University of Missouri-Kansas City Kansas City MO.
Saint Luke's Mid America Heart Institute Kansas City MO.
J Am Heart Assoc. 2020 Nov 17;9(22):e017103. doi: 10.1161/JAHA.120.017103. Epub 2020 Nov 6.
Background Patients with peripheral artery disease (PAD) and coexisting diabetes mellitus (DM) have greater PAD progression and adverse limb events. Our aim was to study whether PAD-specific health status differs by DM. Methods and Results The PORTRAIT (Patient-Centered Outcomes Related to Treatment Practices in Peripheral Arterial Disease: Investigating Trajectories) trial is a 16-center international registry that includes patients with recent exacerbations or new-onset symptomatic PAD presenting to specialty clinics. We assessed PAD-specific health status initially and at 3, 6, and 12 months (Peripheral Artery Questionnaire [PAQ]). We used hierarchical, multivariable, linear regression, and repeated measures analyses to study the association between DM and baseline health status initially and over 3 to 12 months. Models were adjusted for demographics, socioeconomic factors, PAD severity, comorbidities, and psychosocial characteristics. The interaction of DM with PAD revascularization on 3- to 12-month health status was also tested. Of 1204 patients, 398 (33%) had DM (94% type 2). Patients with versus those without DM had lower unadjusted PAQ summary scores at baseline and 3, 6, and 12 months (46.1 versus 50.8, 63.6 versus 68.2, 65.7 versus 71.7, and 65.4 versus 72.6; ≤0.01). In fully adjusted models, the effect of DM on baseline (mean difference, -0.65; 95% CI, -2.86 to 1.56 [=0.56]) and over 3- to 12-month PAQ summary scores (mean difference, -1.59; 95% CI, -4.06 to 0.88 [=0.21]) was no longer significant. Twelve-month health status gains following revascularization were similar in both groups (=0.69). Conclusions Patients with PAD with coexisting DM have poorer health status, mostly explained by the differences in their psychosocial and other comorbidity burden. Patients with PAD and DM versus those without DM experience similar health status benefits following PAD revascularization.
患有外周动脉疾病（PAD）和并存糖尿病（DM）的患者PAD 进展和肢体不良事件更大。我们的目的是研究 PAD 特定的健康状况是否因 DM 而不同。
PORTRAIT（与外周动脉疾病治疗实践相关的患者为中心的结果：探索轨迹）试验是一个 16 中心的国际注册，包括最近恶化或新出现症状性 PAD 并到专科诊所就诊的患者。我们最初在 3、6 和 12 个月时评估了 PAD 特定的健康状况（外周动脉问卷 [PAQ]）。我们使用分层、多变量、线性回归和重复测量分析来研究 DM 与基线健康状况之间的关联，并在 3 至 12 个月期间进行了研究。模型调整了人口统计学、社会经济因素、PAD 严重程度、合并症和社会心理特征。还测试了 DM 与 3 至 12 个月健康状况之间的 PAD 血运重建的相互作用。在 1204 名患者中，398 名（33%）患有 DM（94%为 2 型）。与没有 DM 的患者相比，基线和 3、6 和 12 个月时，患有 DM 的患者的 PAQ 综合评分较低（46.1 与 50.8、63.6 与 68.2、65.7 与 71.7、65.4 与 72.6；≤0.01）。在完全调整的模型中，DM 对基线（平均差异，-0.65；95%CI，-2.86 至 1.56[=0.56]）和 3 至 12 个月 PAQ 综合评分（平均差异，-1.59；95%CI，-4.06 至 0.88[=0.21]）的影响不再显著。两组患者在血运重建后 12 个月的健康状况改善相似（=0.69）。
患有并存 DM 的 PAD 患者的健康状况较差，主要是由于他们的社会心理和其他合并症负担的差异所致。患有 PAD 和 DM 的患者与没有 DM 的患者在 PAD 血运重建后经历相似的健康状况获益。
