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2014 ; 37
(6
): 1636-42
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Diabetes and vascular disease in different arterial territories
#MMPMID24705616
Shah B
; Rockman CB
; Guo Y
; Chesner J
; Schwartzbard AZ
; Weintraub HS
; Adelman MA
; Riles TS
; Berger JS
Diabetes Care
2014[Jun]; 37
(6
): 1636-42
PMID24705616
show ga
OBJECTIVE: The aim of this study was to investigate the relationship between
diabetes and different phenotypes of peripheral vascular disease (lower extremity
peripheral artery disease [PAD], carotid artery stenosis [CAS], and abdominal
aortic aneurysm [AAA]). RESEARCH DESIGN AND METHODS: Prevalence of vascular
disease was evaluated in 3,696,778 participants of the Life Line Screening survey
between 2003 and 2008. PAD was defined as ankle-brachial pressure index <0.90 or
prior revascularization, CAS as ?50% stenosis or prior revascularization, and AAA
as infrarenal aortic diameter ?3 cm or prior repair. Odds ratios (ORs) and 95%
CIs were assessed using logistic regression modeling. RESULTS: Diabetes mellitus
was present in 10.8% of participants (n = 399,884). Prevalence of PAD, CAS, and
AAA was significantly higher (P < 0.0001) in participants with compared with
those without diabetes. After multivariate adjustment for baseline demographics
and clinical risk factors, a significant interaction existed between diabetes and
vascular disease phenotype (P < 0.0001). Diabetes was associated with increased
odds of PAD (OR 1.42 [95% CI 1.41-1.4]; P < 0.0001) and CAS (1.45 [1.43-1.47]; P
< 0.0001) but decreased odds of AAA (0.86 [0.84-0.88]; P < 0.0001). The strength
of association increased with increasing severity of disease in each vascular
phenotype, and this association persisted in the population with asymptomatic
vascular disease. CONCLUSIONS: In a large population-based study, the association
between diabetes and vascular disease differed according to vascular phenotype.
Future studies exploring the mechanism for these vascular-specific differences
are needed.
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