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The ankle brachial index (ABI), i.e. the ratio of systolic blood pressure (SBP) on the ankle and on the arm, is diagnostic for peripheral occlusive artery disease and a marker of cardiovascular (CV) risk. The association between the low ABI0.9 and the CV risk in type 2 diabetes (T2DM) subjects was investigated.We examined 253 T2DM subjects (135 males, 118 females, aged 66 +/- 9 years). The blood pressures were measured in the supine position with the 2 mm Hg accuracy; Doppler ultrasound was used for the ankle SBP and the mercury sphygnomanometer for the arm SBP. The high CV risk was defined as manifest CV diseases, elevated coronary calcium score (CAC) by Agatston (101) or according to the global CV Risk Scoreor = 5% (SCORE).Wilcoxon's unpaired test, chi2 test, multiple logistic regression.The ABI0.9 was found unilateral in 23 T2DM (8%), bilateral in 24 (9%), in older males (71 +/- 8 years) with higher CAC (600 +/- 707) (p0.01), higher total cholesterol (5.4 +/- 1.3 mmol/L) and total homocystein (17.2 +/- 7.1 micromol/L) (p0.05) in comparison to those with the ABIor = 0.9 (age 66 +/- 9 years, CAC 234 +/- 458, total cholesterol 5.0 +/- 0.9, total homocystein 14.3 +/- 78). Many CV risk factors correlated positively with the low ABI0.9; it was significantly independently associated with age (p0.001), smoking (p0.01), LDL-cholesterol, total homocystein and CAC (p0.05). Low ABI0.9 predicted ischemic stroke in subjects with T2DM and manifest CV diseases in the further 3 years. There was no correlation between the ABI and the ultrasensitive C-reactive protein.Low ABI0.9 was in a strong association with the CV risk. The ABI measurement is a simple, noninvasive, time-nonconsuming and inexpensive method for subclinical atherosclerosis detection; the ABI can supply standard methods for the CV risk prediction.

Peripheral arterial disease (PAD) is a disease characterised by narrowing and blockade of peripheral arteries, usually based on underlying obliterating atherosclerosis. According to the results of large epidemiological studies, the risk of PAD in patients with diabetes mellitus (DM) is fourfold higher compared to non-diabetic population. Patients with DM and PAD have a high risk of cardiovascular morbidity and mortality. Diabetes worsens the prognosis of patients with PAD; the onset of PAD in diabetics occurs at an earlier age, the course is faster than in non-diabetic patients and the disease is often diagnosed at its advanced stages. All these factors reduce the likelihood of revascularisation in DM patients with PAD. A range of factors (higher age, arterial hypertension, smoking, obesity, hyperfibrinogenaemia, insulin resistance etc.) contribute to the development of PAD in DM. Diabetes control is an independent risk factor of PAD as every 1% increase of hemoglobin A1C is associated with 28% increase of PAD. There are different clinical signs of PAD in diabetic and non-diabetic patients. In addition to the history of claudications, PAD diagnostic criteria include the presence of murmur over the large arteries, signs of chronic ischemia on the skin and distal ulcerations and gangrene. Among the imaging techniques, non-invasive investigations including Doppler pressure measurement, ankle brachial pressure index, color duplex ultrasonography, plethysmography, transcutaneous tension measurement, MR and CT angiography are preferred. Ankle brachial pressure index measurement is the easiest and the main investigation technique. The key principles of PAD treatment in diabetic patients include modification of risk factors, pharmacotherapy and revascularisation interventions aimed at improving clinical signs and prevention of cardiovascular morbidity and mortality. Antiplatelet treatment may prevent PAD progression and reduce cardiovascular events in DM patients. Early diagnosis of PAD in DM patients, rigorous prevention and aggressive management of the risk factors may significantly impact on the high incidence of amputations and decrease cardiovascular morbidity and mortality.

Duplex sonography is the basic method in diagnosing diseases of both the deep and superficial venous system of the limbs. The scope of and the methods used in such exams still display considerable differences from centre to centre. Guidelines have been drawn under the auspices of the Czech Angiological Society, based on state-of-the-art knowledge and in accordance with internationally accepted documents. The guidelines could contribute to unification ofthe methods used in ultrasound examinations of limb veins.

