Peripheral vascular disease risk in diabetic individuals without coronary heart disease

Abstract

Background and aims: Diabetes mellitus is a coronary heart disease (CHD) risk-equivalent for the outcome of peripheral vascular disease. The impact of diabetes with comorbid risk factors on the outcome of peripheral vascular disease remains unexplored. Methods: We performed a cross-sectional analysis of participants in Lifeline Vascular Screening Inc. age 40–90 who were screened for peripheral vascular disease, defined as lower extremity peripheral artery disease (PAD, ABI <0.9) and/or carotid artery stenosis (CAS, internal CAS ≥50%). CHD was defined as prior myocardial infarction or revascularization. Risk factors included hypertension, hyperlipidemia, smoking, obesity, sedentary lifestyle and family history of cardiovascular disease. Results: Among 3,517,804 participants, PAD and CAS was identified in 4.4% and 3.7%, respectively. Diabetes was identified in 376,528 participants, 324,680 (86%) of whom did not have CHD. Among diabetic participants without CHD, prevalence of PAD increased with 1–2 (4.3%), 3–4 (7.3%), and ≥5 (12.0%) comorbid risk factors (p trend < 0.0001). The pattern was similar for CAS (3.7%, 6.2%, 8.8%, p trend < 0.0001). Compared to participants without diabetes, those with diabetes and 1–2, 3–4 and ≥5 risk factors had increasing odds of PAD and CAS after adjustment for age, sex and race/ethnicity (1.0, 95% CI 0.98–1.06; 1.8, 95% CI 1.8–1.89; 3.5, 95% CI 3.43–3.64, respectively, p trend < 0.0001). By comparison, in nondiabetic participants, CHD increased odds of PAD and CAS by 2-fold (2.06, 95% CI 2.02—2.1; 2.19, 95% CI 2.15–2.23 respectively). Conclusions: Diabetes, particularly with comorbid risk factors, confers increased odds of PAD and CAS, even in the absence of CHD. Counseling regarding screening and prevention for peripheral vascular disease among individuals with diabetes and multiple risk factors may be useful.

Update on peripheral artery disease: Epidemiology and evidence-based facts

“…However, whether diabetes alone, in absence of CAD, should be considered a risk factor for PAD, remains controversial. This aspect has been examined in the paper published by Wilcox, New-man and colleagues in this issue of Atherosclerosis [5]. Using a large database of more than 3.5 million self-referred participants (40–90 years old), the Authors show that diabetes, when accompanied by cardiovascular risk factors (including hypertension, hyperlipidemia, obesity, and cigarette smoking), confers a three-fold increased odds of PAD and carotid artery stenosis, even in absence of CAD.…”

“…Notably, the rates of CAD in patients with diabetes appear to depend in part on coexisting risk factors: patients with diabetes and two or fewer risk factors had minimally increased odds of developing PAD compared with non-diabetic patients with CAD [5], suggesting that diabetes alone – which represents a relatively uncommon condition in the clinical scenario – is not an independent risk factor for PAD.…”

Unmet medical needs in intermittent Claudication with diabetes and coronary artery disease—A “real‐world” analysis on 21 197 PAD patients

“…A vast majority of PAD patients is at subclinical stages of the disease, yet at significant risk of cardiovascular events . Particularly the combination of diabetes mellitus (DM) and coronary artery disease (CAD) promotes development and progression of PAD . Both, CAD and DM are linked in a complex manner with PAD outcome …”

“…3 Particularly the combination of diabetes mellitus (DM) and coronary artery disease (CAD) promotes development and progression of PAD. 2,[4][5][6] Both, CAD and DM are linked in a complex manner with PAD outcome. [5][6][7][8][9] Particularly lower limb calcification as mainly prevalent in DM patients is associated with increased cardiac mortality and morbidity.…”

“…2,[4][5][6] Both, CAD and DM are linked in a complex manner with PAD outcome. [5][6][7][8][9] Particularly lower limb calcification as mainly prevalent in DM patients is associated with increased cardiac mortality and morbidity. 5,6,10 However, insulin-dependent DM has shown to be an independent risk factor of adverse long-term outcome also in ilio-femoral PAD (all-cause death at 5 years increased by 70%).…”