Diabetes mellitus is a coronary heart disease risk equivalent for peripheral vascular disease

Abstract

Background Diabetes Mellitus (diabetes) is associated with significantly increased risk of peripheral vascular disease (PVD). Diabetes is classified as a coronary heart disease (CHD) risk equivalent, but it is unknown whether diabetes is a CHD risk equivalent for PVD. Objectives To evaluate the odds of peripheral arterial disease (PAD) or carotid artery stenosis (CAS) among participants with diabetes, CHD or both, compared to participants without diabetes or CHD, in a nationwide vascular screening database. We hypothesized that diabetes and CHD would confer similar odds of PAD and CAS. Methods A cross-sectional analysis of all eligible Life Line Screening Inc. participants age 30 to 90 years with ankle brachial indices (ABI) for PAD (ABI <0.9 in either leg) and carotid artery duplex ultrasound imaging for CAS (internal carotid artery stenosis ≥50%) were included for analysis, N=3,522,890. Results Diabetes and CHD were present in 372,330 (10.7%) and 182,760 (5.8%) of participants, respectively; PAD and CAS were present in 155,000 (4.4%) and 130,347 (3.7%) of participants. After multivariable adjustment, PAD odds were 1.56 (95% C.I. 1.54,1.59) and 1.69 (95% C.I. 1.65,1.73) for participants with diabetes or CHD, respectively. Participants with both diabetes and CHD had 2.75-fold increased odds of PAD (95% C.I. 2.66, 2.85). Findings were similar for CAS; compared with no diabetes or CHD, CAS odds increased for participants with diabetes alone (1.53, 95% C.I. 1.50,1.56), CHD alone (1.72 (95% C.I. 1.68,1.76), and both diabetes and CHD (2.57 95% C.I. 2.49, 2.66). Findings were consistent for women and men. Conclusion In a large database of over 3.5 million self-referred participants, diabetes was a CHD risk equivalent for PAD and CAS, and participants with comorbid diabetes and CHD had an especially robust association with PAD and CAS. Counseling regarding screening and prevention of peripheral vascular disease may be useful for patients with diabetes.

Peripheral vascular disease risk in diabetic individuals without coronary heart disease

“…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).…”

“…Subsequent analyses demonstrated that it was only in the presence of multiple cardiovascular disease risk factors that diabetes conferred risk of CHD similar to the risk experienced by those with prior CHD events [10]. Recent analysis demonstrated that diabetes is also a CHD-risk equivalent for the outcome of peripheral vascular disease [11]. However, whether the relationship between diabetes and peripheral vascular disease varies by presence of cardiovascular disease risk factors has not been evaluated.…”

Update on peripheral artery disease: Epidemiology and evidence-based facts

“…Current smoking was associated with the highest odds of PAD. These researchers had previously demonstrated that CAD and diabetes synergistically increase the odds of PAD [6]: indeed, individuals with both diabetes and CAD have odds of developing PAD greater than the product of their individual odd ratios.…”

Clinical Impact of Atypical Chest Pain and Diabetes Mellitus in Patients with Acute Myocardial Infarction from Prospective KAMIR-NIH Registry

“…Diabetes mellitus (DM) is considered to have a risk equivalent to that of coronary heart disease, and global prevalence is gradually increasing [8,9]. Diabetic cardiovascular autonomic neuropathy contributes to inappropriate perception of chest pain [10].…”