Single and combined effects of peripheral artery disease and of type 2 diabetes mellitus on the risk of cardiovascular events: A prospective cohort study.

Abstract

BACKGROUND AND AIMS

The individual and combined effects of type 2 diabetes (T2DM) and peripheral artery disease (PAD) on future cardiovascular events are unknown and are addressed in the present investigation.

METHODS

Cardiovascular events were prospectively recorded in 1049 subjects, encompassing 4 groups: 558 with neither PAD nor diabetes, 153 with T2DM but without PAD, 192 with PAD but without T2DM and 146 with the combination of PAD and T2DM.

RESULTS

Over a mean follow-up period of 7.2 ± 2.6 years, the cardiovascular event rate was lowest in patients with neither PAD nor T2DM (16.7%). Compared to this group the event rate was not significantly increased in T2DM patients without PAD (22.2%, p = 0.077) but higher in non-diabetic patients with PAD (52.6%; p < 0.001) and further increased in patients with both PAD and T2DM (71.2%; p < 0.001). Nondiabetic PAD patients were at a higher cardiovascular risk than T2DM patients without PAD (p < 0.001). Compared to those with neither PAD nor T2DM, hazard ratios after multivariate adjustment were 1.26 [0.84-1.91]; p = 0.267, 4.17 [2.97-5.85]; p < 0.001, and 7.82 [5.49-11.12]; p < 0.001 for those with T2DM only, for those with PAD only and for those with the combination of PAD plus diabetes, respectively.

CONCLUSIONS

PAD is a stronger risk factor for future cardiovascular events than T2DM, but T2DM in PAD patients accelerates atherothrombotic disease and strongly increases the incidence of cardiovascular events.