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Increased Risk for Peripheral Arterial Disease Mortality in Patients With Diabetes

Posted: Friday, March 11, 2005

Patients with diabetes are at an increased risk for peripheral arterial disease and peripheral arterial disease mortality, Cynthia Leibson, PhD, department of health sciences research, said these findings indicate that there is a critical need to improve diagnosis and monitoring of PAD in patients with diabetes.

Leibson and her colleagues conducted a longitudinal study to examine the risk of PAD and PAD mortality among patients with diabetes. They analyzed patients who had participated in a study of diabetes and PAD in the late 1970s. A total of 573 participants who had diabetes or PAD were examined for a follow-up study beginning in December 1999. The follow-up study was designed to determine the long-term risks of diabetes, PAD and related mortality.

Of the 573 people who participated in the follow-up study, 149 had PAD only, 238 had diabetes only and 186 had both PAD and diabetes.

Leibson said that survival rates were lower than expected within each of these subgroups, and patients who had both PAD and diabetes were at a particularly high risk for mortality.

The adjusted mortality risk for patients with both conditions was 2.2 times higher than it was for patients with PAD only. “We were surprised by the magnitude of the finding that persons with both peripheral arterial disease and diabetes had an adjusted risk of death greater than two-fold that for persons with peripheral arterial disease alone.”

Mortality risk was highest among patients whose PAD had progressed. The researchers noted that all of the 17 patients who had diabetes and PAD that progressed died. In comparison, 62% of patients with diabetes and PAD that did not progress died. Leibson said this increased mortality risk associated with disease progression was seen only among patients who also had diabetes.

Doctors need to be mindful of PAD progression in patients with diabetes. “This study reinforces the need to closely monitor peripheral arterial disease progression in individuals with diabetes and emphasizes the importance of diabetes prevention and management for reducing the burden of peripheral arterial disease,” she said.

Patients with diabetes need to be more aware of the risks associated with PAD. To reduce these risks, patients with diabetes should exercise and maintain a healthy diet and a desirable weight, she said.

“Patients should be aware of the importance of peripheral arterial disease monitoring,” Leibson said. “They should also be aware of the importance of treating cardiovascular disease risk factors to target levels, and they should adhere to medications prescribed.”

In the study, all the patients who had diabetes and PAD that progressed had died. In those who did not progress, still a very high percentage (62%) died. This indicates that the mortality rates in people with diabetes and PAD is generally high and that halting the progression of PAD is effective in reducing mortality in this high risk population.

Source: Diabetes Care. 2004;27:2843-2849. Leibson C, Ransom J, Olson W, et al. Peripheral arterial disease, diabetes and mortality.