Impact of peripheral arterial disease in patients with diabetes—Results from PROactive (PROactive 11)

Dormandy, J. A.; Betteridge, D. J.; Schernthaner, Guntram; Pīrāgs, Valdis; Norgren, Lars

doi:10.1016/j.atherosclerosis.2008.03.002

Cited by 77 publications

(53 citation statements)

References 39 publications

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“…As compared to previous studies in people with type 2 diabetes, we have observed a lower prevalence of PAD, which may partially be explained by the differences in PAD definitions used [13, 14]. The main limitation of our investigation is that we have studied patients with symptomatic and severe PAD, and may have underestimated outcomes associated with asymptomatic PAD.…”

Section: Discussionmentioning

confidence: 55%

“…In the PROspective pioglitAzone clinical trial in macrovascular events (PROactive) trial, baseline PAD was associated with high risk of all-cause mortality, and macrovascular complications in 5238 patients with type 2 diabetes during a mean follow-up of 2.9 years [14]. In the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D) trial, low ankle-brachial index or non-compressible artery were associated with increased risks of death and major cardiovascular events in 2368 patients with type 2 diabetes followed for an average of 4.3 years [15].…”

Section: Discussionmentioning

confidence: 99%

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Presentations of major peripheral arterial disease and risk of major outcomes in patients with type 2 diabetes: results from the ADVANCE-ON study

Mohammedi

Woodward

Hirakawa

et al. 2016

Cardiovasc Diabetol

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Background: Peripheral arterial disease (PAD) is known to be associated with high cardiovascular risk, but the individual impact of PAD presentations on risk of macrovascular and microvascular events has not been reliably compared in patients with type 2 diabetes. We aimed to evaluate the impact of major PAD, and its different presentations, on the 10-year risk of death, major macrovascular events, and major clinical microvascular events in these patients. Methods:Participants in the action in diabetes and vascular disease: PreterAx and DiamicroN modified-release controlled evaluation (ADVANCE) trial and the ADVANCE-ON post-trial study were followed for a median of 5.0 (in-trial), 5.4 (post-trial), and 9.9 (overall) years. Major PAD at baseline was subdivided into lower-extremity chronic ulceration or amputation secondary to vascular disease and history of peripheral revascularization by angioplasty or surgery.Results: Among 11,140 participants, 516 (4.6 %) had major PAD at baseline: 300 (2.7 %) had lower-extremity ulceration or amputation alone, 190 (1.7 %) had peripheral revascularization alone, and 26 (0.2 %) had both presentations. All-cause mortality, major macrovascular events, and major clinical microvascular events occurred in 2265 (20.3 %), 2166 (19.4 %), and 807 (7.2 %) participants, respectively. Compared to those without PAD, patients with major PAD had increased rates of all-cause mortality (HR 1.35, 95 % CI 1.15-1.60, p = 0.0004), and major macrovascular events (1.47 [1.23-1.75], p < 0.0001), after multiple adjustments for region of origin, cardiovascular risk factors and treatments, peripheral neuropathy markers, and randomized treatments. We have also observed a trend toward an association of baseline PAD with risk of major clinical microvascular events [1.31 (0.96-1.78), p = 0.09]. These associations were comparable for patients with a lower-extremity ulceration or amputation and for those with a history of peripheral revascularization. Furthermore, the risk of retinal photocoagulation or blindness, but not renal events, increased in patients with lower-extremity ulceration or amputation [1.53 (1.01-2.30), p = 0.04].Conclusions: Lower-extremity ulceration or amputation, and peripheral revascularization both increased the risks of death and cardiovascular events, but only lower-extremity ulceration or amputation increased the risk of severe retinopathy in patients with type 2 diabetes. Screening for major PAD and its management remain crucial for cardiovascular prevention in patients with type 2 diabetes (ClinicalTrials.gov number, NCT00949286).

