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Peripheral Arterial Disease and Risk of Cardiac Death in Type 2 Diabetes

The Fremantle Diabetes Study

¹ School of Surgery and Pathology, University of Western Australia, Fremantle Hospital, Fremantle, Australia
² School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, Fremantle, Australia

Address correspondencereprint requests to Associate Professor Paul Norman, School of SurgeryPathology, Fremantle Hospital, P.O. Box 480, Fremantle, Western Australia 6959. E-mail: pnorman{at}cyllene.uwa.edu.au

OBJECTIVE—The purpose of this study was to examine the natural history of peripheral arterial disease (PAD) complicating type 2 diabetes, in particular the influence of PAD on the risk of cardiac death and the adequacy of PAD risk factor management.

RESEARCH DESIGN AND METHODS—The Fremantle Diabetes Study (FDS) was a prospective community-based observational study of diabetic patients recruited between 1993 and 1996. The present sample comprised the 1,294 FDS type 2 diabetic patients and a subgroup of 531 of these who had valid data at baseline and five or more subsequent consecutive annual reviews. Assessments consisted of a range of clinical and biochemical variables including the ankle/brachial index (ABI). PAD was defined as an ABI 0.90 at two consecutive reviews or any PAD-related lower-extremity amputation.

RESULTS—The prevalence of PAD at study entry was 13.6% and the incidence of new PAD was 3.7 per 100 patient-years. Both prevalent and incident PAD was strongly and independently associated with increasing age, systolic blood pressure, total serum cholesterol, and especially smoking. Risk factor management improved but remained suboptimal during follow-up. An ABI of 0.90 was independently associated with an increased risk of cardiac death of 67%.

CONCLUSIONS—Measurement of the ABI is a simple means of identifying PAD in diabetic patients. PAD is common in diabetic patients and predicts cardiac death. These data further support the role of regular screening for PAD in diabetes so that intensive management of vascular risk factors can be pursued.

Abbreviations: ABI, ankle/brachial index • ACR, albumin-to-creatinine ratio • CHD, coronary heart disease • CVD, cerebrovascular disease • FDS, Fremantle Diabetes Study • LEA, lower-extremity amputation • OHA, oral hypoglycemic agent • PAD, peripheral arterial disease • UKPDS, U.K. Prospective Diabetes Study

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