Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2021 Feb 27;20(1):54.
doi: 10.1186/s12933-021-01249-y.

Traditional and non-traditional risk factors for peripheral artery disease development/progression in patients with type 2 diabetes: the Rio de Janeiro type 2 diabetes cohort study

Claudia R L Cardoso  1 , Juliana V Melo  2 , Thainá R M Santos  2 , Nathalie C Leite  1 , Gil F Salles  3
Affiliations
Observational Study

Traditional and non-traditional risk factors for peripheral artery disease development/progression in patients with type 2 diabetes: the Rio de Janeiro type 2 diabetes cohort study

Claudia R L Cardoso et al. Cardiovasc Diabetol. .

Abstract

Background: The prognostic importance of non-traditional risk factors for peripheral artery disease (PAD) development/progression is scarcely studied in diabetes. We investigated if carotid intima-media thickness (CIMT) and carotid-femoral pulse wave velocity (cf-PWV) added prognostic information beyond traditional cardiovascular risk markers for PAD outcomes.

Methods: Ankle-brachial index (ABI) was measured at baseline and after a median of 91 months of follow-up in 681 individuals with type 2 diabetes. Multivariate Cox regressions examined the associations between the candidate variables and the outcome. PAD development/progression was defined by a reduction in ABI ≥ 0.15 (to a level < 0.9) or limb revascularization procedures, lower-extremity amputations or death due to PAD. The improvement in risk discrimination was assessed by increases in C-statistics of the models.

Results: Seventy-seven patients developed/progressed PAD: 50 reduced ABI to < 0.9, seven had lower-limb revascularizations, and 20 had amputations or death. Age, male sex, diabetes duration, presence of microvascular complications (peripheral neuropathy and diabetic kidney disease), baseline HbA1c, 24-h systolic BP (SBP) and mean cumulative office SBP and LDL-cholesterol were associated with PAD development/progression in several models. CIMT and cf-PWV were additionally associated with PAD outcomes, and their inclusion further improved risk discrimination (with C-statistic increases between 0.025 and 0.030). The inclusion of ambulatory 24-h SBP, instead of office SBP, also improved PAD risk discrimination.

Conclusions: Increased CIMT and aortic stiffness are associated with greater risks of developing/progressing PAD, beyond traditional risk factors, in type 2 diabetes.

Keywords: Aortic stiffness; Carotid intima-media thickness; Peripheral artery disease; Risk factors; Type 2 diabetes.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Criqui MH, Aboyans V. Epidemiology of peripheral artery disease. Circ Res. 2015;116:1509–1526. doi: 10.1161/CIRCRESAHA.116.303849. - DOI - PubMed
    1. Jude EB, Oyibo SO, Chalmers N, Boulton AJ. Peripheral arterial disease in diabetic and nondiabetic patients: a comparison of severity and outcome. Diabetes Care. 2001;24:1433–1437. doi: 10.2337/diacare.24.8.1433. - DOI - PubMed
    1. Dawn Abbott JD, Lombardero MS, Barsness GW, Pena-Sing I, Buitrón LV, Singh P, et al. Ankle-brachial index and cardiovascular outcomes in the bypass angioplasty revascularization investigation 2 diabetes trial. Am Heart J. 2012;164:585–590. doi: 10.1016/j.ahj.2012.06.017. - DOI - PMC - PubMed
    1. Cardoso CRL, Melo JV, Salles GC, Leite NC, Salles GF. Prognostic impact of the ankle-brachial index on the development of micro- and macrovascular complications in individuals with type 2 diabetes: the Rio de Janeiro type 2 diabetes cohort study. Diabetologia. 2018;61:2266–2276. doi: 10.1007/s00125-018-4709-9. - DOI - PubMed
    1. Buso G, Aboyans V, Mazzolai L. Lower extremity artery disease in patients with type 2 diabetes. Eur J Prev Cardiol. 2019;26(2-suppl):114–124. doi: 10.1177/2047487319880044. - DOI - PubMed

Publication types

MeSH terms