[Peripheral artery disease of the lower limbs and morbidity/mortality in type 2 diabetics].

OBJECTIVE

To study the relationship between the presence of peripheral artery disease (PAD) and the morbidity and mortality at 6 years, and the ankle-brachial index (ABI) as a predictor of morbidity and mortality in type 2 diabetes mellitus.

DESIGN

Retrospective cohort study. Six years follow-up.

SETTING

Urban health centre.

PARTICIPANTS

A total of 269 type 2 diabetics, of which 63 had PAD in 1996: 20 were previously diagnosed and 43 had an ABI of < or =0.90.

PRINCIPAL MEASUREMENTS

An appointed was made with the patients to find out the incidence of fatal and non-fatal microvascular and macrovascular events and the histories were reviewed. Six patients were excluded as all their data were not available.

RESULTS

Thirty nine patients had died, of whom 19 had PAD in 1996 (30.1%) and 20 did not (9.7%) (P = .001). Sixteen patients died in the group with an ABI < or =0.9 (30.2%) and 21 (10.1%) in the group with normal ABI values (P = .001). 7 (13.2%) patients died due to a cardiovascular cause with a pathological ABI, and 8 (3.9%) with a normal value (P = .009). The presence of PAD has been associated with a higher probability of having a non-fatal episode of ischaemic cardiac disease (P = .04), a cerebrovascular accident (CVA) (P < .001) and ulcers (P = .006). A low ABI has been associated with a higher probability of presenting with a fatal or non-fatal cardiovascular event (P < .001). After the multivariate analysis an increase was observed in cardiovascular (odds ratio [OR] =2.81; 95% confidence interval [CI], 1.16-6.78), CVA (OR = 3.47; 95% CI, 1.19-10.07), and cardiac failure (OR = 6.75; 95% CI, 1.34-33.81), morbidity and mortality in diabetics with an ABI of < or = 0.90.

CONCLUSIONS

The type 2 diabetics with PAD present with a higher morbidity and mortality. The ABI is a good predictor of cardiovascular disease and heart failure morbidity and mortality.