Department of Orthopaedic Surgery, National University Health System, Level 11 Tower Block, 1E, Lower Kent Ridge Road, Singapore, 119228, Singapore.
Department of Cardiology, National University Heart Centre Singapore, NUHS Tower Block Level 9, 1E Kent Ridge Road, Singapore, 119228, Singapore.
Endocrine. 2024 Jun;84(3):852-863. doi: 10.1007/s12020-024-03696-5. Epub 2024 Jan 27.
To conduct a systematic review and meta-analysis of prevalence of cardiovascular-related morbidity and mortality in patients with diabetic foot ulcers (DFU), as well as compare risks of cardiovascular-related morbidity and mortality between diabetic patients with and without DFU.
A systematic search was conducted on Medline, Embase, and Cochrane databases for randomized controlled trials and observational studies which explored the association between DFU and cardiovascular-related morbidity & mortality, or compared differences in hazard ratios of cardiovascular diseases between diabetics with and without DFU. Frequentist, pairwise meta-analysis was performed on studies with two comparator arms, whereas single-arm studies reporting pooled incidences of cardiovascular-related mortality and morbidity were calculated based on exact binomial distributions. A random-effect meta-analysis model was used with heterogenicity of studies assessed using I, τ, and χ statistics.
10 studies were identified and included in the systematic review & meta-analysis of 8602 patients. DFU was consistently found to have significant association with cardiovascular-related morbidity and mortality, with pooled prevalences of all cause cardiovascular-related morbidity (37.1%), IHD (44.7%), CHF (25.1%), CAD (11.7%), and CVA (10.9%), and all cause cardiovascular-related mortality (14.6%), fatal IHD (6.2%), fatal CHF (3.67%), fatal CAD (7.92%), and fatal CVA (1.99%). Diabetic patients with DFU were found to have significantly increased risk of IHD (RR 1.25), CVA (RR 2.03), and all-cause cardiovascular-related mortality (RR 2.59) compared to those without DFU.
The presence of DFU is associated with major adverse cardiac events. The alarming rates of cardiovascular-related morbidity and mortality in DFU patients highlight its potential role as a marker of cardiovascular complications and should prompt early clinical investigation and management.
系统评价和荟萃分析糖尿病足溃疡（DFU）患者心血管相关发病率和死亡率，并比较有和无 DFU 的糖尿病患者心血管相关发病率和死亡率的风险。
在 Medline、Embase 和 Cochrane 数据库中进行系统检索，以查找探讨 DFU 与心血管相关发病率和死亡率之间关系的随机对照试验和观察性研究，或比较有和无 DFU 的糖尿病患者心血管疾病风险比的差异。对具有两个比较臂的研究进行了频率论、成对荟萃分析，而报告心血管相关死亡率和发病率的单臂研究则基于精确二项式分布进行计算。使用随机效应荟萃分析模型，使用 I、τ 和 χ 统计量评估研究的异质性。
确定了 10 项研究，并对 8602 例患者进行了系统评价和荟萃分析。DFU 与心血管相关发病率和死亡率始终存在显著关联，所有原因心血管相关发病率的汇总率为 37.1%，IHD（44.7%），CHF（25.1%），CAD（11.7%）和 CVA（10.9%），以及所有原因心血管相关死亡率（14.6%），致命性 IHD（6.2%），致命性 CHF（3.67%），致命性 CAD（7.92%）和致命性 CVA（1.99%）。与无 DFU 的患者相比，有 DFU 的糖尿病患者的 IHD（RR 1.25）、CVA（RR 2.03）和全因心血管相关死亡率（RR 2.59）风险显著增加。
DFU 的存在与主要不良心脏事件相关。DFU 患者心血管相关发病率和死亡率的惊人率突出了其作为心血管并发症标志物的潜在作用，应促使早期临床调查和管理。
