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CV risk factors predicted PAD in patients with type 2 diabetes
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In a large cohort of patients with type 2 diabetes, traditional cardiovascular risk factors were found to be the main risk factors predicting incidence of peripheral arterial disease, according to research published online first in Diabetes Care.
Researchers also found that different CV risk factors were more predictive than others among patients prescribed insulin-sensitizing medications compared with those prescribed insulin-providing medications.
Researchers analyzed data from 1,479 participants with normal ankle-brachial index at baseline of the Bypass Angioplasty Revascularization Investigation 2 Diabetes (BARI 2D), a randomized controlled trial that compared patients assigned insulin-sensitizing therapy and insulin-providing therapy. The researchers used Cox proportional hazards models to analyze baseline risk factors within the overall cohort. They also assessed time-varying risk factors within particular glycemic control arms.
Study participants were followed for an average of 4.6 years. During that time, 303 (20.5%) of the 1,479 participants experienced incident PAD. Of those who experienced incident PAD, age, sex, race and baseline smoking status were all found to be significantly associated with incidence of PAD outcomes. After adjusting for age, sex, race and baseline smoking status, baseline HbA1c (HR=1.17; P<0.01) and pulse pressure and albumin-to-creatinine ratio (P<.05 for each) were also significantly associated with PAD outcomes.
Researchers then conducted a stratified analysis of time-varying covariates and found changes in BMI, LDL, HDL, systolic blood pressure and pulse pressure to be the primary risk factors associated with PAD incident in patients prescribed insulin-sensitizing medications, whereas change in HbA1c was the primary risk factor associated with PAD incident in patients prescribed insulin-providing medications.
“Increased pulse pressure is generally indicative of arterial stiffness, so it is interesting to note that pulse pressure demonstrates a strong relationship with PAD outcomes,” the researchers wrote. “This manuscript reports the associations between traditional and nontraditional risk factors for PAD and related lower extremity outcomes over time in patients with type 2 diabetes. … Glycemic control strategy may have differential effects on the progression of atherosclerosis in patients with type 2 diabetes.”
Disclosures: Althouse reports receiving support from Amylin, Boehringer Ingelheim, Bristol-Myers Squibb, Daiichi Sankyo, Genentech, GlaxoSmithKline, Janssen, Lexicon, Merck, Novartis Pharmaceuticals, Pfizer, Hoffman-La Roche Omthera, Sanofi, Shionogi and Takeda. One researcher reports receiving support from Abbott Vascular, and another researcher reports receiving support from Sanofi.
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