Dr. Paul E. Norman and colleagues from the University of Western Australia, Fremantle, examined the natural history of peripheral artery disease (PAD) complicating type 2 diabetes. Specifically, they assessed the influence of PAD on the risk of cardiovascular death and whether PAD risk factor management is adequate. The team used data from the Fremantle Diabetes Study (FDS), a prospective community-based observational study of diabetics recruited between 1993 and 1996.

Included in the current analysis were 1294 type 2 diabetics and a subgroup of 531 type 2 diabetics with complete data at baseline and at least five subsequent annual reviews. A range of clinical and biochemical variables were assessed, including ABI. The investigators defined PAD as an ABI of no more than 0.90 at two consecutive reviews or any PAD-related lower-extremity amputation.

The prevalence of PAD at baseline was 13.6%. The incidence of new PAD was 3.7 per 100 patient-years. A strong independent association was observed between both prevalent and incident PAD and increasing age, systolic blood pressure, total serum cholesterol, and smoking. While risk factor management improved, it remained suboptimal during follow-up, according to the authors. An association was found between a baseline ABI of no more than 0.90 and an increased risk of cardiac death of 67%.