Kamel Mohammedi1, Mark Woodward2, Yoichiro Hirakawa1, Sophia Zoungas3, Bryan Williams4, Liu Lisheng5, Anthony Rodgers1, Giuseppe Mancia6, Bruce Neal1, Stephen Harrap7, Michel Marre8, John Chalmers9. 1. The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia. 2. The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia The George Institute for Global Health, University of Oxford, Oxford, U.K. Department of Epidemiology, Johns Hopkins University, Baltimore, MD. 3. The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia. 4. Institute of Cardiovascular Sciences, University College London (UCL) and National Institute of Health Research UCL Hospitals Biomedical Research Centre, London, U.K. 5. The Chinese Hypertension League Institute, Beijing, China. 6. The University of Milan-Bicocca and Istituto Auxologico Italiano, Milan, Italy. 7. The University of Melbourne and Royal Melbourne Hospital, Melbourne, Victoria, Australia. 8. INSERM, UMRS 1138, Centre de Recherche des Cordeliers, Paris, France Assistance Publique Hôpitaux de Paris, Bichat Hospital, DHU FIRE, Department of Diabetology, Endocrinology and Nutrition, Paris, France Université Paris Diderot, Sorbonne Paris Cité, UFR de Médecine, Paris, France. 9. The George Institute for Global Health, University of Sydney, Sydney, New South Wales, Australia chalmers@georgeinstitute.org.au.
Abstract
OBJECTIVE:Peripheral arterial disease (PAD) is a common manifestation of atherosclerosis in type 2 diabetes, but the relationship between other vascular diseases and PAD has been poorly investigated. We examined the impact of previous microvascular and macrovascular disease on the risk of major PAD in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: We analyzed 10,624 patients with type 2 diabetes free from baseline major PAD in the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) clinical trial. The primary composite outcome was major PAD defined as PAD-induced death, peripheral revascularization, lower-limb amputation, or chronic ulceration. The secondary end points were the PAD components considered separately. RESULTS:Major PAD occurred in 620 (5.8%) participants during 5 years of follow-up. Baseline microvascular and macrovascular disease were both associated with subsequent risk of major PAD after adjustment for age, sex, region of origin, and randomized treatments. However, only microvascular disease remained significantly associated with PAD after further adjustment for established risk factors. The highest risk was observed in participants with a history of macroalbuminuria (hazard ratio 1.91 [95% CI 1.38-2.64], P < 0.0001) and retinal photocoagulation therapy (1.60 [1.11-2.32], P = 0.01). Baseline microvascular disease was also associated with a higher risk of chronic lower-limb ulceration (2.07 [1.56-2.75], P < 0.0001) and amputation (1.59 [1.15-2.22], P = 0.006), whereas baseline macrovascular disease was associated with a higher rate of angioplasty procedures (1.75 [1.13-2.73], P = 0.01). CONCLUSIONS: Microvascular disease, particularly macroalbuminuria and retinal photocoagulation therapy, strongly predicts major PAD in patients with type 2 diabetes, but macrovascular disease does not.
RCT Entities:
OBJECTIVE:Peripheral arterial disease (PAD) is a common manifestation of atherosclerosis in type 2 diabetes, but the relationship between other vascular diseases and PAD has been poorly investigated. We examined the impact of previous microvascular and macrovascular disease on the risk of major PAD in patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: We analyzed 10,624 patients with type 2 diabetes free from baseline major PAD in the Action in Diabetes and Vascular Disease: Preterax and Diamicron MR Controlled Evaluation (ADVANCE) clinical trial. The primary composite outcome was major PAD defined as PAD-induced death, peripheral revascularization, lower-limb amputation, or chronic ulceration. The secondary end points were the PAD components considered separately. RESULTS: Major PAD occurred in 620 (5.8%) participants during 5 years of follow-up. Baseline microvascular and macrovascular disease were both associated with subsequent risk of major PAD after adjustment for age, sex, region of origin, and randomized treatments. However, only microvascular disease remained significantly associated with PAD after further adjustment for established risk factors. The highest risk was observed in participants with a history of macroalbuminuria (hazard ratio 1.91 [95% CI 1.38-2.64], P < 0.0001) and retinal photocoagulation therapy (1.60 [1.11-2.32], P = 0.01). Baseline microvascular disease was also associated with a higher risk of chronic lower-limb ulceration (2.07 [1.56-2.75], P < 0.0001) and amputation (1.59 [1.15-2.22], P = 0.006), whereas baseline macrovascular disease was associated with a higher rate of angioplasty procedures (1.75 [1.13-2.73], P = 0.01). CONCLUSIONS:Microvascular disease, particularly macroalbuminuria and retinal photocoagulation therapy, strongly predicts major PAD in patients with type 2 diabetes, but macrovascular disease does not.
Authors: Lauren K Park; Elizabeth J Parks; Ryan J Pettit-Mee; Makenzie L Woodford; Thaysa Ghiarone; James A Smith; Allan R K Sales; Luis A Martinez-Lemus; Camila Manrique-Acevedo; Jaume Padilla Journal: J Appl Physiol (1985) Date: 2020-07-02
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Authors: Joshua A Beckman; Meredith S Duncan; Scott M Damrauer; Quinn S Wells; Joey V Barnett; David H Wasserman; Roger J Bedimo; Adeel A Butt; Vincent C Marconi; Jason J Sico; Hilary A Tindle; Marc P Bonaca; Aaron W Aday; Matthew S Freiberg Journal: Circulation Date: 2019-07-08 Impact factor: 29.690