Vasa 2015; 44: 59 – 64 © 2015 Hans Huber Publishers, Hogrefe AG, Bern
O. Onalan et al.: Onychomycosis and atherosclerosis DOI 10.1024/0301 – 1526/a000407
Original communication 59
Onychomycosis is associated with subclinical atherosclerosis in patients with diabetes Orhan Onalan, Adem Adar, Hakan Keles, Goksen Ertugrul, Nurhayat Ozkan, Habibullah Aktas, and Ekrem Karakaya Karabuk University Faculty of Medicine, Turkey
Summary
Zusammenfassung
Background: We aimed to investigate the association of toenail onychomycosis with subclinical atherosclerosis in patients with diabetes mellitus. Patients and methods: Consecutive diabetic patients who were seen at our outpatient clinic were enrolled. The carotid intima-media thickness (CIMT) was assessed and toenail onychomycosis was diagnosed with microscopic evaluation. Results: We investigated 127 patients with diabetes melltus type 2. Overall, the prevalence of toenail onychomycosis was 37.8 % (48 of 127). Of the 127 patients, 60 (47.2 %) had subclinical atherosclerosis (CIMT ≥ 1 mm). Prevalence of male gender (43.3 % vs. 22.4 %, p = 0.012) and onychomycosis (53.3 % vs. 23.9 %, p = 0.001) was significantly higher in patients with subclinical atherosclerosis. Among biochemical parameters, low-density lipoprotein (122 ± 38 mg/dL vs. 108 ± 36 mg/dL, p = 0.039) and glycosylated hemoglobin levels (median 8.4 %, IQR: 2.1 % vs. median 7.5 %, IQR: 1.6 %, p = 0.002) were significantly higher in patients with subclinical atherosclerosis. Study groups were similar with respect to all other demographic, clinical, and laboratory parameters. After adjustment for all potential confounders, the presence of onychomycosis was independently associated with subclinical atherosclerosis (OR 2.77, 95 % CI 1.16 to 6.30) in multivariate logistic regression analysis. Conclusions: Presence of onychomycosis in patients with diabetes is associated with subclinical atherosclerosis. Onychomycosis may be a marker of atherosclerotic arterial involvement.
Die Beziehung zwischen Onychomykose und subklinischer Arteriosklerose bei Patienten mit Diabetes mellitus Hintergrund: Wir haben die Beziehung der Onychomykose an den Fuβnägeln mit der subklinischen Arteriosklerose bei Patienten mit Diabetes untersucht. Patienten und Methoden: Aufeinanderfolgende Diabetiker, die wir ambulant gesehen haben, wurden registriert. Die Intima-Media Dicke der Arteria carotis (CIMT) wurde bewertet. Die Fuβnagelonychomykose wurde mikroskopisch diagnostiziert. Ergebnisse: Wir haben 127 Patienten untersucht. Bei 48 (37,8 %) fanden wir eine Fuβnagelonychomykose. Von den 127 Patienten hatten 60 (47,2 %) eine subklinische Arteriosklerose (CIMT > 1 mm). Das männliche Geschlecht (43,3 % vs. 22,4 %, p = 0,012) und die Onychomykose (53,3 % vs. 23,9 %, p = 0,001) waren bei Paitenten mit subklinischer Arteriosklerose signifikant häufiger. Unter den biochemischen Parametern war das LDL Cholesterin (122+38 mg/dl vs. 108+36 mg/dl, p = 0,039) und das glykolisierte Hämoglobin (median 8.4 %, IQR: 2.1 % vs. median 7.5 %, IQR: 1.6 %, p = 0,002) bei Patienten mit subklinischer Arteriosklerose signifikant höher. Die Gruppen waren im Hinblick auf alle anderen demografischen, klinischen, und laborchemischen Parametern ähnlich. Nach Adjustierung für alle potentiellen Einflussgrössen war die Existenz der Onychomykose in der multivariaten Regressionsanalyse eigenständig mit der subklinischen Arteriosklerose (OR 2.77, 95 % CI 1.16 bis 6.30) vergesellschaftet. Schlussfolgerungen: Onychomychose kann ein Marker der Arteriosklerose bei Diabetikern sein.
Key words: Onychomycosis, subclinical atherosclerosis, carotid intima-media thickness
Introduction Atherosclerotic cardiovascular disease is the leading cause of death in patients with diabetes. Early identification of atherosclerosis may help to prevent disease progression and associated complications. Approximately one-third of the diabetic patients have toenail onychomycosis [1, 2]. Onychomycosis in these patients
has been shown to be associated with peripheral artery disease, chronic kidney disease, hyperlipidemia, diabetes duration, fasting blood glucose, glycosylated hemoglobin, metabolic syndrome, obesity, advanced age, smoking and male gender [1 – 6]. All above-mentioned conditions are also associated with atherosclerosis. However, to date no study has evaluated the association of toenail
onychomycosis with atherosclerosis. We hypothesized that the presence of toenail onychomycosis in diabetic patients is a marker of atherosclerosis. Thus, the aim of this study was to investigate the association of toenail onychomycosis with subclinical atherosclerosis in patients with diabetes mellitus.
