The prevalence of lower-extremity arterial occlusive disease (LEAOD), the progression of LEAOD, and the incidence of new LEAOD were determined by noninvasive method in 410 volunteers between the ages of 50 and 70 yr; 252 individuals had type II (non-insulin-dependent) diabetes, 158 were control subjects. LEAOD was monitored with the ankle/arm systolic blood pressure index in combination with Doppler arterial velocity waveform analysis. LEAOD was much more prevalent in the type II patients (22%, 55 of 252) than in the control subjects (3%, 4 of 158) (P less than .00001). The prevalence of risk factors for LEAOD was much higher in the type II patients, including elevated triglyceride, depressed high-density lipoprotein (HDL) cholesterol, hypertension, smoking, and elevated systolic blood pressure. In type II diabetic patients the incidence of new LEAOD over a 2-yr period (14%, 28 of 197) was lower than the incidence of LEAOD progression (87%, 45 of 52). Type II patients with LEAOD also had a high incidence of mortality (22%, 12 of 55) compared with those without LEAOD (4%, 8 of 197) (P less than .0005). A risk score including smoking history, duration of diabetes, depressed HDL cholesterol, total cholesterol, elevated systolic blood pressure, and low obesity index is related to LEAOD. After accounting for the effect of all of the risk factors, we suggest that type II diabetes contributes additional risk for LEAOD.

There was a strong association between severe renal artery atherosclerosis and severe carotid artery disease. Patients with renal artery disease also had a high prevalence of lower extremity arterial disease. In this patient population, screening for lower extremity arterial disease can be reserved for those with signs or symptoms of peripheral ischemia. Noninvasive carotid screening is justified in patients with renal artery disease to detect asymptomatic lesions that require either immediate surgical treatment or serial follow-up for disease progression.

Risk factors for arteriosclerosis, such as age, duration of diabetes, sex, and plasma lipoprotein levels, were correlated with the presence of arteriosclerosis obliterans (ASO) as determined by noninvasive methods in 485 of 506 subjects studied with diabetes mellitus. The diabetic subjects were separated into two major groups for analysis: insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM). The NIDDM group was subdivided into those treated by diet (NIDDM-D), sulfonylureas (NIDDM-S), and insulin (NIDDM-I). Overall, lipoprotein levels in the diabetics were higher than in an age- and sex-adjusted nondiabetic group. Cholesterol levels were elevated in all females and HDL cholesterol levels were depressed in diet- and sulfonylurea-treated females. VLDL levels were most elevated in diet-treated subjects followed by sulfonylurea-treated subjects; VLDL levels in insulin-treated subjects were not elevated. The prevalence of ASO is related to different factors in each group. In IDDM and NIDDM-I subjects, VLDL triglyceride, LDL cholesterol, and duration of diabetes or age are important risk indicators. By contrast, in NIDDM-S subjects, age alone is the significant risk indicator, and in NIDDM-D subjects, inverse HDL cholesterol correlated with ASO. While males have a higher prevalence of ASO than females, the difference is not statistically significant in any group. Other possible factors, such as hypertension, smoking, and obesity, were not considered in this initial analysis.

A prospective study of 135 controls, 286 non-insulin-dependent diabetic patients, and 31 subjects with an elevated fasting plasma glucose was performed to assess the prevalence of high-grade carotid artery stenosis. The carotid artery evaluation was performed using an ultrasonic duplex scanner. When those patients with an elevated fasting plasma glucose and non-insulin-dependent diabetes were considered together, the prevalence was 8.2% as compared with 0.7% for the controls (P = 0.0007). Those risk factors found to be significantly related to the higher prevalence of carotid disease in the combined groups of patients included age, ratio of systolic blood pressure to diastolic blood pressure, plasma cholesterol, and cigarette smoking. These findings may be an explanation for the greater incidence of stroke in patients with diabetes mellitus.

No abstract