Diabetic Foot Ulcers: A Red Flag for Cardiovascular Complications

A recent meta-analysis published in the journal Endocrine has shed light on the significant association between diabetic foot ulcers (DFU) and cardiovascular-related morbidity and mortality. The study, led by Brian Zhaojie Chin and colleagues, analyzed data from 8062 patients to understand the prevalence and risks of cardiovascular complications in individuals with DFUs.

These data are very similar to previous work by Saluja and coworkers who identified a 2.5-fold annual greater risk

The Link Between DFUs and Cardiovascular Health

DFUs are a common and severe complication of diabetes, often leading to lower limb amputations. However, their association with cardiovascular health has not been extensively studied until now. This systematic review and meta-analysis aimed to fill this gap by evaluating the prevalence of cardiovascular-related morbidity and mortality in patients with DFUs and comparing the risks between diabetic patients with and without DFUs.

Methodology of the Meta-Analysis

The researchers conducted a comprehensive search across Medline, Embase, and Cochrane databases to identify relevant studies. They included randomized controlled trials and observational studies that explored the association between DFUs and cardiovascular-related morbidity and mortality. The meta-analysis used a frequentist approach and a random-effect model to account for the heterogeneity of the included studies.

Findings of the Study

The meta-analysis revealed alarming statistics:

• Pooled prevalences of cardiovascular-related morbidity were high, with 37.1% for all causes, 44.7% for ischemic heart disease (IHD), 25.1% for congestive heart failure (CHF), 11.7% for coronary artery disease (CAD), and 10.9% for cerebrovascular accidents (CVA).
• Cardiovascular-related mortality was also significant, with 14.6% for all causes, 6.2% for fatal IHD, 3.67% for fatal CHF, 7.92% for fatal CAD, and 1.99% for fatal CVA.
• Diabetic patients with DFUs had a significantly increased risk of IHD (relative risk [RR] 1.25), CVA (RR 2.03), and all-cause cardiovascular-related mortality (RR 2.59) compared to those without DFUs.

Implications for Clinical Practice

The study’s findings underscore the urgent need for healthcare providers to assess and treat cardiovascular-related comorbidities in patients with DFUs proactively. The presence of a DFU could serve as a marker for underlying cardiovascular disease, prompting early clinical investigation and management to mitigate the risk of cardiac morbidity and mortality.

Conclusion

This meta-analysis highlights the critical association between DFUs and cardiovascular complications. The evidence suggests that DFUs are not only a concern for limb health but also an indicator of potential cardiovascular risks. As such, a multidisciplinary approach that includes cardiovascular risk assessment and management should be integral to the care of patients with DFUs.