O. Onalan et al.: Onychomycosis and atherosclerosis DOI 10.1024/0301 – 1526/a000407
Original communication 59
Onychomycosis is associated with subclinical atherosclerosis in patients with diabetes Orhan Onalan, Adem Adar, Hakan Keles, Goksen Ertugrul, Nurhayat Ozkan, Habibullah Aktas, and Ekrem Karakaya Karabuk University Faculty of Medicine, Turkey
Summary
Zusammenfassung
Background: We aimed to investigate the association of toenail onychomycosis with subclinical atherosclerosis in patients with diabetes mellitus. Patients and methods: Consecutive diabetic patients who were seen at our outpatient clinic were enrolled. The carotid intima-media thickness (CIMT) was assessed and toenail onychomycosis was diagnosed with microscopic evaluation. Results: We investigated 127 patients with diabetes melltus type 2. Overall, the prevalence of toenail onychomycosis was 37.8 % (48 of 127). Of the 127 patients, 60 (47.2 %) had subclinical atherosclerosis (CIMT ≥ 1 mm). Prevalence of male gender (43.3 % vs. 22.4 %, p = 0.012) and onychomycosis (53.3 % vs. 23.9 %, p = 0.001) was significantly higher in patients with subclinical atherosclerosis. Among biochemical parameters, low-density lipoprotein (122 ± 38 mg/dL vs. 108 ± 36 mg/dL, p = 0.039) and glycosylated hemoglobin levels (median 8.4 %, IQR: 2.1 % vs. median 7.5 %, IQR: 1.6 %, p = 0.002) were significantly higher in patients with subclinical atherosclerosis. Study groups were similar with respect to all other demographic, clinical, and laboratory parameters. After adjustment for all potential confounders, the presence of onychomycosis was independently associated with subclinical atherosclerosis (OR 2.77, 95 % CI 1.16 to 6.30) in multivariate logistic regression analysis. Conclusions: Presence of onychomycosis in patients with diabetes is associated with subclinical atherosclerosis. Onychomycosis may be a marker of atherosclerotic arterial involvement.
Die Beziehung zwischen Onychomykose und subklinischer Arteriosklerose bei Patienten mit Diabetes mellitus Hintergrund: Wir haben die Beziehung der Onychomykose an den Fuβnägeln mit der subklinischen Arteriosklerose bei Patienten mit Diabetes untersucht. Patienten und Methoden: Aufeinanderfolgende Diabetiker, die wir ambulant gesehen haben, wurden registriert. Die Intima-Media Dicke der Arteria carotis (CIMT) wurde bewertet. Die Fuβnagelonychomykose wurde mikroskopisch diagnostiziert. Ergebnisse: Wir haben 127 Patienten untersucht. Bei 48 (37,8 %) fanden wir eine Fuβnagelonychomykose. Von den 127 Patienten hatten 60 (47,2 %) eine subklinische Arteriosklerose (CIMT > 1 mm). Das männliche Geschlecht (43,3 % vs. 22,4 %, p = 0,012) und die Onychomykose (53,3 % vs. 23,9 %, p = 0,001) waren bei Paitenten mit subklinischer Arteriosklerose signifikant häufiger. Unter den biochemischen Parametern war das LDL Cholesterin (122+38 mg/dl vs. 108+36 mg/dl, p = 0,039) und das glykolisierte Hämoglobin (median 8.4 %, IQR: 2.1 % vs. median 7.5 %, IQR: 1.6 %, p = 0,002) bei Patienten mit subklinischer Arteriosklerose signifikant höher. Die Gruppen waren im Hinblick auf alle anderen demografischen, klinischen, und laborchemischen Parametern ähnlich. Nach Adjustierung für alle potentiellen Einflussgrössen war die Existenz der Onychomykose in der multivariaten Regressionsanalyse eigenständig mit der subklinischen Arteriosklerose (OR 2.77, 95 % CI 1.16 bis 6.30) vergesellschaftet. Schlussfolgerungen: Onychomychose kann ein Marker der Arteriosklerose bei Diabetikern sein.
Key words: Onychomycosis, subclinical atherosclerosis, carotid intima-media thickness
Introduction Atherosclerotic cardiovascular disease is the leading cause of death in patients with diabetes. Early identification of atherosclerosis may help to prevent disease progression and associated complications. Approximately one-third of the diabetic patients have toenail onychomycosis [1, 2]. Onychomycosis in these patients
has been shown to be associated with peripheral artery disease, chronic kidney disease, hyperlipidemia, diabetes duration, fasting blood glucose, glycosylated hemoglobin, metabolic syndrome, obesity, advanced age, smoking and male gender [1 – 6]. All above-mentioned conditions are also associated with atherosclerosis. However, to date no study has evaluated the association of toenail
onychomycosis with atherosclerosis. We hypothesized that the presence of toenail onychomycosis in diabetic patients is a marker of atherosclerosis. Thus, the aim of this study was to investigate the association of toenail onychomycosis with subclinical atherosclerosis in patients with diabetes mellitus.
