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HDL cholesterol as a predictor for the incidence of lower extremity amputation and wound-related death in patients with diabetic foot ulcers.
Atherosclerosis 2015; 239(2):465-9A

Abstract

OBJECTIVE

We examined whether HDL cholesterol levels are a predictor for an incidence of lower-extremity amputation (LEA) and wound-related death in patients with diabetic foot ulcers (DFUs).

RESEARCH DESIGN AND METHODS

This was a single-center, observational, longitudinal historical cohort study of 163 Japanese ambulatory patients with DFUs, 45 woman and 118 men, with a mean (standard deviation) age of 62 (14) years. The primary composite endpoint was defined as the worst of the following outcomes for each individual; (1) minor amputation, defined as amputation below the ankle, (2) major amputation, defined as amputation above the ankle, and (3) wound-related death.

RESULTS

During the median follow-up period of 5.1 months, 67 patients (41.1%) reached the endpoint (43 minor amputations, 16 major amputations, and 8 wound-related deaths). In the univariate Cox proportional hazard model analysis, lower HDL cholesterol levels (mmol/L) were significantly associated with the incidence of the primary composite endpoint (hazard ratio 0.16 [95% CI 0.08-0.32], p < 0.001). In the multivariate Cox proportional hazard model analysis using a stepwise variable-selecting procedure, HDL cholesterol levels in addition to the presence of ankle brachial index <0.9 or ≥1.4 and serum albumin levels were selected as independent risk factors for the incidence of the endpoint (hazard ratio 0.30 [95% CI 0.14-0.63], p = 0.002). Similar results were obtained when HDL cholesterol levels were treated as a categorical variable (≥1.03 mmol/L or less).

CONCLUSIONS

HDL cholesterol levels might be a novel clinical predictor for the incidence of LEA and wound-related death in patients with DFUs.

Authors+Show Affiliations

Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan. Electronic address: hanai@dmc.twmu.ac.jp.Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.Diabetes Center, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

25697577

Citation

Ikura, Kazuki, et al. "HDL Cholesterol as a Predictor for the Incidence of Lower Extremity Amputation and Wound-related Death in Patients With Diabetic Foot Ulcers." Atherosclerosis, vol. 239, no. 2, 2015, pp. 465-9.
Ikura K, Hanai K, Shinjyo T, et al. HDL cholesterol as a predictor for the incidence of lower extremity amputation and wound-related death in patients with diabetic foot ulcers. Atherosclerosis. 2015;239(2):465-9.
Ikura, K., Hanai, K., Shinjyo, T., & Uchigata, Y. (2015). HDL cholesterol as a predictor for the incidence of lower extremity amputation and wound-related death in patients with diabetic foot ulcers. Atherosclerosis, 239(2), pp. 465-9. doi:10.1016/j.atherosclerosis.2015.02.006.
Ikura K, et al. HDL Cholesterol as a Predictor for the Incidence of Lower Extremity Amputation and Wound-related Death in Patients With Diabetic Foot Ulcers. Atherosclerosis. 2015;239(2):465-9. PubMed PMID: 25697577.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - HDL cholesterol as a predictor for the incidence of lower extremity amputation and wound-related death in patients with diabetic foot ulcers. AU - Ikura,Kazuki, AU - Hanai,Ko, AU - Shinjyo,Takamichi, AU - Uchigata,Yasuko, Y1 - 2015/02/07/ PY - 2014/11/07/received PY - 2015/01/25/revised PY - 2015/02/02/accepted PY - 2015/2/21/entrez PY - 2015/2/24/pubmed PY - 2015/12/15/medline KW - Diabetic foot ulcer KW - HDL cholesterol KW - Lower extremity amputation SP - 465 EP - 9 JF - Atherosclerosis JO - Atherosclerosis VL - 239 IS - 2 N2 - OBJECTIVE: We examined whether HDL cholesterol levels are a predictor for an incidence of lower-extremity amputation (LEA) and wound-related death in patients with diabetic foot ulcers (DFUs). RESEARCH DESIGN AND METHODS: This was a single-center, observational, longitudinal historical cohort study of 163 Japanese ambulatory patients with DFUs, 45 woman and 118 men, with a mean (standard deviation) age of 62 (14) years. The primary composite endpoint was defined as the worst of the following outcomes for each individual; (1) minor amputation, defined as amputation below the ankle, (2) major amputation, defined as amputation above the ankle, and (3) wound-related death. RESULTS: During the median follow-up period of 5.1 months, 67 patients (41.1%) reached the endpoint (43 minor amputations, 16 major amputations, and 8 wound-related deaths). In the univariate Cox proportional hazard model analysis, lower HDL cholesterol levels (mmol/L) were significantly associated with the incidence of the primary composite endpoint (hazard ratio 0.16 [95% CI 0.08-0.32], p < 0.001). In the multivariate Cox proportional hazard model analysis using a stepwise variable-selecting procedure, HDL cholesterol levels in addition to the presence of ankle brachial index <0.9 or ≥1.4 and serum albumin levels were selected as independent risk factors for the incidence of the endpoint (hazard ratio 0.30 [95% CI 0.14-0.63], p = 0.002). Similar results were obtained when HDL cholesterol levels were treated as a categorical variable (≥1.03 mmol/L or less). CONCLUSIONS: HDL cholesterol levels might be a novel clinical predictor for the incidence of LEA and wound-related death in patients with DFUs. SN - 1879-1484 UR - https://www.unboundmedicine.com/medline/citation/25697577/HDL_cholesterol_as_a_predictor_for_the_incidence_of_lower_extremity_amputation_and_wound_related_death_in_patients_with_diabetic_foot_ulcers_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0021-9150(15)00094-5 DB - PRIME DP - Unbound Medicine ER -