Type 2 diabetes and the risk of cardiovascular events in peripheral artery disease versus coronary artery disease

Abstract

IntroductionThe prevalence of type 2 diabetes mellitus (T2DM) is higher in peripheral artery disease (PAD) than in coronary artery disease (CAD) patients, and PAD overall confers higher cardiovascular risk than CAD. How cardiovascular risk compares between PAD and CAD patients when analyses are stratified by the presence of type 2 diabetes is unclear and is addressed in the present study.Research design and methodsWe prospectively recorded major cardiovascular events (MACE; ie, cardiovascular death, myocardial infarction or stroke) over 10.0±4.7 years in 923 patients with stable CAD, of whom 26.7% had T2DM and in 292 patients with PAD, of whom 42.1% had T2DM. Four groups were analyzed: CAD patients without diabetes (CAD/T2DM−; n=677), CAD patients with T2DM (CAD/T2DM+; n=246), PAD patients without diabetes (PAD/T2DM−; n=169) and PAD patients with T2DM (PAD/T2DM+; n=123).ResultsThe event rate for MACE increased over our four investigated groups: it was lowest in CAD/T2DM− patients (2.52 events per 100 person-years). It was significantly higher in CAD/T2DM+ patients (3.96 events per 100 person-years; p<0.001), in PAD/T2DM− patients (3.68 events per 100 person-years; p=0.022), and in PAD/T2DM+ patients (7.10 events per 100 person-years; p<0.001), who in turn were at a higher risk than CAD/T2DM+ or PAD/T2DM− patients (p=0.001 and p<0.001, respectively). Cox regression analysis after multivariate adjustment showed that the presence of T2DM (HR=1.44 (95% CI 1.09 to 1.92); p=0.012) and the presence of PAD versus CAD (HR=1.48 (95% CI 1.15 to 1.91); p=0.002) were mutually independent predictors of cardiovascular events.ConclusionsIn conclusion, our data show that T2DM as well as the presence of PAD versus CAD are mutually independent predictors of MACE. Patients with both PAD and T2DM are at an exceedingly high risk of cardiovascular events.

Challenges and opportunities in the management of type 2 diabetes in patients with lower extremity peripheral artery disease: a tailored diagnosis and treatment review

“…The therapeutic approach of PAD in individuals with T2DM is consistent across different clinical practice guidelines, as summarized in Table 1 . Given that the combination of T2DM and PAD is associated with a very high cardiovascular risk [ 67 ], general cardiovascular prevention is of the utmost importance and encompasses non-pharmacological measures such as smoking cessation, a healthy diet, and structured exercise [ 12 , 13 ]. In addition, pharmacological therapy includes antihypertensive drugs, lipid-lowering agents, glucose-lowering agents, and antithrombotic agents [ 23 , 58 ].…”

Individualisierung der antihypertensiven Therapie bei Patient:innen mit Diabetes mellitus. Leitlinie der Österreichischen Diabetes Gesellschaft (Update 2023)

“…Diabetes-Patient:innen mit PAVK haben eine weitaus schlechtere Prognose als Diabetes-Patient:innen nach Herzinfarkt oder Schlaganfall, wie in der PROactive-Studie nachgewiesen werden konnte [ 61 ]; eine rezente österreichische Studie zeigt ähnliche Ergebnisse [ 62 ]. Früher wurden für PAVK-Patient:innen generell Blutdruckzielwerte < 130/80 mm Hg gefordert, obwohl dafür keine Evidenz aus Studien vorlag.…”

“…Diabetes-Patient:innen mit PAVK haben eine weitaus schlechtere Prognose als Diabetes-Patient:innen nach Herzinfarkt oder Schlaganfall, wie in der PROactive-Studie nachgewiesen werden konnte [61]; eine rezente österreichische Studie zeigt ähnliche Ergebnisse [62].…”

Contribution of type 2 diabetes to major adverse cardiovascular events (MACE) in a long-term observational study with different stages of atherosclerosis

“…Patients with both PAD and T2DM are at an exceedingly high risk of cardiovascular events. 7 Based on these data, we aimed to investigate incident MACE in patients with or without T2DM presenting with two extremes of atherosclerotic disease, namely those with angiographically documented minor coronary atherosclerotic lesions (Group II) and those with a severe manifestation of atherosclerosis, i.e. symptomatic peripheral artery disease (PAD; Group III).…”