Development of New Peripheral Arterial Occlusive Disease in Patients With Type 2 Diabetes During a Mean Follow-Up of 11 Years
- Milla Kallio, MD1,
- Carol Forsblom, MD2,
- Per-Henrik Groop, MD, DMSC2,
- Leif Groop, MD3 and
- Mauri Lepäntalo, MD1
- 1Department of Vascular Surgery, Helsinki University Central Hospital, Helsinki, Finland
- 2Department of Medicine, Division of Nephrology, Helsinki University Central Hospital, Helsinki, Finland
- 3Department of Medicine, Malmö General Hospital, University of Lund, Lund, Sweden
Abstract
OBJECTIVE— To assess the occurrence and development of new peripheral arterial occlusive disease (PAOD), its risk factors, and the outcome in patients with type 2 diabetes.
RESEARCH DESIGN AND METHODS— A total of 130 type 2 diabetic patients (mean age 58 years) were examined at baseline and after a mean follow-up of 11 years (range 7–14). The ankle-brachial index (ABI) and toe-brachial index were used to detect PAOD. Blood and urine samples were taken at baseline, and a history of cardiovascular events was recorded during follow-up.
RESULTS— PAOD was diagnosed in 21 (16%) patients at baseline. During follow-up, 21 of 89 (24%) patients developed new PAOD. There were 29 patients who died, 21 (72%) of them from cardiovascular disease. Patients with PAOD suffered an excess mortality compared with patients without PAOD (58 vs. 16%; P < 0.001). Logistic regression analysis showed that PAOD at baseline was associated with age, duration of diabetes, smoking, and urinary albumin excretion rate. Patients who developed new PAOD during follow-up had higher serum LDL cholesterol concentrations and lower HDL cholesterol concentrations and were older than the patients who remained free of PAOD.
CONCLUSIONS— Objectively measured PAOD is frequent in type 2 diabetic patients. It presents the early clinical signs of atherosclerosis and is strongly associated with cardiovascular death. The risk factor pattern for PAOD was different at baseline and after a mean follow-up of 11 years. We consider routine ABI measurements and modification of risk factors necessary also in patients with asymptomatic PAOD.
- ABI, ankle-brachial index
- PAOD, peripheral arterial occlusive disease
- TBI, toe-brachial index
- UAER, urinary albumin excretion rate
Footnotes
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Address correspondence and reprint requests to Per-Henrik Groop, MD, DMSc, Folkhälsan Research Centre, Biomedicum Helsinki (C318b), POB 63, University of Helsinki, FIN-00014, Finland. E-mail: per-henrik.groop{at}helsinki.fi.
Received for publication 17 March 2002 and accepted in revised form 13 December 2002.
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