The study has three main aims: 1. it evaluates occurrence of depression symptoms in patients with peripheral arterial occlusive disease (PAOD), 2. it evaluates global quality of life (QoL) in patients with PAOD and 3. it evaluates effect of age and stage of PAD on seriousness of depression symptoms and on the QoL in patients with PAOD.the study is local, prospective and cross-sectional. It was carried out at the 2nd Internal Clinic of University Hospital in Hradec Králové. Data were obtained during the year 2006.The total number of respondents with PAOD was 42 (28 male, 14 female). The average age of all respondents with PAOD was 65.4 years and age range was 45-79 years. The evaluation of occurrence of depression symptoms in patients with PAOD was performed by means of self-assessment Zung-SDS and evaluation of QoL in patients with PAOD was performed by means of Czech version of international generic European Quality of Life Questionnaire-EQ-5D Version. Statistical significance was determined by means of analysis of variance. Main The mean SDS index certifies the presence of signs of minimum or light depression in patients with PAOD. The QoL in patients with PAOD is on the low level. The above-mentioned aspects proved statistically significant dependence of QoL in patients with PAOD on depression (p0.001), on age (p0.01) and on stage of PAOD (p0,01). We proved statistically significant dependence of depression in patients with PAOD on age (p0.01) and on stage of PAOD (p0.01).The results show the existence of the association between PAOD and depression symptoms with its negative effect on QoL in patients.

The authors present a review of information on the incidence éf obliterations of peripheral vessels, incl. their own experience, with a group of diabetic patients. Attention is paid to the pathophysiology of affections of peripheral vessels. In the final part data on the relationship of lipids or their fractions and the development of obliteration of peripheral vessels are presented.

A rise of the homocysteine plasma level--mild hyperhomocysteinaemia--is considered an independent risk factor for the development of vascular damage. It is due to hereditary deficiency of 5,10-methylene-tetrahydrofolate reductase with accentuation of vitamin deficiency (folic acid, vitamin B6 and B12). In previous studies the authors confirmed this fact in the population of patients with aortocoronary or peripheral arterial bypasses. The assumed autosomal recessive transmission of this deficiency should make it possible to detect carriers of this metabolic deviation already in childhood. By selective screening of the child population at risk it would thus be possible to detect affected subjects in time and prevent the development of vascular disease by preventive folate administration.In a group of 38 children and grandchildren from risk families where at least one of the parents or grandparents was operated on account of vascular obliterating disease the total homocysteine plasma level was examined by the chromatographic method. An increase of total homocystein (8.7 +/- 2.7 mumol/l) was found as compared with children from the non-risk population (5.4 +/- 1.8 mumol/l), (p0.001). The total homocysteine values however were dependent on the child's age and were more marked in children above 12 years of age. In the parental population mild hyperhomocysteinaemia was present in 38% of those with aortocoronary bypasses and in 43% of those with peripheral arterial bypasses.The authors found significantly elevated total homocysteine levels in the child population from risk families with obliterating vascular disease. The total homocysteine level depends on the child's age and is more markedly expressed in children above 12 years of age.

Concomitant occurrence of carotid atherosclerosis, coronary artery disease (CAD) and peripheral vascular disease (PVD) has been described in a number of studies. The objective of the present trial was to assess the degree of correlation between atherosclerosis of the carotid beds as well as PVD and the extent of CAD.Carotid morphologies of 170 patients in total (121 men, 49 women), ranging between 23 and 81 years in age were assessed ultrasonographically. Their carotid beds searched for plaques, stenoses and occlusions. In all patients intima-media thickness (IMT) of the common carotid artery (CCA) were measured ultrasonographically. In addition, case histories of PVD were taken. CAD was proved angiographically in 138 patients. Plaques in carotid beds were found in 98 patients, carotid artery stenoses75% were found in 4 patients whereas complete carotid occlusion was not detected in any patient. Clinically manifested PVD was found in 20 patients. A significant difference in IMT of the CCA was assessed by t-test between patients having and not having CAD (0.67 +/- 0.16 mm vs. 0.87 +/- 0.24 mm; P0.0001). The correlation between the IMT of the CCA and extent of CAD was weak (r = 0.30, p0.01). A positive correlation between carotid plaque occurrence and the number of CAD-affected arteries was statistically assessed (Trend test: P = 0.0001). The sensitivity of incidence of plaques on the carotid beds for prediction of CAD was 64%, the specificity 72%, the positive predictive value 91% and the negative predictive value 32%. The sensitivity of clinically manifested PVD for prediction of CAD was 15%, the specificity 100%, the positive predictive value 100% and the negative predictive value 21%.The authors confirmed a statistically significant but weak correlation between IMT of the CCA and severity of CAD. They found a positive trend between the occurrence of carotid plaques and the number of CAD-affected arteries. The presence of carotid plaques and clinically manifested PVD were confirmed as a reliable positive predictive factors for CAD.