects of the analysis of data from retrospective studies of disease. J Natl Cancer Inst 22: 719–748
Rothman KJ, Boice JD (1982) Follow-up (cohort) studies. In: Epidemiologic analysis with a programmable calculator. Epidemiology Resources, Boston, pp 11–17
Harrell FE (1983) The PHGLM procedure. In: Joyner SP (ed) SUGI supplemental library user's guide, 1983 edn. SAS Institute, Cary, North Carolina, pp 267–94
Nilsson SE, Nilsson JE, Frostberg N, Emilsson T (1967) The Kristianstad survey II. Acta Med Scand [Suppl] 469: 1–42
Heyden S, Heiss G, Bartel AG, Hanes CG (1980) Sex differences in coronary mortality among diabetics in Evans county, Georgia. J Chronic Dis 33: 265–273
Barrett-Connor E, Wingard DL (1983) Sex differential in ischemic heart disease mortality in diabetics. Am J Epidemiol 118: 489–496
Butler WJ, Ostrander LD, Carman WJ, Lamphear ED (1985) Mortality from coronary heart disease in the Tecumseh study. Am J Epidemiol 121: 541–547
Kannel WB, McGee L (1979) Diabetes and cardiovascular disease. The Framingham study. JAMA 241: 2035–2038
Deutscher S, Rockette HE, Krishnaswami V (1984) Diabetes and hypercholesterolemia among patients with calcific aortic stenosis. J Chron Dis 37: 407–415
Ferrier TM (1967) Comparative study of arterial disease in amputated lower limbs from diabetics and non-diabetics (with special reference to feet arteries). Med J Austr 1: 5–11
Christensen NJ (1968) Muscle blood flow, measured by xenon133 and vascular calcifications in diabetics. Acta Med Scand 183: 449–454
Christensen NJ (1973) Diabetic macroangiopathy: blood flow and radiological studies. In: Camerini-Davalos RA, Cole HS (eds) Vascular and neurological changes in early diabetes. Academic, New York, pp 129–135
Young RJ, Macintyre CCA, Martyn CN, Prescott RJ, Smith AF, Viberti G, Clarke BF (1986) Progression of subclinical polyneuropathy in young patients with Type 1 (insulin-dependent) diabetes: associations with glycaemic control and microangiopathy (microvascular complications). Diabetologia 29: 156–161
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Everhart, J.E., Pettitt, D.J., Knowler, W.C. et al. Medial arterial calcification and its association with mortality and complications of diabetes. Diabetologia 31, 16–23 (1988). https://doi.org/10.1007/BF00279127
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DOI: https://doi.org/10.1007/BF00279127