Diabetes and Vascular Disease in Different Arterial Territories

Shah, Binita; Rockman, Caron; Guo, Yu; Chesner, Jaclyn; Schwartzbard, Arthur; Weintraub, Howard; Adelman, Mark A.; Riles, Thomas S.; Berger, Jeffrey S.

doi:10.2337/dc13-2432

Cited by 33 publications

(30 citation statements)

References 31 publications

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“…Therefore, assuming the population paying for screening represents a higher socioeconomic sample, our results may underestimate the burder of PAD. However, prevalence of PAD and CAS in the dataset were similar to other cohorts suggesting good external validity of our dataset [12,24]. …”

Section: Discussionsupporting

confidence: 78%

“…The dataset contained screening results collected between 2003 and 2008 from 3,696,778 mostly self-referred adults in all 50 US states. Before undergoing the screening procedure, individuals completed a questionnaire that included information on demographics, smoking, exercise, cardiovascular risk factors, medical comorbidities, and family history of atherosclerosis and vascular disease [11,12]. For the purposes of this study, peripheral vascular disease is defined as lower extremity periphery artery disease (PAD) or carotid artery stenosis (CAS).…”

Section: Methodsmentioning

confidence: 99%

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Peripheral vascular disease risk in diabetic individuals without coronary heart disease

et al. 2018

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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.

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Section: Discussionsupporting

confidence: 78%

Section: Methodsmentioning

confidence: 99%

Peripheral vascular disease risk in diabetic individuals without coronary heart disease

et al. 2018

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“…Likewise, the fee associated with the screening exam, although modest, may have introduced further selection bias by underrepresenting individuals with low socioeconomic status. However, our previous analyses of income suggest an overall fairly good representation of a broad range of socioeconomic status (Shah et al, 2014). …”

Section: Discussionmentioning

confidence: 88%

“…The geographic distribution of the sample was similar to that of the overall population of the United States. The sample also included a broad representation of socioeconomic status, as represented by participant zip-code (Shah et al, 2014). As we have published previously, the prevalence of different cardiovascular risk factors in this population database was similar to those of the general US adult population (Savji et al, 2013).…”

Section: Resultsmentioning

confidence: 99%

Greater frequency of nut consumption is associated with lower prevalence of peripheral arterial disease

Heffron

Rockman

Gianos

et al. 2015

Preventive Medicine

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Nut consumption has been associated with lower risk of coronary heart disease and all-cause mortality. The association between nut intake and peripheral arterial disease (PAD) is uncertain. Objective We sought to investigate the association between nut consumption and presence of prevalent PAD in a large cross-sectional sample. Methods Self-referred participants at >20,000 US sites who completed a medical and lifestyle questionnaire were evaluated by screening ankle brachial indices for PAD. Multivariable logistic regression analysis was used to estimate odds of PAD in different nut consumption categories. Results Among 3,312,403 individuals, mean age was 63.6 ±10.6 years and 62.8% were female. There were 219,527 cases of PAD. After multivariable adjustment there was an inverse association of nut intake with PAD. Compared to subjects with consumption of nuts

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“…In addition, associations of lifestyle on different phenotypes of CVD should be studied. In a study of 3,696,778 self-referred participants in the Life Line Screening survey between 2003 and 2008, diabetes was associated with increased odds of peripheral artery disease (odds ratio [OR] 1.42, 95 % CI 1.41-1.44) and carotid artery stenosis (OR 1.45, 95 % CI 1.43-1.47), but a decreased odds of abdominal aortic aneurysm (OR 0.86, 95 % CI 0.84-0.88) [48]. In addition, more work is needed to ascertain which lifestyle components or combinations thereof provide the greatest benefit in particular subgroups of disease risk.…”

Section: Future Researchmentioning

confidence: 99%

The Role of Lifestyle Change for Prevention of Cardiovascular Disease in Diabetes

Staimez

Weber

Gregg

2014

Curr Atheroscler Rep

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The burden of cardiovascular disease (CVD) is disproportionately greater in those with diabetes than in the general population, including higher rates of hospitalization, stroke, myocardial infarction, and mortality. Health-promoting lifestyle factors reduce both diabetes and CVD in healthy individuals; however, the efficacy of these strategies for CVD reduction in people with preexisting diabetes is unclear. In this review, we describe the most recent evidence (2013-2014) surrounding the effects of lifestyle changes on CVD outcomes in those with diabetes, and we contextualize the evidence against a backdrop of earlier key findings. Two major randomized controlled trials were identified, providing opposing conclusions about the role of lifestyle factors on CVD events in those with diabetes. Other recent prospective observational analyses support associations of physical activity and reduced CVD risk in diabetes. Limitations across studies include the use of self-report for measurement of lifestyle or lifestyle change, the length of follow-up needed to measure CVD outcomes, and the role of participants' medications on associations of lifestyle factors and CVD outcomes. Equivocal findings from the two randomized controlled trials support the need for additional research to identify the specific lifestyle factors that reduce CVD mortality and macrovascular complications in populations with diabetes.

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Diabetes and Vascular Disease in Different Arterial Territories

Cited by 33 publications

References 31 publications

Peripheral vascular disease risk in diabetic individuals without coronary heart disease

Peripheral vascular disease risk in diabetic individuals without coronary heart disease

Greater frequency of nut consumption is associated with lower prevalence of peripheral arterial disease

The Role of Lifestyle Change for Prevention of Cardiovascular Disease in Diabetes

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