Rerkasem Amaraporn, Mangklabruks Ampica, Buranapin Supawan, Sony Kiran, Inpankaew Nimit, Rerkasem Rath, Pongtam Sasinat, Phirom Kochaphan, Rerkasem Kittipan
Environmental - Occupational Health Sciences and Non Communicable Diseases Research Center, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand.
Research Center for Infectious Diseases and Substance Use, Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand.
PLoS One. 2025 May 16;20(5):e0322502. doi: 10.1371/journal.pone.0322502. eCollection 2025.
This cohort study estimated the incidence and predictors of cardiovascular disease (CVD) and all-cause mortality among patients with type 2 diabetes mellitus (T2DM) and various stages of peripheral arterial disease (PAD) at the largest tertiary referral hospitals in upper-northern Thailand.
This study recruited 278 T2DM and PAD patients for a 7-year cohort study. These patients completed health questionnaires and underwent physical examinations including ankle-brachial index measurements and clinical assessment to determine PAD severity. Mortality endpoints were determined using hospital death registers and national death records. The Cox proportional hazards and subdistribution hazard models were used to estimate PAD's effect on mortality, quantifying the association with hazard ratios (HR) and subdistribution hazard ratios (SHR).
PAD patients were categorized into three subgroups. Over seven years, the cumulative all-cause mortality rate was 36%, or 6.4 deaths per 100 person-years. Multivariable analysis revealed critical limb ischemia (CLI) patients had significantly higher risks of all-cause (HR 5.26, 95%CI 3.10-8.94) and CVD mortality (SHR 6.20, 95%CI 3.20-12.03) compared to their asymptomatic peers. No statistically significant differences in non-CVD mortality were noted across PAD subgroups.
CLI, chronic kidney disease, and underweight (body mass index < 18.5 kg/m2) emerged as independent mortality predictors. Conversely, asymptomatic PAD patients had a similar overall mortality risk as those with intermittent claudication. These findings highlight the need for risk stratification and patient empowerment to optimize management of these complex conditions.
这项队列研究评估了泰国北部最大的三级转诊医院中，2型糖尿病（T2DM）合并不同阶段外周动脉疾病（PAD）患者的心血管疾病（CVD）发病率、预测因素以及全因死亡率。
本研究招募了278例T2DM合并PAD患者进行为期7年的队列研究。这些患者完成了健康问卷，并接受了包括踝臂指数测量和临床评估在内的体格检查，以确定PAD的严重程度。使用医院死亡登记册和国家死亡记录确定死亡率终点。采用Cox比例风险模型和亚分布风险模型来评估PAD对死亡率的影响，通过风险比（HR）和亚分布风险比（SHR）量化关联。
PAD患者被分为三个亚组。在七年期间，累积全因死亡率为36%，即每100人年有6.4例死亡。多变量分析显示，与无症状的同龄人相比，严重肢体缺血（CLI）患者的全因死亡风险（HR 5.26，95%CI 3.10 - 8.94）和CVD死亡风险（SHR 6.20，95%CI 3.20 - 12.03）显著更高。在PAD各亚组中，非CVD死亡率无统计学显著差异。
CLI、慢性肾脏病和体重过轻（体重指数<18.5 kg/m²）是独立的死亡预测因素。相反，无症状PAD患者的总体死亡风险与间歇性跛行患者相似。这些发现凸显了进行风险分层和增强患者能力以优化这些复杂病症管理的必要性。
