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Relationship Between HbA_1c Level and Peripheral Arterial Disease

¹ Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
² Department of Medicine, Tulane University School of Medicine, New Orleans, Louisiana

Address correspondence and reprint requests to Paul Muntner, Department of Epidemiology, Tulane University SPHTM, 1430 Tulane Ave., SL-18 New Orleans, LA 70112. E-mail: pmuntner{at}tulane.edu

OBJECTIVE—Homeostatic glucose control may play an important role in the development of peripheral arterial disease among individuals without diabetes. We sought to evaluate the association of HbA_1c (A1C) with peripheral arterial disease in a representative sample of the U.S. population with and without diabetes.

RESEARCH DESIGN AND METHODS—A cross-sectional study was conducted among 4,526 National Health and Nutrition Examination Survey 1999–2002 participants 40 years of age. Peripheral arterial disease was defined as an ankle-brachial index <0.9 (n = 327).

RESULTS—Among nondiabetic subjects, the age-standardized prevalence of peripheral arterial disease was 3.1, 4.8, 4.7, and 6.4% for participants with an A1C <5.3, 5.3–5.4, 5.5–5.6, and 5.7–6.0%, respectively (P trend <0.001). The prevalence of peripheral arterial disease was 7.5 and 8.8% for diabetic participants with A1C <7 and 7%, respectively. After multivariable adjustment and compared with nondiabetic participants with A1C <5.3%, the odds ratio (95% CI) of peripheral arterial disease for nondiabetic participants with an A1C of 5.3–5.4, 5.5–5.6, and 5.7–6.0% was 1.41 (0.85–2.32), 1.39 (0.70–2.75), and 1.57 (1.02–2.47), respectively, and it was 2.33 (1.15–4.70) and 2.74 (1.25–6.02) for diabetic participants with A1C <7 and 7%, respectively.

CONCLUSIONS—An association exists between higher levels of A1C and peripheral arterial disease, even among patients without diabetes. Individuals with A1C levels 5.3% should be targeted for aggressive risk factor reduction, which may reduce the burden of subclinical cardiovascular disease even among those without diabetes.

Abbreviations: ABI, ankle-brachial index • NHANES, National Health and Nutrition Examination Survey

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