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Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 99%

Presentations of major peripheral arterial disease and risk of major outcomes in patients with type 2 diabetes: results from the ADVANCE-ON study

Mohammedi

Woodward

Hirakawa

et al. 2016

Cardiovasc Diabetol

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“…20,24,25 To our knowledge, this is the first study to link the association between MC and mortality to the coexistence of atherosclerotic lesions. Using soft-tissue X-rays, Lehto et al reported increased risk for mortality and CVD events in case of MC in diabetic patients.…”

Section: Discussionmentioning

confidence: 93%

The prognosis of diabetic patients with high ankle-brachial index depends on the coexistence of occlusive peripheral artery disease

Aboyans

Lacroix

Tran

et al. 2011

Journal of Vascular Surgery

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“…Subjects were defined as having diabetes mellitus (i) if they had been assigned the clinical diagnosis by their physician and/or (ii) if their HbA 1c was ≥6.5% (criterion used in 94 cases) and/or (iii) if they were receiving any oral antidiabetic drug and/or insulin at baseline. The ≥6.5% HbA 1c value is above the typically used upper reference value of 6.0% and is highly specific for diabetes [21,22]. Subjects were defined as taking hypertension medication, if they were receiving AT 1 receptor antagonists and/or ACE inhibitors and/or diuretics at baseline.…”

Section: Methodsmentioning

confidence: 99%

Peripheral Arterial Disease as an Independent Predictor for Excess Stroke Morbidity and Mortality in Primary-Care Patients: 5-Year Results of the getABI Study

Meves

Diehm²,

Berger³

et al. 2010

Cerebrovasc Dis

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Background:There is controversial evidence with regard to the significance of peripheral arterial disease (PAD) as an indicator for future stroke risk. We aimed to quantify the risk increase for mortality and morbidity associated with PAD. Methods:In an open, prospective, noninterventional cohort study in the primary care setting, a total of 6,880 unselected patients ≧65 years were categorized according to the presence or absence of PAD and followed up for vascular events or deaths over 5 years. PAD was defined as ankle-brachial index (ABI) <0.9 or history of previous peripheral revascularization and/or limb amputation and/or intermittent claudication. Associations between known cardiovascular risk factors including PAD and cerebrovascular mortality/events were analyzed in a multivariate Cox regression model. Results:During the 5-year follow-up [29,915 patient-years (PY)], 183 patients had a stroke (incidence per 1,000 PY: 6.1 cases). In patients with PAD (n = 1,429) compared to those without PAD (n = 5,392), the incidence of all stroke types standardized per 1,000 PY, with the exception of hemorrhagic stroke, was about doubled (for fatal stroke tripled). The corresponding adjusted hazard ratios were 1.6 (95% confidence interval, CI, 1.1–2.2) for total stroke, 1.7 (95% CI 1.2–2.5) for ischemic stroke, 0.7 (95% CI 0.2–2.2) for hemorrhagic stroke, 2.5 (95% CI 1.2–5.2) for fatal stroke and 1.4 (95% CI 0.9–2.1) for nonfatal stroke. Lower ABI categories were associated with higher stroke rates. Besides high age, previous stroke and diabetes mellitus, PAD was a significant independent predictor for ischemic stroke. Conclusions:The risk of stroke is substantially increased in PAD patients, and PAD is a strong independent predictor for stroke.

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Impact of peripheral arterial disease in patients with diabetes—Results from PROactive (PROactive 11)

Cited by 77 publications

References 39 publications

Presentations of major peripheral arterial disease and risk of major outcomes in patients with type 2 diabetes: results from the ADVANCE-ON study

Presentations of major peripheral arterial disease and risk of major outcomes in patients with type 2 diabetes: results from the ADVANCE-ON study

The prognosis of diabetic patients with high ankle-brachial index depends on the coexistence of occlusive peripheral artery disease

Peripheral Arterial Disease as an Independent Predictor for Excess Stroke Morbidity and Mortality in Primary-Care Patients: 5-Year Results of the getABI Study

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