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Observational Study
. 2018 Aug:275:419-425.
doi: 10.1016/j.atherosclerosis.2018.04.026. Epub 2018 Apr 30.

Peripheral vascular disease risk in diabetic individuals without coronary heart disease

Tanya Wilcox  1 , Jonathan D Newman  2 , Thomas S Maldonado  3 , Caron Rockman  3 , Jeffrey S Berger  4
Affiliations
Observational Study

Peripheral vascular disease risk in diabetic individuals without coronary heart disease

Tanya Wilcox et al. Atherosclerosis. 2018 Aug.

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.

Keywords: Carotid artery stenosis; Coronary heart disease; Diabetes mellitus; Peripheral arterial disease; Peripheral vascular disease.

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Conflict of interest statement

Conflicts of interest

The authors declared they do not have anything to disclose regarding conflict of interest with respect to this manuscript.

Figures

Fig. 1.
Fig. 1.
Prevalence (%) of peripheral artery disease and carotid artery stenosis by risk factor profile. (A) Peripheral artery disease prevalence (%) by risk factor profile, (B) carotid artery stenosis prevalence (%) by risk factor profile.
Fig. 2.
Fig. 2.
Adjusted odds ratios of peripheral artery disease and carotid artery stenosis by risk factor profile. (A) Odds and 95% confidence intervals of peripheral artery disease adjusted for age, sex and race/ethnicity by risk factor profile. (B) Odds and 95% confidence intervals of carotid artery stenosis adjusted for age, sex and race/ethnicity by risk factor profile.
See this image and copyright information in PMC

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