Newman Jonathan D, Rockman Caron B, Kosiborod Mikhail, Guo Yu, Zhong Hua, Weintraub Howard S, Schwartzbard Arthur Z, Adelman Mark A, Berger Jeffrey S
Division of Cardiology, Department of Medicine, New York University Medical Center, New York, NY; Center for the Prevention of Cardiovascular Disease, New York University Medical Center, New York, NY.
Division of Vascular Surgery, Department of Surgery, New York University Medical Center, New York, NY.
Am Heart J. 2017 Feb;184:114-120. doi: 10.1016/j.ahj.2016.09.002. Epub 2016 Sep 18.
Diabetes mellitus (diabetes) is associated with significantly increased risk of peripheral vascular disease. Diabetes is classified as a coronary heart disease (CHD) risk equivalent, but it is unknown whether diabetes is a CHD risk equivalent for peripheral vascular disease. The objective was to evaluate the odds of peripheral arterial disease (PAD) or carotid artery stenosis (CAS) among participants with diabetes, CHD, or both, compared with participants without diabetes or CHD, in a nationwide vascular screening database. We hypothesized that diabetes and CHD would confer similar odds of PAD and CAS.
A cross-sectional analysis of all eligible Life Line Screening Inc participants age 30 to 90 years with ankle brachial indices for PAD (ankle brachial index <0.9 in either leg) and carotid artery duplex ultrasonographic imaging for CAS (internal CAS ≥50%) was performed (N=3,522,890).
Diabetes and CHD were present in 372,330 (10.7%) and 182,760 (5.8%) of participants, respectively; PAD and CAS were present in 155,000 (4.4%) and 130,347 (3.7%) of participants. After multivariable adjustment, PAD odds were 1.56 (95% CI 1.54-1.59) and 1.69 (95% CI 1.65-1.73) for participants with diabetes or CHD, respectively. Participants with both diabetes and CHD had 2.75-fold increased odds of PAD (95% CI 2.66-2.85). Findings were similar for CAS; compared with no diabetes or CHD, CAS odds increased for participants with diabetes alone (1.53, 95% CI 1.50-1.56), CHD alone (1.72, 95% CI 1.68-1.76), and both diabetes and CHD (2.57, 95% CI 2.49-2.66). Findings were consistent for women and men.
In a large database of more than 3.5 million self-referred participants, diabetes was a CHD risk equivalent for PAD and CAS, and participants with comorbid diabetes and CHD had an especially robust association with PAD and CAS. Counseling regarding screening and prevention of peripheral vascular disease may be useful for patients with diabetes.
糖尿病与外周血管疾病风险显著增加相关。糖尿病被归类为冠心病（CHD）风险等同情况，但糖尿病是否为外周血管疾病的冠心病风险等同情况尚不清楚。目的是在一个全国性血管筛查数据库中，评估糖尿病患者、冠心病患者或两者兼有的参与者发生外周动脉疾病（PAD）或颈动脉狭窄（CAS）的几率，与无糖尿病或冠心病的参与者进行比较。我们假设糖尿病和冠心病会赋予相似的PAD和CAS发生几率。
对所有符合条件的生命线筛查公司30至90岁参与者进行横断面分析，这些参与者进行了用于评估PAD的踝臂指数（任何一条腿的踝臂指数<0.9）和用于评估CAS的颈动脉双功超声成像（颈内动脉狭窄≥50%）（N = 3,522,890）。
分别有372,330名（10.7%）和182,760名（5.8%）参与者患有糖尿病和冠心病；分别有155,000名（4.4%）和130,347名（3.7%）参与者患有PAD和CAS。经过多变量调整后，糖尿病患者或冠心病患者发生PAD的几率分别为1.56（95%置信区间1.54 - 1.59）和(1.69)（95%置信区间1.65 - 1.73）。同时患有糖尿病和冠心病的参与者发生PAD的几率增加了2.75倍（95%置信区间2.66 - 2.85）。CAS的结果相似；与无糖尿病或冠心病相比，仅患有糖尿病的参与者CAS发生几率增加（1.53，95%置信区间1.50 - 1.56），仅患有冠心病的参与者（1.72，95%置信区间1.68 - 1.76），以及同时患有糖尿病和冠心病的参与者（2.57，95%置信区间2.49 - 2.66）。男性和女性的结果一致。
在一个超过350万自我推荐参与者的大型数据库中，糖尿病是PAD和CAS的冠心病风险等同情况，并且合并糖尿病和冠心病的参与者与PAD和CAS的关联尤为显著。针对外周血管疾病筛查和预防的咨询可能对糖尿病患者有用。
