Wilcox T, et al. - Researchers evaluated the effect of diabetes with comorbid risk factors on the outcome of peripheral vascular disease. Increased odds of peripheral artery disease (PAD) and carotid artery stenosis (CAS) were noted among diabetics, even in the absence of coronary heart disease (CHD); this was particularly seen among those who had comorbid risk factors in addition to diabetes. This group of patients may benefit from counseling regarding screening and prevention for peripheral vascular disease.

Methods

• This cross-sectional analysis included 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%).
• Prior myocardial infarction or revascularization was how researchers defined CHD.
• Hypertension, hyperlipidemia, smoking, obesity, sedentary lifestyle and family history of cardiovascular disease were included as risk factors.

Results

• A total of 3,517,804 subjects were included, and of those 4.4% had PAD and 3.7% had CAS.
• A total of 376,528 subjects were diabetics, 324,680 (86%) of whom did not have CHD.
• An increase in the incidence of PAD was seen with 1–2 (4.3%), 3–4 (7.3%), and ≥5 (12.0%) comorbid risk factors (p trend <0.0001) among diabetic participants without CHD.
• A similar pattern was observed for CAS (3.7%, 6.2%, 8.8%, p trend < 0.0001).
• After adjustment for age, sex and race/ethnicity, relative to those without diabetes, those with diabetes and 1–2, 3–4 and ≥5 risk factors had increasing odds of PAD and CAS (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).
• CHD was shown to increase odds of PAD and CAS by 2-fold in nondiabetic participants (2.06, 95% CI 2.02–2.1; 2.19, 95% CI 2.15–2.23 respectively).