Atherosclerosis index and diabetic foot ulcers: an NHANES database investigation

BACKGROUND: Atherosclerosis, a chronic vascular disease, is linked to cardiovascular and metabolic conditions, including diabetic foot ulcers, though the underlying mechanisms are unclear. This study investigates this relationship using data from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018, involving 2,056 participants. METHODS: Data were sourced from NHANES (1999-2018). Multivariable logistic regression models analyzed the associations between four atherosclerosis indices (AIP, NHHR, LAP, and VAI) and diabetic foot ulcers. Statistical analyses were conducted using R (version 4.1.3) and Empower Stats (version 2.0), with significance set at P < 0.05. Subgroup analyses compared these associations across different populations. RESULTS: The study included 875 diabetic foot ulcer patients (prevalence rate: 42.56%). All four atherosclerosis indices were positively correlated with diabetic foot ulcers. After adjusting for covariates, NHHR showed a 24% increased risk per unit increase (OR = 1.24, 95% CI: 1.16-1.33, P < 0.0001), AIP a 95% increased risk (OR = 1.95, 95% CI: 1.45-2.61, P < 0.0001), LAP a 38% increased risk (OR = 1.38, 95% CI: 1.18-1.61, P < 0.0001), and VAI a 6% increased risk (OR = 1.06, 95% CI: 1.03-1.10, P < 0.0001). Non-linear relationships were observed for LAP, NHHR, and VAI, with inflection points at 0.8, 2.51, and 2.77, respectively. Subgroup analyses showed consistent associations across most populations, with some exceptions in specific subgroups. CONCLUSION: Diabetic foot ulcers are prevalent among diabetic patients, and all four atherosclerosis indices are associated with their occurrence. Future research should focus on elucidating these mechanisms to develop more effective prevention and treatment strategies for diabetic foot ulcers.